Can Spouse Receiving Medicaid Pay Income to Community Spouse

We know that a community spouse generally does not have to pay out of his or her income for the nursing home expenses of the spouse on medicaid; however, can the nursing home spouse pay part of his or her income to the spouse at home? Yes, here's how:

-- By K. Gabriel Heiser, Attorney

"My wife is on Medicaid, now, which is great. They pay all her nursing home bills and she's well taken care of, there. But what about me? I can barely pay the bills!" exhorted my client one chilly fall morning.

"Mr. Jones, not to worry. Let me explain how this works...."

First of all, the spouse living at home (or "in the community" as it's known; hence, this spouse is called the "Community Spouse") never has to pay anything toward the nursing home bill of the spouse receiving Medicaid in the nursing home. Thus, even if the Community Spouse has Social Security of $1,200/month and a pension of $4,000/month, the Community Spouse does not have to contribute one dime to the care of the Institutionalized (nursing home) Spouse.

But if it's the other way around, then in that case, the Community Spouse is entitled to a contribution from the Institutionalized Spouse. The federal government resets this amount every year on July 1, to keep up with inflation. The 2006 figure is currently $1,650 per month. It is known as the "Minimum Monthly Maintenance Needs Allowance" or MMMNA.

So if Mr. Jones, my client, is trying to live off his meager $900/month Social Security check, but his wife, a retired college professor, receives a $1,600/month pension check, then he will be entitled to siphon off a minimum of $1,650 - 900 = $750 per month from her check. (The rest of her check ($850) must be paid each month to the nursing home, and Medicaid picks up the balance of her nursing home expenses.)

"Whew, that's a relief," says Mr. Jones. "But that really doesn't cover my expenses! I have very high monthly bills. Isn't there any way I can get to shift even more from my wife each month?" Indeed there is, Mr. Jones!

Under the federal rules, there are several ways for Mr. Jones to increase his income allowance from his wife. First of all, if he has shelter expenses that exceed a certain amount, he can get an automatic increase, up to the maximum MMMNA of $2,488.50 (again, this figure changes annually, this time on Jan. 1 of each year).

The "excess shelter allowance" (ESA) is the amount by which Mr. Jones's costs for his rent or mortgage payment, condo fees (if any), real estate taxes and homeowner’s insurance, and either the standard utility allowance (currently between $198 and $546, depending on the state) or, if his state does not use such an allowance, the actual cost of utilities (heat, electricity, gas), exceeds 30% of the MMMNA, i.e., $495 in 2006. Some states even permit you to use the higher of the standard utility allowance or actual cost of utilities when calculating whether or not you qualify for the Excess Shelter Allowance. Once again, you need to check your own state’s regulations on this point.

So, for example, if Mr. Jones's total shelter costs were $1,000/month, then his $1,650 MMMNA may be increased by $1,000 - 495 = $505/month, to a total of $2,155. Since this amount is still under the maximum permitted MMMNA of $2,488.50, he's okay.

"But I have very high prescription costs, and I need home health care, too, that I have to pay out of my own pocket! What about those?" pleads Mr. Jones. If the Community Spouse still needs more income, he or she can request a Fair Hearing before the state Medicaid agency or even seek a court order for an increase in the monthly payments from the Institutionalized Spouse.

As you can see, with proper advice from an elder law attorney, it is possible for the spouse living at home to shift more income from a spouse in the nursing home who is receiving Medicaid coverage, thereby causing Medicaid to bear more of the burden and allowing the at-home spouse to continue to live a comfortable life.

K. Gabriel Heiser is an attorney with over 25 years experience in elder law and estate planning. Heiser is the author of “How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets,” an annually updated practical guide for the layperson. For more information about this book, visit Medicaid Secrets.

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