When one spouse of a married couple enters a nursing home using Medicaid benefits, the government provides spousal impoverishment protections to ensure the well spouse can continue to live comfortably in the community.
In states like Illinois, Arkansas, and Indiana, when one spouse enters long-term care, the community spouse is simply assigned a portion of the couple’s assets, up to a limit. However, in Missouri, a division of assets is completed, wherein the couple’s combined assets are split in half, with half assigned to each spouse. Countable assets include bank accounts, IRAs, and certificates of deposit. Exempt assets include the family home and one personal vehicle. The institutionalized spouse may have to spend down their portion, but the community spouse may retain their portion. In both scenarios, the community spouse’s portion is called the community spouse resource allowance (CSRA). In Missouri, once the division is completed and submitted to the state, the community spouse may retain that portion and there is no asset limit that must be maintained, so theoretically the community spouse could continue to earn and save their own income post-division.
Additionally, the community spouse may be assigned a portion of the nursing home spouse’s monthly income. In most cases, the nursing home spouse is required to pay their income to the nursing home as a sort of co-pay for their care. However, if the healthy spouse’s income does not meet the minimum monthly maintenance needs allowance (MMMNA), she can be assigned a portion of her husband’s income, which would include Social Security payments, pensions, and any other income.
It is highly recommended to visit an estate planning or elder law attorney prior to applying for Medicaid, and preferably long before nursing home care is needed. Attorneys can use various Medicaid planning strategies to preserve assets while maintaining Medicaid eligibility. Attorneys can also advise you on how to avoid penalties by observing Medicaid rules like the five-year look-back period and selling assets at or above fair market value.
Although Quality Medicaid Care does not provide legal advice, our staff are happy to guide Medicaid applicants through the process of applying for and receiving benefits.