Effective January 1, 2026, the Community Spouse Resource Allowance will increase to $162,660.00. The combined resource allowance will increase to $164,660.00. The Community Spouse income allowance will increase to $4,066.50. The SSI monthly rate in 2026 will be $994, so the 2026 Medicaid income cap will be $2,982. In general terms, all 2025 rates and […]
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On November 15, 2024, the Centers for Medicare and Medicaid Services posted the 2025 spousal impoverishment standards. These are the standards used to determine how the amount of income and resources that can be diverted to or retained by a Community Spouse. They also tell us the SSI rate and the Medicaid income cap. In […]
When the Deficit Reduction Act of 2005 changed 42 U.S.C. § 1396p, new restrictions were imposed on promissory notes. Subsection (c)(1)(I) note provides that the purchase of a promissory notes is treated as a transfer subject to the penalty rules unless the note meets the following guidelines: (I) For purposes of this paragraph with respect […]
In Lamle ex rel. Lamle v. Shropshire (W.D. Oklahoma 5/29/2024), a United States District Court upheld a denial of benefits where three Medicaid applicants refused to answer questions about promissory notes. Penelope Lamle, Marilyn Garrison and Maxine Houston each loaned money to others in exchange for a promissory note. Lamle and Garrison made loans to […]
Section 1115 of the Medicaid statute allows sates to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP). The home health waivers are designed to meet the needs of people who prefer to get long-term care services and supports in their home […]
Medicaid Post Eligibility Treatment of Income and Incurred Medical Expenses After Medicaid eligibility is established, 42 C.F.R. § 435.725 addresses how income is treated. For clarity, if the Medicaid recipient is married,income of the non-recipient spouse does not count toward eligibility and is not part of the patient cost share. Specifically, 42 U.S.C. § 1396r-5(b)(1) […]
In Parker v. Louisiana Department of Health (April 30, 2024), the U.S. District Court for the Eastern District of Louisiana granted a motion for preliminary injunction prohibiting the State from terminating a grandmother’s QI Medicaid based on the State’s determination of family size. The Plaintiff, a 71 year old widow who was raising her grandchild, […]
The federal Medicaid statute authorizes the use of individual self-settled special needs trusts for individuals under the age of 65. See 42 U.S.C. § 1396p(d)(4)(A). It also authorizes any applicant, regardless of age, to establish a self-settled pooled special needs trust sub-account. 42 U.S.C. § 1396p(d)(4)(C). An open question not addressed in (d)(4)(C) is whether […]
On March 27, 2024, the Social Security Administration published a final rule in the Federal Register which changes its calculation of In-Kind Support and Maintenance (ISM). Under the prior rule, if food and/or shelter is provided to a recipient of Supplemental Security Income (SSI), the income is deemed to the recipient, reducing his or her […]
On November 17, 2023, Georgia issued Manual Transmittal 71, updating its Medicaid Manual, making technical changes to the following sections. The following sections were updated: 2054 – Emergency Medical Assistance 2060 – ABD Medicaid Application Processing 2101 – ABD Medicaid Classes of Assistance Overview 2111 – SSI Medicaid 2135 – Hospice Medicaid 2143 – QMB […]
On November 14, 2023, the Centers for Medicare and Medicaid Services announced the 2024 SSI and Spousal Impoverishment Standards. The SSI rate for 2024, which was previously announced by the Social Security Administration, will rise to $943. The Medicaid Income Cap will rise to $2,829. The minimum MMMNA will be $2,465 and the maximum MMMNA […]
Effective January 1, 2024, the federal Supplemental Security Income payment amount will increase by 3.2 percent. The amounts paid to individuals and couples are below: Recipient Unrounded annual amounts for— Monthly amounts for 2024 2023 2024 a Eligible individual $10,970.44 $11,321.49 $943 Eligible couple 16,453.84 16,980.36 1,415 Essential person 5,497.80 5,673.73 472 Impact on Medicaid This […]
Am I Eligible for Medicaid? Recently we were asked about the following fact pattern. Parent had multiple properties in different counties. More than 60 months ago, parent gave these properties to children reserving a life estate. The question, initially, was whether parent is eligible for nursing home Medicaid. The follow-up question was whether the property […]
On October 24th and 25th, 2023, the Tennessee Justice Center will present its annual two day virtual training event on Medicaid eligibility. This event is designed for health care providers and advocates. Information regarding what’s covered and how to register is below: Medicaid Eligibility Boot Camp – A Virtual Training Event Navigating the Red Tape […]
We’re just getting to the point where we’re producing videos for EZ Elder Law. There are, after all, only so many hours in the day. This video published on September 17, 2023, runs through basic Medicaid eligibility in Georgia under the 2023 rules. It focuses on nursing home Medicaid and home health Medicaid. Slides for […]
The SSI rules are a good beginning point because Medicaid cannot impose rules more restrictive than the SSI rules. SSI excludes burial funds up to the exemption limit which is currently $1,500 for the applicant and the applicant’s spouse. POMS SI 01130.410. Burial funds can be: revocable burial contracts; revocable burial trusts; other revocable burial […]
Obviously, if you follow the law, get a license and have the event officiated, you’re married. See O.C.G.A. § 19-3-1 (Requiring parties able to contract, an actual contract and consummation according to law). And with marriage goes the benefits and liabilities. Although not a traditional case, Justice Kennedy concluded Obergfell v. Hodges with the following […]
The following Georgia Medicaid cases were litigated outside the context of an administrative hearing, or were appealed beyond that point. Of course, we are not representing there are no other published decisions on point. United Cerebral Palsy of Georgia v. Ga. Dep’t of Behavioral Health and Dev. Disabilities, 331 Ga. App. 616 (2015). A provider […]
July 18, 2011 Paul A. Kryglik, Director Office of Regulations Social Security Administration 6401 Security Blvd Baltimore, MD 21235 Re: Program Operations Manual System SI 1120.220, cash loans Dear Director Kryglik: I am requesting a ruling from your office on an issue involving Program Operations Manual System (POMS) SI 1120.220, cash loans, with respect to […]
When applying for Medicaid, the nursing home spouse (called the Institutionalized Spouse) is often a joint owner (or sole owner) on checking, savings and other acounts. Should those resource be taken out of the name of the Institutionalized Spouse? The answer is generally “yes,” but it requires some context and some qualifications. The context and […]
One of the most fundamental, but often overlooked issues when planning for – or evaluating – Medicaid eligibility is this: Medicaid does not alter property rights, contract rights or other legal rights with value. Medicaid simply measures those rights to determine whether they cause an applicant to be eligible or ineligible. In other words, if […]
Each year, most Medicaid eligibility limits are adjusted for inflation. The 2023 Georgia Medicaid income and resource limits are: SSI Medicaid: Income: $914 per month, Countable Resources: $2,000 QMB Medicaid: Income: $1,235 (100% FPL + $20), Countable Resources: $9,090 SLMB Medicaid: Income: $1,478 (120% FPL +$20), Countable Resources: $9,090 CCSP/EDWP/Nursing Home Income Cap: $2,742; Applicant […]
The Medicaid Spousal Impoverishment allowances are updated annually. Below are some of the annual allowance figures we’ve saved. The most current figures are usually posted here. 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 1998 – 2011
The Centers for Medicare and Medicaid Services released the 2023 SSI and Spousal Impoverishment Standards. Among the highlights are the following: Community Spouse Resource Allowance: $148,620 Maximum Monthly Maintenance Needs Allowance: $3,715.50 Income Cap: $2,742 (used to deterine whether a QIT is needed) Individual SSI rate: $914
Another “option” that may be considered in appropriate cases is divorce. Deeming between spouses terminates when the marriage terminates. In most cases, this “option” should be avoided because the emotional turmoil associated with divorce is significant and the CSRA can be set by court order, see § 1396r-5(f)(2)(iv) and (f)(3). Divorce also prevents an applicant […]
MCCA includes a mechanism for increasing both the CSRA and the MMMNA in certain cases. The methods by which this can be effected are described in 1396r-5(e), (d)(5) and (f)(3). Blumberg v. Tennessee Department of Human Resources, 2000 WL 1586454 (Tenn.Ct.App.) was a case where a Community Spouse sought a court adjustment of the default […]
As eligibility is being determined, if the Community Spouse’s monthly income falls below the Minimum Monthly Maintenance Needs Allowance (“MMMNA”), then MCCA contemplates two methods of raising her income up to the MMMNA. First, a portion of the Institutionalized Spouse’s income may be transferred to her to bring her income up to the MMMNA. Second, […]
Income and resources are treated differently. Unlike resources, income is not pooled in determining eligibility; the Community Spouse’s separate income is never considered available to the Institutionalized Spouse. Thus, the standard income eligibility process for one person applies. First, all income earned by the Community Spouse is always unavailable to pay nursing home bills, regardless […]
In Dullard v. Minnesota Department of Human Services, 529 N.W.2d 438, 443 (Minn. App. 1995), Minnesota was allowed to reevaluate eligibility after a couple moved from Illinois to Minnesota. There, Illinois (like Georgia) allowed the Community Spouse to keep the maximum CSRA, while Minnesota (like Tennessee) applied a formula resulting in a lower CSRA. The […]
Some couples might consider reducing the size of the marital estate by giving their resources away. Frequently this is the result when the plan is “home-made.” However, transfers for less than fair market value, including complete and partial gifts) trigger a period of ineligibility. 42 U.S.C. 1396p(c). It does not matter whether the applicant or […]
Federal law protects the healthy (or healthier) spouse of a nursing home resident. The healthier spouse is known in Medicaidland as the Community Spouse. The protections, known as the Spousal Impoverishment Rule (but logically be called the anti-impoverishment rule) were passed as part of the Medicare Catastrophic Coverage Act of 1988, P.ub. L. No. 100-360 […]
The following the committe report for the Medicare Catastrophic Coverage Act of 1988 (MCCA): The leading cause of financial catastrophe among the elderly is the need for long-term care, especially the need for nursing home placement. The expense of nursing home care–which can range from $2,000 to $3,000 per month or more–has the potential for […]
While nursing home bills accrue, the healthy or well spouse, known as the “Community Spouse,” [Note 1] struggles to identify and keep income and resources that are necessary to support herself. [Note 2]. To remedy this situation, Congress enacted spousal impoverishment provisions as part of the Medicare Catastrophic Coverage Act of 1988 (“MCCA”). [Note 3]. […]
If you agree to file a client’s Medicaid application as part of your representation, here are a few practical considerations. Keep in mind, these suggestions are how we handle matters in our office. If you have a different approach, that’s fine. If you have suggestions on other ways to approach applications, we’d love to hear […]
As with the income rules, the resource defaults may be changed. First, if all of the Applicant’s income has been diverted to the Community Spouse and the monthly income available to the Community Spouse still does not reach the minimum monthly maintenance needs allowance, then 42 U.S. Code § 1396r–5(e)(2)(C) provides an administrative remedy for […]
Let’s assume Betty, a widow, will go to a Georgia nursing home in the near future (using 2022 eligibility rules and limits) and has the following resources: A home A retirement account A CD designated for burial in the amount of $14,000 One vehicle Savings of $15,000 Checking of $1,600 In addition to her resources, […]
Several overriding rules control the creation and application of Medicaid eligibility criteria by the states. These rules are applicable to all mandatory and optional coverage groups, as well as all medically needy individuals. First, a state may not impose any eligibility requirements prohibited by Title XIX. Next, the state must base coverage or optional coverage […]
In Merritt v. Ohio Department of Job and Family Services, Case No. CA2021-04-044 (12/27/2021), Jerome Merrit applied for Ohio nursing home Medicaid. His son, Glenn Merritt, arranged for Jerome’s admission to Heritagespring of West Cherster, using his healthcare and general power of attorney. The nursing home applied for Medicaid, but told Glenn that Jerome must […]
The standards for the 2022 Community Spouse Resource Allowance and Community Spouse Monthly Income Allowance have been updated in the document below:
The worksheet below is not intended as a substitute for legal advice. It requires an understanding of the Medicaid budgeting process in the State where the applicant is applying for Medicaid. However, if the user knows how that process works, then this worksheet is designed to provide a “quick and dirty” estimate of the patient […]
Sometime people assume monthly income counts toward the $2,000 resource limit. Assets (anything of value) are either income or resources. ” An asset cannot be considered income and a resource during the same month.” Georgia ABD Manual 2300-1 and 2300-2. See also POMS SI 01110.600 B.3.This confuses many people because they are trying to keep bank […]
Every year the Supplemental Security Income (SSI) benefit rate and Medicaid resource allowances are updated. For 2022, the federal benefit rate increased by 5.9%. There was no change in the SSI benefit rate. The SSI monthly benefit increased to $841. This means the Medicaid income cap increases to $2,523 of gross monthly income. The one-third […]
H.R. 1717, known as the Protecting Married Seniors from Impoverishment Act of 2021, and a companion bill in the Senate (S.1099) would require States to extend Community Spouse Resource and Income allowances to couples needing in-home care. A temporary modification extending these protections was already in place through the Consolidated Appropriations Act, 2021 (Pub. L. […]
What are people talking about when they say you have to “spend down” to become eligible for Medicaid? Well, it can describe two different things. Most of the time elder law attorneys are referring to to resource spend-down where the applicant is trying to get below the resource eligibiity threshold. But it can also refer […]
VA Improved Pension Not Income. Petitioner applied for Medicaid on November 4, 2008. Petitioner was the surviving spouse of a veteran eligible for VA Improved Pension. At the time, the income cap was $2,022 and, if the Improved Pension was included in Petitioner’s income, then her gross monthly income exceeded the income cap. Of Petitioner’s $1,056 […]
Increase CSRA in Superior Court, followed by Application and Fair Hearing. After admission to a nursing home, but prior to application for Medicaid, the Superior Court in Glascock County issued an order setting aside all of Petitioner’s marital resources for the Community Spouse’s benefit for the purpose of generating sufficient income to reach the MMMNA. […]
Use of Burial Funds for Care Results in them Being Treated as Income. In a one page decision, the ALJ affirmed an increase in Petitioner’s cost-share for December 2008 where Petitioner used funds set aside for burial for personal care. The ALJ noted this decision did not impact eligibility for any month other than December […]
No QIT, No Medicaid if Income Exceeds Cap, Part 2. Petitioner entered a nursing home in June 2008 and filed an application for Medicaid. DFCS did not receive or act on the application until July 22, 2008. As a result of inaction, Petitioner did not know that a QIT was needed because income exceeded the […]
No QIT means No Medicaid If Income Exceeds Cap. Petitioner entered the nursing home in July 2007 and applied for Medicaid in August 2007. No one told Petitioner a qualified income trust was needed. A denial was sent in October and Petitioner reapplied in November 2007, establishing the QIT by December 17, 2007. Eligibility was denied for […]
