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 […]
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 […]
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]. […]
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 […]
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. […]
Deeming Terminates After Eligibility Is Established. Four years later, the Duprees were back in Court. At the annual review on February 29, 2012, DFCS denied eligibility due to a failure to submit documentation. The documents were then submitted and eligibility was denied with DFCS alleging petitioner was over resourced. Petitioner had not acquired any new […]
Which Home is the Homeplace? Pernie Dupree entered a nursing home on September 11, 2009. Prior to her admission, she had lived with her husband at 1 Bragg Circle since 1949. The Bragg Circle property was valued at $45,411. After hs wife entered the nursing home, due to his declining health Mr. Dupree moved into his […]
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. […]
Incorrect Decision Reached Regarding Status of Community Spouse. A nursing home resident’s spouse was denied a Community Spouse Monthly Income Allowance when she moved to the Philippines after her husband was admitted to a nursing home. She was attempting to secure a visa to return to the U.S. at the time of the hearing and […]
Community Spouse Resource Allowance administratively raised. Evidence was stipulated that the combined marital income of the couple did not result in post-eligibility income for the Community Spouse that equaled or exceeded the MMMNA. Therefore, the Community Spouse Monthly Income Allowance (CSMIA), 42 U.S.C. § 1396r-5(d)(1)(B), was inadequate to raise the Community Spouse’s post-eligibility income to the […]
Treatment of retirement accounts. Section Section 2332 indicates that an applicant must apply for periodic benefits, but does not indicate whether the individual must take a minimum distribution from “each” account or whether the individual can aggregate the retirement accounts for purposes of determining whether a sufficient minimum distribution was taken. The ALJ looked to 26 C.F.R. § […]
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