In this Chapter, we’re addressing protections for the Community Spouse of an Institutionalized Spouse. The term ”institutionalized spouse” means an individual who – (A) is in a medical institution or nursing facility or who (at the option of the State) is described in section 1396a(a)(10)(A)(ii)(VI) of this title, and (B) is married to a spouse who is not in a medical institution or nursing facility; but does not include any such individual who is not likely to meet the requirements of subparagraph (A) for at least 30 consecutive days. 42 U.S.C. § 1396r-5(h)(1). The term ”community spouse” means the spouse of an institutionalized spouse. 42 U.S.C. § 1396r-5(h)(2).
We will not address specific planning strategies in this Chapter as those will be covered later.
- Opening Comments regarding the Medicaid Community Spouse
- MCCA’s Legislative History
- Protecting Resources for the Community Spouse
- Transfer Penalties and the Community Spouse
- Potential Redetermination When Moving to a New State
- Protecting Income for the Community Spouse
- Post-Eligibility Treatment of the Institutional Spouse’s Income
- Seeking Adjustments to the CSRA or MMMNA
- Divorce and the Community Spouse
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Locating Medicaid Law
Sometimes finding Medicaid law is tough, but we hope to give you resources here. Federal and state statutes, regulations and case law is available to subscribers of LEXIS and Westlaw. The federal statute, which is Title XIX of the Social Security Act, is at 42 U.S.C. § 1396 et seq. (the “Medicaid Act”). The federal […]
Medicaid Estate Recovery is Required
At common law there is no obligation to reimburse the government for financial support and services received while impoverished. When the Medicaid Act was enacted, Congress gave States the option of pursuing estate recovery and, until 1993, estate recovery remained optional. Now, within the parameters of the federal rule, States must pursue estate recovery (1) […]
Structure of the Medicaid Program
“Each participating State develops a plan containing reasonable standards . . . for determining eligibility for and the extent of medical assistance” within boundaries set by the Medicaid statute and the Secretary of Health and Human Services.” Wis. Dep’t of Health & Family Servs v. Blumer, 534 U.S. 473 (2002) (quoting Schweiker v. Gray Panthers, […]
Introduction to Medicaid Estate Recovery
Medicaid, as opposed to Medicare, is a health insurance program, jointly funded by the state and federal governments that pays for health care for America’s poor. See Medicaid Act (Title XIX of the Social Security Act), 42 U.S.C. § 1396 et seq. Not everyone is eligible for medical assistance; only those persons who fall within […]
Idaho Medicaid Agency Sets Aside Deeds to Grandchildren in Estate Recovery Action
In State of Idaho v. Beason, 546 P.3d 684 (2024), the Medicaid agency filed an estate recovery claim in Juanita Gilbert’s estate. she received Medicaid benefits from 1996 until her death in 2015, totaling $137,023.29 and, after she died, the State wanted its money back. Juanita and her husband, Robert, owned real property in Butts […]
Medicaid Post Eligibility Treatment of Income and Incurred Medical Expenses
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) […]
Medicaid’s Refusal to Provide 24/7 Care in the Community Might be Discrimination
Medicaid’s Refusal to Provide 24/7 Care in the Community Might be Discrimination In Harrison v. Young (5th Cir. June 6, 2024), the Fifth Circuit considered Ms. Barbara Harrison’s claim challenging Medicaid‘s denial of funding for medical services that she claimed are necessary for her survival. Harrison has severe physical and intellectual disabilities. She cannot walk […]
New Article Discussing Medicaid Enrollment and Wealth Transfers
On June 11, 2024, the Gerontologist published an article on Medicaid enrollment and Intergenerational transfers of wealth among older adults. The article was based on a review of data from 2008 through 2018 analyzing estate planning and family wealth transfers of older adults aged 65 and older who became Medicaid recipients. There were 8,347 respondents […]
Medicaid’s “any circumstance” test for trusts
Medicaid’s “Any Circumstance” Test for Trusts In case you missed the memo, Medicaid doesn’t like trusts. The rules relating to trusts you create with your money or property are found at 42 U.S.C. § 1396p(d). To put this discussion in context, we’ll begin with the sections relevant to the “any circumstances” test, but the full […]
SNT Trustee Ordered to Reimburse Some Conservator Expenses
SNT Trustee Ordered to Reimburse Some Conservator Expenses In Weidner v. Stevenson (Cal. App. 2nd Dist. May 13, 2024), Roberta Davis established a special needs trust inside her living trust for her disabled adult son, Daniel. Daniel was under a conservatorship. Daniel’s aunt, Charlyne, was the successor trustee of the trust after Roberta’s death, while […]
