Medicaid Planning for Married Couples Needing Nursing Home Care

The decision for one spouse to move into a nursing home and receive nursing home care while the other remains at home is not an easy one. Couples deliberating must account for many factors including the physical and mental capacities of both spouses, the logistics of the separation, and the financial burden. Such a time of uncertainty can be stressful, but caring and qualified legal professionals can help inform, plan, and ease the anxiety.

The information below is a brief overview of what to expect financially when one spouse needs nursing home care. For more detailed and personal information, or to make a financial plan, contact one of our attorneys at Stevenson Smith Hood Knudson, P.C.

Paying for a Nursing Home

Nursing home care is tremendously expensive, and it can add a financial burden on a couple that seems unbearable. There are a few ways in which to pay for nursing home care.

Self-Pay is often the first resort for those establishing themselves or a loved one in a nursing home. They pay out of pocket until their resources are depleted.

Long-Term Care Insurance is a relatively new option that has its pros and cons. It often has high premiums, and applicants must apply while healthy, which makes it an ill fit for those who find themselves or their spouse unexpectedly needing nursing home care. This makes it a relatively uncommon option even though it is gaining popularity since a long-term care policy can secure payment for many facets of nursing home care.

Medicare is federally-funded health insurance designed for seniors over 64 years old or for those with disabilities. Requirements for entry and the amount and kind of care available varies by state and the program in which a person is enrolled. It is designed to provide limited coverage for a short designated period of time. 

Medicaid has become the default long-term care insurance plan for the middle class. It is designed to provide healthcare coverage for people who have restricted resources and meet other requirements. The guidelines are established by the federal government as it provides partial funding for the program. Like Medicare, the guidelines for eligibility and the funding received varies from state to state.

Medicaid for Married Couples: Division of Assets

Medicaid statutes have special provisions for married couples. These are referred to as the Division of Assets, and they work on a common sense principle so one spouse doesn’t have to live in poverty in the event that the other requires and receives nursing care. It applies only to married couples.

When applying for Medicaid assistance during the transition of one spouse to a nursing home, a couple pools their countable assets and the relevant documentation. These are valued, totaled, and divided in half. The spouse going to the nursing home receives a portion determined by Medicare and the spouse remaining home receives the brunt of the assets, up to the Community Spouse Resource Allowance. 

As income continues to come in, its allocation is dependent on which spouse is the primary earner. Some of the income paid out to nursing home residents often goes to the facility to support operations and is supplemental payment toward the cost of care. None of the money earned by the spouse at home goes to the nursing home. If, however, the spouse in the nursing home was the breadwinner of the family and the spouse at home does not otherwise receive sufficient income—a measure classified as the Minimum Monthly Maintenance Needs Allowance—that spouse is allowed to keep the nursing home-bound spouse’s income in quantities to meet the MMMNA.

Exploring Medicaid Options for Nursing Home Care

Unfortunately, many couples find that, when the time comes for one of them to enter a nursing home, they do not qualify for Medicaid. Because of this, many families end up paying for nursing home care services until they have depleted their assets enough to qualify for government assistance. This is clearly not the ideal approach, but it can feel like a couple’s only option without qualified legal help.

Fortunately, an attorney experienced in estate planning and other relevant legal agreements can help you find the right solution for your situation. At Stevenson Smith Hood Knudson, P.C., a member of our legal team can sit down with you and your spouse to assess your financial situation, take note of your goals, and determine how Medicaid guidelines apply to your circumstances. We can then recommend strategies for working within the Medicaid guidelines to best meet your family’s needs.