Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Spousal Protections


The state does not use the option to provide federal spousal impoverishment protections for the incomes of spouses of waiver clients. The state allows a maximum of $552 per month in protected income for an HCBS waiver spouse, whereas the community spouses of nursing homes residents have a maximum protected income of $2,232 per month. This policy creates an economic incentive to enter a nursing home even though a person could receive services at home or in an assisted living facility.

In a recently implemented pilot nursing home transition program, which was part of the Assisted Living for the Elderly waiver, nursing home residents who were suitable and willing to be moved to an assisted living facility were identified. Four hundred nursing home residents were moved, some of whom had been in the nursing home for two or more years. However, there were others who wanted to transition but could not because their community spouse would lose too much income as a result.

Florida is in the process of implementing revised spousal impoverishment policies in the Assisted Living for the Elderly waiver program. However, the community spouse will still have less income to keep than if their spouse is in a nursing home.

  • The maximum income protected for a community spouse--whether the waiver client is receiving services at home or in an assisted living facility--is the SSI standard, which is $552 per month. If the community spouse has less than this amount, the spouse in the assisted living facility can make up the difference. For example, if a waiver client living in an assisted living facility has a monthly income of $1200.40, and the community spouse has an income of only $200, the following calculations would be made:

    1. Subtract $630.40 from $1,200.40 for the recipient's personal maintenance allowance (of which $54.00 will be retained by the resident as the PNA and $576.40 will be paid for room and board). The remainder is $570.00.

    2. The SSI income standard of $552 is applied to the spouse, minus the spouse's $200 income, leaving $352.00 which can be diverted from the waiver recipient's remaining income ($570 minus $352 = $218).

    3. The waiver client's cost-sharing responsibility is $218.

  • With few exceptions, all waiver programs consider applicants/recipients as individuals and only the assets in their names count in determining if their assets fall within program limits. The applicant/recipient may transfer assets to their spouse without penalty up to the federal maximum of $90,660.

View full report


"med4rcs.pdf" (pdf, 3.73Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®