Protections for the Healthy Spouse
The Medi-Cal law provides special protections for the spouse of a nursing home resident to make sure she has the minimum support needed to continue to live in the community.
The so-called “spousal protections” work this way: If the Medi-Cal applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the date of “institutionalization,” the day on which the ill spouse enters either a hospital or a long-term care facility in which he or she then stays for at least 30 days. (This is sometimes called the “snapshot” date because Medi-Cal is taking a picture of the couple’s assets as of this date.)
In general, the community spouse may keep one half of the couple’s total “countable” assets up to a maximum of $119,220. Called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order.
Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medi-Cal once the couple’s assets have been reduced to a combined figure of $52,000 — $2,000 for the applicant and $50,000 for the community spouse.
Some states, including California, are more generous toward the community spouse. In these states, the community spouse may keep up to $119,220, regardless of whether or not this represents half the couple’s assets.
Example: If the couple had $60,000 in countable assets on the “snapshot” date, the community spouse could keep the entire amount, instead of being limited to $30,000.
In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medi-Cal benefits. But what if most of the couple’s income is in the name of the institutionalized spouse, and the community spouse’s income is not enough to live on? In such cases, the community spouse is entitled to some or all of the monthly income of the institutionalized spouse. How much the community spouse is entitled to depends on what the Medi-Cal agency determines to be a minimum income level for the community spouse.
This figure is $2,981. If the community spouse’s own income falls below his or her MMMNA, the shortfall is made up from the nursing home spouse’s income.
In exceptional circumstances, community spouses may seek an increase in their MMMNAs either by appealing to the state Medicaid agency or by obtaining a court order of spousal support.