If you were fortunate over the course of your working years to be covered by employer-sponsored or privately purchased health insurance, you likely know very little about the Medicaid program. During your retirement years, however, you may find yourself in a position where eligibility for Medicaid becomes important. One of the many myths about Medicaid is that relying on Medicaid to pay for long-term care means your spouse will be left out in the cold. The Londonderry Medicaid planning attorneys at DeBruyckere Law Offices explain how the Medicaid Community Spouse rules protect a spouse that remains in the community.
The Cost of Long-Term Care
Given the high cost of healthcare in general across the United States, it should come as no real surprise to find that the cost of LTC is also high. For the year 2018, the average cost of a year in LTC nationwide was close to $100,000. If you are paying for LTC in New Hampshire, you can expect to pay considerably more as the yearly average was over $133,000 for 2018. By the year 2038, experts predict that number to be almost $250,000 per year. What makes the cost of LTC even more problematic is that neither Medicare nor most health care insurance will cover LTC expenses. That means that unless you can easily afford to cover LTC expenses out of pocket, Medicaid will likely be your only hope for assistance. You are not alone though. Currently, over half of all seniors living in an LTC facility count on Medicaid to help with LTC expenses.
Medicaid Eligibility Basics
Of course, in order to get help from Medicaid with your LTC expenses, you must first qualify for the program. The Medicaid eligibility guidelines impose both an income and a “countable resources” (assets) limit. Typically, a couples’ income and assets are combined for the purpose of determining Medicaid eligibility. If a couple’s assets exceeded the program limit, those assets must be “spent-down” (sold or transferred) until their value drops below the limit. If the need to qualify springs from the fact that one spouse is in LTC, the spend-down requirement would clearly leave the other spouse (referred to as the “community spouse”) with no resources. The good news is that the Medicaid “Spousal Impoverishment” rules protect a community spouse from being left without resources when LTC is needed.
Understanding the Community Spouse Rules
When one spouse needs long-term care, instead of combining the couples’ assets for the purpose of Medicaid eligibility, the Medicaid program allows for a “division of assets.” It works like this: All non-exempt assets belonging to either spouse are added together. One-half of the total, but not less than $24,720.00 nor more than $123,600 as of January 2019, is considered as the “spousal share” for the community spouse. The spousal share is protected from the Medicaid spend-down requirement, leaving them available for use by the community spouse. In addition, the “Minimum Monthly Maintenance Needs Allowance,” or “MMMNA” means that the community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $2,030 per month. New Hampshire is an “income first” state. This means the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
Contact Londonderry Medicaid Planning Attorneys
For more information, please join us for an upcoming FREE seminar. If you have additional questions about the community spouse guidelines, or about Medicaid planning in general, contact the Londonderry Medicaid planning attorneys at DeBruyckere Law Offices by calling (603) 894-4141 or (978) 969-0331 to schedule an appointment.
Daniel DeBruyckere
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