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

12/01/2003

  • The institutionalized individual's eligibility is determined using the individual income limit before the protected spousal needs allowance is determined.

  • Community spouses may keep any income in their own name, and the state allows the institutionalized spouse's income to supplement the community spouse's income up to the federal maximum permitted, which is $2267 per month.

  • The protected resource amount will be the greater of the following: the state minimum resource standard, which is $18,132; or one-half of the couple's combined countable resources not to exceed the maximum resource standard of $90,660; or the amount transferred to the community spouse under a court order. All assets over this maximum must be spent on nursing home care before Medicaid will begin to pay.

  • In cases where there is a community spouse, the client can appeal to increase the protected resource amount to produce additional income for the spouse. The hearing officer may then increase the protected resource amount to a level adequate to produce income up to, but not exceeding, the monthly maintenance needs allowance.

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