ElderCare Matters Partner answers question about Nursing Home Medicaid

Question:  “I desperately need some advice.  My wife is 79 years old and has progressively gotten so debilitative that I (82 years old) can no longer care for her at home.  We have lived in our paid off home for more than 30 years and we receive every month about $2,800 in total benefits, including our Social Security checks.  Other than the value of our home (which is about $125,000), we have a modest about of savings and no other assets to speak of.  How can I afford to place my wife in a nursing facility, which I understand may cost $5,000 – $6,000 per month?  What are my options?  Please help!”

Answer: It would appear that your circumstances are not as desperate as you may believe. Your wife should probably qualify for Medicaid assistance to pay her nursing home bills, and you should be protected by the spousal impoverishment rules.  Medicaid is a joint federal-state welfare program. One portion of the program pays for nursing home care, if eligibility requirements set forth in statute and regulations are met by the applicant. The program is governed by both federal and state law and regulations. Individual state eligibility rules may vary. Though the exact dollar amounts can vary from state to state, in general your assets and income are such that your wife should qualify for Medicaid to pay for her nursing home care.

Typically Medicaid will provide nursing home coverage in Medicare/Medicaid certified nursing homes if its strict financial eligibility requirements are met. A detailed and lengthy application process is used to determine those who qualify for the coverage.   To qualify, not only does the individual have to meet the financial qualifications at the time of the application, but cannot have improperly transferred assets or income away for less than fair market value during the look back period.  When an application is filed, the applicant caseworker will inquire about any gifts or transfers for less than fair market value made by the applicant, the applicant’s spouse or anyone acting on behalf of either of them within the preceding 60 months. These five years before application is known as the “lookback” period, gifts made before that period will not affect eligibility. Gifts made during the “lookback” period will result in a period of ineligibility, and that disqualifying period will not start to run until the applicant has already spent down all of his or her assets and applied for Medicaid.

While Medicaid is a “spend down” program, you don’t have to be destitute, or leave your spouse destitute, to qualify for Medicaid. Certain assets and transfers are exempt from a Medicaid spend down, and by effective planning, you can qualify for Medicaid and still keep, transfer, or gift certain assets.

This is especially true with a community spouse such as you.  There are special exemptions and rules in regard to resources which apply only to community spouses. In general, “resource” means cash or any other personal or real property that a person owns and has the right, authority or power to liquidate. Certain resources are considered exempt and do not affect one’s eligibility.  The idea behind the special rules for community spouses is the desire to allow the nursing home resident to receive the appropriate care while avoiding spousal impoverishment.

The Community Spouse Resource Allowance” (CSRA) is the amount of non-exempt resources the “institutionalized spouse” is permitted to transfer to the “community spouse” without affecting the resident spouse’s eligibility. The current CSRA in Illinois is $109,560.00. In addition to this amount the community spouse is also entitled to keep several other assets as exempt including the homestead property and an automobile.  In Illinois the net value of the homestead property cannot exceed $500,000.00, so in Illinois all of your assets as well as your home as you have described them would be protected.  In addition to the CSRA, the community spouse is entitled to a contribution of monthly income from the resident spouse to bring the community spouse’s monthly income up to what is known as the “Minimum Monthly Maintenance Needs Allowance”. The current MMMNA in Illinois is $2,739.00 per month.  Though your monthly income is slightly above this figure, your wife will be entitled to a monthly allowance of $30.00 while in the facility, and accordingly in Illinois you would not have to contribute any of your wife’s or your income to the monthly nursing home bill.

I strongly recommend that you consult with an Elder Law Attorney to make sure you meet all the eligibility requirements of your state. Generally the Elder Law Attorney as well as ElderCareMatters.com can direct you to the appropriate resources you will need to find an appropriate place for your wife as well as protect your interests.

James C. Siebert, Attorney at Law
The Law Office of James C. Siebert & Associates
An ElderCare Matters Partner

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