“Spousal Impoverishment Protection” refers to special financial provisions in Medicaid for the Elderly, Blind or Disabled (EBD) law. These provisions affect how we count income and assets for certain married couples receiving or applying for nursing home or community waiver services.
Home and Community-Based Waiver programs, such as Family Care, Family Care Partnership, IRIS (Include, Respect, I Self Direct), and PACE (Program of All-Inclusive Care for the Elderly) provide a home care alternative to a nursing home. These protections apply to persons who are elderly or have disabilities.
Medicaid EBD pays for health care and long-term care services for low-income people of all ages. Medicaid EBD is a federally and state-funded government program. To qualify, a person’s income and assets must be below specified levels.
Spousal impoverishment protection affects legally married couples when one spouse is in a nursing home or taking part in a community waiver program and the other spouse is not residing in a nursing home or other medical institution for 30 days or more. The person in the nursing home or the community waiver program is referred to as the “institutionalized spouse.” The other spouse is the “community spouse”.
There are special rules for counting assets and allocating the assets between the spouses. When you or your spouse first enter a medical institution, nursing home or request a community waiver program, your agency will, if requested, conduct an assessment of your total combined assets. The amount of your total combined assets at the time of institutionalization determines the amount of assets each spouse may keep.
If your combined assets are $100,000 or less, the community spouse can keep $50,000, and the institutionalized spouse may keep $2,000. If your assets are over $100,000 you should contact your agency for help in determining the amount of assets you can keep. The community spouse share can be higher than the standard if a court or administrative hearing officer orders a higher amount.
Assets Transferred Between the Spouses
Once the couple’s assets are at or below their asset limit, they have one year in which to ensure the institutionalized spouse has no more than $2,000 worth of assets in his or her name. During this time period, the institutionalized spouse usually transfers all but $2,000 of his or her assets to the community spouse.
For example: Bob and Carley have $40,000 in a money market account and $10,000 in a checking account. The accounts are in both their names. Bob is the institutionalized spouse, and Carley is the community spouse. The couple spends $1,500 on an adjustable bed for Bob and $20,000 on a newer used car for Carley after trading in their old car. They open a new checking account for Bob and take his name off both the money market and the couple’s checking account. Bob’s new account has $1,000. Carley’s accounts have the remaining $27,500, which is only in her name.
Examples of countable assets may include, but are not limited to:
- Checking accounts
- Life insurance policies
- Savings accounts
- Certificates of deposit
- Real estate
- Stocks and bonds
Assets Not Counted
Medicaid EBD does not count some assets. Those not counted include:
- Your home (as long as the community spouse or other dependent relative lives there).
- One vehicle.
- Burial assets (including insurance, some amounts in irrevocable burial trusts, and plots).
- Household furnishings.
- Clothing and other personal items.
Reducing Assets to the Allowable Limit
“Excess” assets (assets that 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 for other things, such as home repairs or improvements, vehicle repair or replacement, clothing, or other household expenses. If excess assets are not reduced, the institutionalized spouse cannot be enrolled in Medicaid.
Divestment is when you or your spouse:
- Give away income and/or assets for less than fair market value.
- Avoid taking income or assets you are entitled to, such as a pension income or an inheritance.
- Buy certain types of assets, such as a life estate, loan, or annuity. Excess assets usually cannot be reduced by divesting those assets.
Please see the Medicaid for the Elderly, Blind, or Disabled Divestment fact sheet, P-10058, for more information on divestment.
There are special rules for counting income and the amount of income that can be transferred from one spouse to another. Only the institutionalized person’s income is counted in determining enrollment. The community spouse cannot be required to pay for the institutionalized spouse’s care except when there is a court order to do so.
Income Transferred Between the Spouses
An institutionalized person who qualifies for Medicaid may be allowed to protect some of his or her income by transferring it to the community spouse, depending on the amount of income the community spouse has. The institutionalized person can also transfer income to other dependent family members. To find out the amount that can be transferred, contact your agency.
Income and Asset Limits
The spouse participating in Medicaid long-term care services must meet the same income and asset tests as a single person applying for Medicaid in a nursing home or community-based waiver program. The assets directly available to the spouse participating in Medicaid long-term care services are limited to $2,000. Except for a small personal needs allowance, the spouse participating in Medicaid long-term care services must either transfer his or her income to the community spouse or use it to pay for nursing home or home care. If both you and your spouse are participating in Medicaid long-term care services and your spouse lives in a nursing home, the single individual income and asset limits apply to you.
Spousal Impoverishment Asset Limits (Total Amount)
|If the total countable assets of the couple are:||Then the community spouse asset share (CSAS) is:||Wisconsin Medicaid enrollment limit: (CSAS + $2,000)|
|$260,760 or more||$130,380||$132,380|
|Less than $260,760 but greater than $100,000||Half of the total countable assets of the couple||Half of the total countable assets of the couple + $2,000|
|$100,000 or less||$50,000||$52,000|
|Spousal Impoverishment Income Allocation and Allowances (Monthly Amounts)
Effective July 1, 2021 and January 1, 2021
Community spouse allocation
|The maximum allocation is $3,259.50 or $2,903.34, plus an excess shelter allowance, whichever is less.
The excess shelter allowance is calculated by adding together shelter expenses such as mortgage, rent, taxes, maintenance fees, and utility costs and subtracting $871.00. Any remaining amount is considered the excess shelter allowance and is added to $2,903.34 up to the maximum of $3,259.50.
Dependent family member allocation
|$725.84 per dependent family member living with the community spouse|
Personal needs allowance (effective 7/1/01)
|$45 for institutionalized individuals|
Community-based waiver programs allowance for the spouse participating in a community-based waiver program
|The community-based waiver basic needs allowance is $974. The amount of this deduction can be higher if the member also has earned income (income from a job or self-employment), housing costs above $350 a month, or both. The maximum allowance is $2,382.|
For More Information:
- Contact your local aging and disability resource center (ADRC). Go to FindMyADRC.com for contact information.
- Ask hospital and nursing home staff.
- Refer to the ForwardHealth Enrollment and Benefits Handbook, P-00079.
- Call Member Services at 800-362-3002 or 711 (TTY).
- Contact your local income maintenance agency.