Medicaid for the Elderly, Blind or Disabled

Spousal Impoverishment Protections

Special financial protections are allowed for the spouse and dependent children of a LTC member to keep assets and income that are above Medicaid financial limits.

Asset Limit for Spousal Impoverishment 

For LTC cases where one spouse is still living in the community, special asset protection rules apply at application.

Asset Assessment

An Asset Assessment is done by your agency to establish the asset limit for your Medicaid LTC (Institutions, HCBW, Family Care) application.

During the asset assessment you will be required to provide proof of assets that you and your spouse owned on the date of the first continuous period of institutionalization 30 days or longer or the date of initial request for community waivers, Family Care or Partnership, whichever occurs earlier.

Based on the proof you provide, the agency will determine “the total countable assets of the couple” and the Community Spouse Asset Share (CSAS).

The asset limit for the applicant is $2,000 plus the CSAS. The CSAS is the amount of countable assets above $2,000 that the community spouse, the institutionalized person, or both, can have at the time the institutionalized person wants to enroll in Medicaid LTC. Once the spouse in the institution is enrolled, the assets of the community spouse are considered unavailable to the institutionalized spouse.

If the total countable assets of the couple are $231,840, or more, then the CSAS is $115,920; the Medicaid LTC asset limit at the time of application in LTC is $117,920 ($115,920 + $2,000).

If the total countable assets of the couple are less than $231,840 but greater than $100,000, then the CSAS is ½ of the total countable assets; the Medicaid LTC asset limit is ½ of the total countable assets + $2,000.

If the total countable assets of the couple are $100,000 or less, then the CSAS is $50,000; the Medicaid LTC asset limit is $52,000 ($50,000 + $2,000).

The institutional spouse cannot be enrolled in Medicaid LTC, as long as the total assets of the community spouse and institutional spouse are above the combined asset limit of $2,000 plus the CSAS amount.

Excess assets (assets which are above the asset limit) can be reduced to allowable limits if they are used to pay for nursing home or home care costs, or other things such as home repairs or improvements, vehicle repair or replacement, clothing or other household expenses.

Calculation for Spousal Impoverishment

The LTC income limit is the same whether or not the institutionalized person has a spouse or dependent relative(s) in the community. However, for the person who does have a spouse in the community, the person applying for or enrolled in the LTC program is allowed to give some of his/her income back to the community spouse and dependent relative(s) living with the community spouse. This is referred to as an income allocation.

Community Spouse Income Allocation

The community spouse income allocation is calculated by subtracting the gross income of the community spouse from the Maximum Community Spouse Income Allocation.

The maximum allocation is the lesser of:

• The Maximum Community Spouse Income Allocation of $2,898.00, or

• $2,521.67 plus excess shelter allowance.

Community Spouse Excess Shelter Cost Limit — As of 2012, the allowance is any shelter expense over $756.50. This amount may be updated each year. (Spousal Impoverishment)

Excess Shelter Allowance:

Maximum Community Spouse Income Allocation — As of 2013, this amount is $2,898. This amount may be updated each year.

Dependent Relative Income Allocation — The dependent relative income allocation is calculated by subtracting the dependent relative’s income from the Maximum Dependent Family Member Income Allocation.

Family Maintenance Allowance Credit (Community Waiver/Family Care) — The Family Maintenance Allowance is for the support of the family members when spousal impoverishment protections do not apply. If the member is a disabled child, the Family Maintenance Allowance is not included.

When the waiver member is the custodial parent of minor children living in the home, and there is no spouse in the home, the Family Maintenance Allowance is calculated using the following steps:

Compare the Minor Children’s Adjusted Income total with the Medicaid Level 1 Income Limit for the number of individuals in the household. (Do not include the waiver applicant in the group size.)

If the Minor Children’s Adjusted Income is greater than Medicaid Level 1 Income Limit, there is no Family Maintenance allowance. If Minor Children’s Adjusted Income is less than Medicaid Level 1 Income Limit, the Family Maintenance Allowance is the difference between Minor Child’s Adjusted Income and the Medicaid Level 1 Income Limit.

If there are no minor children in the home, and spousal impoverishment policies do not apply, the Family Maintenance Allowance is then calculated as follows:

SSI Payment Level Plus the E Supplement for one person ($889.77).

If the Spouse’s Adjusted Income is greater than the SSI Payment Level Plus the E Supplement for one person there is no Family Maintenance Allowance.

If Spouse’s Adjusted Income is less than SSI Payment Level Plus the E Supplement for one, the Family Maintenance Allowance is calculated as follows:

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Last Revised: February 06, 2013