Medi-Cal Protections for the Stay at Home Spouse

Medi-Cal regulations provide special protections for the spouses of Medi-Cal applicants to ensure the spouses have at least the minimum support needed to continue to live at home while their husband or wife is receiving long term care benefits in a skilled nursing facility.
The Medi-Cal “spousal protections” work this way: if the Medi-Cal applicant is married, the “countable” assets of both spouses are used to determine Medi-Cal eligibility for the nursing home patient spouse. In order to be eligible for Medi-Cal benefits, a married couple’s combined “countable” assets must be below $130,640. On the other hand, a single Medi-Cal applicant is only permitted $2,000 in “countable” assets. There are also significant “exempt” assets that are not counted in determining eligibility (most significant is the value of a principal residence and qualified retirement accounts or investments).
Income is not used in determining eligibility for the Medi-Cal nursing home program. However, income from both spouses is used to determine what amount, if any, the patient spouse must contribute towards their care in the form of a monthly co-payment obligation. Medi-Cal does recognize that the stay at home spouse will need income to meet their own personal monthly expenses. Medi-Cal has determined that a stay at home spouse will need a minimum of $3,216 per month to meet their own individual expenses. If the stay at home spouse’s monthly income is less than $3,216, they are permitted to keep the shortfall amount from patient spouse’s income, thereby reducing or even eliminating the patient spouse’s co-payment obligation.
Example: Joe Smith and his wife Sally Smith have combined income of $4,000 a month,
$2,500 of which is in Joe’s name and $1,500 is in Sally’s name. Joe enters a nursing home and applies for Medi-Cal. Medi-Cal regulations state that Sally is entitled to income in the amount $3,216 to meet her personal monthly expenses while remaining at home. Since Sally’s own income is only $1,500 a month, she is $1,716 short of the $3,216 figure determined by Medi-Cal that she needs to survive on. Therefore, Medi-Cal allocates
$1,716 of Joe’s income towards Sally’s support. Since Joe also may keep a $35 a month personal needs allowance, his obligation to pay the nursing home is only $749 a month ($2,500 – $1,716 – $35 = $749). After meeting his co-pay obligation of $749 each month, Medi-Cal pays the balance of monies owed to the nursing home.
With the guidance of a knowledgeable elder law attorney, there are several planning techniques available to potentially achieve Medi-Cal eligibility, reduce or eliminate the co- payment obligation and to protect assets from Medi-Cal estate recovery.
For more information please contact the Law Office of Sean D. Ethington at (661)295-4604 or visit our website at www.ElderLawSite.com.