Important Facts About Medi-Cal: 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.
In general, the community spouse may keep one half of the couple’s total “countable” assets up to a maximum of $89,280 (in 2002). 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. The least that a state may allow a community spouse to retain is $17,856 (in 2002).
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 have raised this amount to as much as $89,280, meaning that in those states the community spouse can keep the first $89,280 of the couple’s combined countable assets. For instance, 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 institution- alized 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, known as the minimum monthly maintenance needs allowance or MMMNA, is calculated for each community spouse according to a complicated formula based on his or her housing costs. The MMMNA may range from a low of $1,493 to a high of $2,232 a month (in 2002).
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 some states, the community spouse is permitted to increase the MMMNA by retaining more resources, as discussed in Long-Term Care Planning, “Increased CSRA”.) Example: Mr. and Mrs. Smith have a joint income of $2,000 a month, $1,500 of which is in Mr. Smith’s name and $500 is in Mrs. Smith’s name. Mr. Smith enters a nursing home and applies for Medi-Cal. The Medi-Cal agency determines that Mrs. Smith’s MMMNA is $1,500 (based on her housing costs). Since Mrs. Smith’s own income is only $500 a month, the Medi-Cal agency allocates $1,000 of Mr. Smith’s income to her support. Since Mr. Smith also may keep a $60 a month personal needs allowance, his obligation to pay the nursing home is only $440 a month ($1,500 - $1,000 -$ 60 = $440). In exceptional circumstances, community spouses may seek an increase in their MMMNAs either by appealing to the state Medi-Cal agency or by obtaining a court order of spousal support