Spousal Impoverishment Protection refers to special financial provisions in Medicaid for the Elderly, Blind or Disabled (EBD) law regarding income and assets that affect certain married couples receiving or applying for nursing home or community waiver services.
Community waivers programs, such as the Community Options Program (COP Waiver), Community Integration Programs (CIP) or Family Care, 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 state and federally 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 you may keep.
If you have assets of $100,000 or less, you can keep $50,000 for the community spouse and $2,000 for the institutionalized spouse. 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 Allocated Between the Spouses
Once the couple’s assets are at or below their asset limit, they have one year in which to assure the institutionalized spouse has no more than $2,000 worth of assets in his/her name. During this time period, the institutionalized spouse usually transfers all but $2,000 of his/her assets to the community spouse.
Examples of countable assets may include, but are not limited to:
- Checking Accounts
- Savings Accounts
- Life Insurance Policies
- Certificates of Deposit
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, trust funds, and plots).
- Household furnishings.
- Clothing and other personal items.
Reducing Assets to the Allowable Limit
"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 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.
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.
An institutionalized person who qualifies for Medicaid may be allowed to protect some of his/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 local county or tribal agency.
Income and Asset Limits
The institutionalized spouse must meet the same income and asset tests as a single person applying for Medicaid for the Elderly, Blind or Disabled in a nursing home or community waiver program. The assets directly available to the institutionalized spouse are limited to $2,000. Except for a small personal needs allowance, the institutionalized spouse must either transfer his/her income to the community spouse or use it to pay for nursing home or home care. The spousal impoverishment protection applies only when one spouse is institutionalized and the other is not. If both of you are institutionalized, the single individual income and asset limits apply. The purpose of the spousal impoverishment protection is to prevent the community spouse from being impoverished by his or her spouse’s institutionalization.
Spousal Impoverishment Asset Limits (Total Amount)
|If the total countable assets of the couple are:||Then the community spouse asset share is:||Wisconsin Medicaid enrollment limit: (community spouse asset share + $2,000)|
|$252,840 or more||$126,420||$128,420|
|Less than $252,840 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, 2018 and January 1, 2019
Community Spouse Allocation
|The maximum allocation is the lesser of $3,160.50 or $2,743.34, plus an excess shelter allowance.
“Excess shelter allowance” means shelter expenses above $823. Shelter expenses are mortgage, rent, taxes, maintenance fees, and a utility allowance.
$823 is subtracted from the community spouse’s shelter costs. If there is a remainder, it is added to $2,743.34.
Dependent Family Member Allocation
|$685.83 per dependent family member living with the community spouse.|
Personal Needs Allowance (effective 7/1/01)
|$45 for institutionalized nonveterans|
Community Waivers Allowance
|$951 to $2,313 for a person in a Home and Community-Based Waiver Program|
For More Information:
- Contact a Disability Benefit Specialist or Elderly Benefit Specialist at your local Aging and Disability Resource Center (ADRC) or County Aging Office or call 1-800-362-3002.
- Hospital and nursing home staff.
- Member Services at 1-800-362-3002 or 711 (TTY).
- Your local agency. To get the address and phone number of your local agency, call 1-800-362-3002 or go to www.dhs.wisconsin.gov/forwardhealth/resources.htm.