Medicaid does provide assistance for In Home Care for married couples when one spouse needs a moderate level of care and can remain in place. The Medicaid rules are identical to those applicable to Vendor Medicaid in a nursing home setting.
When one spouse needs a moderate level of care, most married couples seek to remain together in the home if at all possible. If the availability of funds to pay for care is an issue, then Medicaid planning and eventual Medicaid benefits can bring home health assistance into the family home to assist with the ailing spouse.
The Medicaid home health program, Home and Community Based Services (HCBS), provides in home care for individuals in medical need who have the ability with assistance to remain in the family home and in the community. The rules applicable for Medicaid eligibility requirements are the same as those that apply to families seeking Medicaid for nursing home care.
For married couples, the first step in the Medicaid planning process is the filing of a Medicaid Division of Assets under the Spousal Impoverishment Rules. Under a Division of Assets, the state will divide the married couple’s assets, and assign to the “Community Spouse” (the non applicant healthy spouse) a portion of the couple’s assets that are exempt from spend down and may be used by the Community Spouse to live on, thus avoiding the possibility of spousal impoverishment. This Spousal Share, called the Community Spouse Resource Allowance (CSRA), is equal to one half of the couple’s countable assets/non exempt assets (annuities, iras, mutual funds, investments, fair market value of real estate outside of the home, cash value of life insurance policies, bank accounts, etc.) up to a maximum CSRA of approximately $160.000. The primary residence, and one automobile are exempt assets and are not considered countable resources.
After the Division, the Institutionalized Spouse will have his or her portion of the couple’s countable resources that will be subject to spend down, likely on the initial in home care needs and medical expenses provided by a home health agency. The share of the assets assigned to the Institutionalized Spouse must be spent down. Asset transfers to others for less than fair market value are prohibited and would be subject to the 5 year look back period and hence the imposition of a penalty period before Medicaid benefits could begin. Any irrevocable trusts established for the purpose of protecting funds from spend down must be established before the 5 year look back period
Once the Institutionalized Spouse’s assets have been spent down to under the Medicaid asset limit, the spouse in need qualifies for Medicaid. Once the Medicaid application has been approved, Medicaid benefits will pay for in home care. The Institutionalized Spouse’s income is subject to a partial spend down of his or her income on the home care before the Medicaid benefits will begin to pay each month, often through the use of a Miller Trust. (The Institutionalized Spouse will however receive a portion of his or her income as a personal needs allowance.
Medicaid will, however, calculate the Community Spouse’s income and determine whether he or she may need some of the Applicant Spouse’s income to supplement his or her own. If the Community Spouse is deemed in need and does not meet the minimum income limit, then Medicaid will establish a Minimum Monthly Maintenance Needs Allowance (MMMNA) as an income allowance, transferring some of the Institutionalized Spouse’s income to the Community Spouse, and thus not subject to spend down.
QMC is equipped to assist families with all of these steps, and can bring Medicaid eligibility to even the most complex of circumstances. An elder law attorney my also be a valued part of the team, if estate planning needs to be adjusted.
#186