Medicaid

Opening Comments regarding the Medicaid Community Spouse

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].

Note 1: 42 U.S.C. § 1396r-5(h)(2); State Medicaid Manual, CMS Publication 45, § 3260.1.

Note 2: Throughout this Chapter, we assume the husband is the Institutionalized Spouse and the wife is the Community Spouse. The analysis, however, would be identical if the situation were reversed.

Note 3: 100 P.L. 360; 102 Stat. 683; 1988 Enacted H.R. 2470; 100 Enacted H.R. 2470 (enacted July 1, 1988). “Prior to 1988, a married individual who was institutionalized was required to “spend down” all of the couple’s jointly held assets in order to become eligible for Medicaid benefits. H.R.Rep. No. 100-105(II), 100th Cong., 2nd Sess., at 65-67 (1988), reprinted in 1988 U.S.C.C.A.N. 857, 888-90. That policy had the effect of forcing the community spouse to “spend down” virtually all of the marital assets before the institutionalized spouse could be eligible for Medicaid and resulted in “community spouses” having to sue their institutionalized spouses for support or become prematurely institutionalized themselves. See 1988 U.S.C.C.A.N. at 892.” Johnson v. Guhl, 166 F.Supp.2d 42, 46 (D. N.J. 2001); See also Dullard v. Minnesota Department of Human Services, 529 N.W.2d 438, 443 (Minn. App. 1995).

The spousal impoverishment provisions were designed to end the pauperization of Community Spouses by allowing them to protect a sufficient, but not excessive, spousal share of the marital resources and income to meet their own needs. Meanwhile, the Institutionalized Spouse is in a nursing home at Medicaid’s expense. The spousal impoverishment provisions are codified at 42 U.S.C. § 1396r-5.

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