MEDICAID ELIGIBILITY FOR MARRIED COUPLES © 2005 Nursing Home Ombudsman Agency of the Bluegrass, Inc. Many people are worried about what to do if they have to put their spouse in a nursing home.
One of their major concerns is finances. They want to know how much money in resources and
income they are allowed to have. Kentucky looks at finances in two categories: resources and income. (Resources mean liquid
assets; money you can get your hands on.) Currently, an "institutionalized spouse" is allowed to keep $2,000 in resources in his/her name.
However, the "community spouse" (the one not in the nursing home) is allowed to keep a
different sum of money. Any money the couple has over certain limits must be used to pay the
nursing home bill. (Note: The community spouse has up to six (6) months after the medicaid
application has been approved to get everything into his/her name only. Staff at the Department
for Community Based Services-DCBS-can offer guidance in this matter.) The DCBS worker uses a calculation which takes into account the community spouse's income
and shelter expenses. The resident may only allocate up to $1604 of the couple's monthly
combined income to the community spouse. The resident may be allowed to allocate an
additional amount for shelter expenses if the spouse can prove that those shelter expenses (rent,
utilities and telephone) exceed $482 a month. The amount of resources which can be transferred to the community spouse by the nursing home
resident is calculated by the worker at the DCBS office. In order to determine eligibility, a
calculation is done to see whether or not the resident has available resources in excess of $2,000.
The resources of the community spouse and those resources which the resident has transferred to
the spouse (or indicated the intent to transfer to the community spouse within six months of the
date of a previous application) are not considered available to the nursing home resident.
However, there are limits on the number of resources that the resident may transfer to the
community spouse. Only one-half of the couple's combined countable resources can be
transferred to the community spouse or $20,000 whichever is greater, so long as their resources
do not exceed $90,600. These calculations do not affect residents who were in a nursing facility
and using Medicaid prior to June 2003. For example: If together the couple has $100,000, then $50,000 can be kept by the community
spouse and $2000 can be kept by the spouse in the nursing home. This leaves $48,000 which is
available to pay the bill at the nursing home. Other things may also be purchased with this money
such as funeral expenses, necessary upkeep to a home, or personal items for the resident. When
that $48,000 is gone, then the Medicaid program will kick in. If the couple has $30,000 together,
the community spouse can keep $20,000, the nursing home resident can keep $2000, and $8000 is
available to pay the bill before Medicaid kicks in. Once a nursing home resident has been assessed, and a determination of eligibility has been made, the state won't look at resources again as long as the resident remains in the facility. If a resident is out of the facility for a hospital stay or any other reason for more than 30 days, they will be Medicaid for Married Couples reassessed using these guidelines when they return. Joint income is reassessed annually. There are only a few ways a nursing facility resident can use to dispose of resources which put them over the Medicaid limit. It would be wise to talk to a financial planner, attorney, or benefit's counselor before disposing of any resources to make sure that any transfers are appropriate and will not disqualify the person from Medicaid. Estate recovery needs to be considered for the married couple, as well. Estate recovery is the process where Medicaid recoups some or all of their expenses by placing a lien against the house of a deceased resident. The recovery attempt only takes place when there is no surviving spouse or disabled child who needs the home. Previously the exemption was $50,500. The new exemption will vary, depending upon where you live. The exemption will be 50% of the value of the homestead up to the allowable exemption for your area of the state. Exemptions are based on the average cost of homes in each area. People living in areas of the state where real estate values are high will have the greatest exemptions. People in rural areas will have much lower exemptions. Income is another story. The "community spouse" allowance is now (as of 7/05) $1604 and the shelter allowance is $482. This means the community spouse may be allowed to get as much as $2086 per month in income from the institutionalized spouse, but no less than $1604, depending upon the couple's joint income. These calculations will be made by the DCBS worker, based on information the community spouse provides at the time of application. The worker looks at joint income as well as shelter allowance needs. Money not allocated to the community spouse or to the institutionalized spouse is considered available to pay to the nursing home. Under Medicaid rules, the "institutionalized spouse" is allowed $40 per month for personal needs while in a facility. Resource and income limits usually change each year based on inflation. August 2005 (This InfoSheet reflects the changes made by KMAP 7/05)
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