| Consumers as well as agents and brokers who | | | | An amount designated by a state hearing officer |
| market long-term care insurance should have a | | | | to raise the community spouse's protected |
| current knowledge and understanding of Medicaid's | | | | resources up to the minimum monthly |
| Spousal Impoverishment rules that come into play | | | | maintenance needs standard. |
| when an individual or a spouse enters a nursing | | | | After the PRA is subtracted from the couple's |
| home. | | | | combined countable resources, the remainder is |
| It is important to understand that far too many | | | | considered available to the spouse residing in the |
| people fail to properly plan for the potential risk of | | | | medical institution as countable resources. If the |
| needing long-term care. At a point in time when | | | | amount of countable resources is below the |
| they finally anticipate the need, they are generally | | | | State's resource standard, the individual is eligible |
| in too poor health to qualify. Counting on | | | | for Medicaid. Once resource eligibility is determined, |
| government programs such as Medicaid is | | | | any resources belonging to the community spouse |
| certainly not going to be a viable answer going | | | | are no longer considered available to the spouse in |
| forward as Federal and State programs become | | | | the medical facility. |
| more severely strapped for cash. | | | | Income Eligibility |
| The expense of nursing home care, which | | | | The community spouse's income is not considered |
| according to the 2008 LTC Insurance | | | | available to the spouse who is in the medical |
| Sourcebook, ranges from $4,000 to $7,000 a | | | | facility, and the two individuals are not considered |
| month or more, can rapidly deplete the lifetime | | | | a couple for income eligibility purposes. The state |
| savings of elderly couples. The cost of home care | | | | uses the income eligibility standard for one person |
| as well as assisted living can be costly as well. | | | | rather than two, and the standard income eligibility |
| Generally government programs such as Medicaid | | | | process for Medicaid is used. |
| do not pay for this care and, as a result, as | | | | Post-Eligibility Treatment of Income |
| personal savings were depleted many people | | | | This process is followed after an individual in a |
| were (and are) forced into nursing homes. | | | | nursing facility/medical institution is determined to |
| In 1988, Congress enacted provisions to prevent | | | | be eligible for Medicaid. The post-eligibility process |
| what has come to be called "spousal | | | | is used to determine how much the spouse in the |
| impoverishment" that can leave the spouse who | | | | medical facility must contribute toward his/her |
| is still living at home in the community (as they | | | | cost of nursing facility/institutional care. This |
| refer to it) with little or no income or resources. | | | | process also determines how much of the income |
| These provisions are designed to help ensure that | | | | of the spouse who is in the medical facility is |
| this situation will not occur and that community | | | | actually protected for use by the community |
| spouses are able to live out their lives with | | | | spouse. |
| independence and dignity. | | | | The process starts by determining the total |
| 2009 Resource Eligibility (According to Center for | | | | income of the spouse in the medical facility. From |
| Medicaid Services, CMS) | | | | that spouse's total income, the following items are |
| The spousal impoverishment provisions apply | | | | deducted: |
| when one member of a couple enters a nursing | | | | A personal needs allowance of at least $30; |
| facility or other medical institution and is expected | | | | A community spouse's monthly income allowance |
| to remain there for at least 30 days. When the | | | | (between $1,750 and $2,739 for 2009), as long as |
| couple applies for Medicaid, an assessment of their | | | | the income is actually made available to her/him; |
| resources is made. The couple's resources, | | | | A family monthly income allowance, if there are |
| regardless of ownership, are combined. The | | | | other family members living in the household; |
| couple's home, household goods, an automobile, | | | | An amount for medical expenses incurred by the |
| and burial funds are not included in the couple's | | | | spouse who is in the medical facility. |
| combined resources. The result is the couple's | | | | The community spouse's monthly income |
| combined countable resources. This amount is | | | | allowance is the amount of the institutionalized |
| then used to determine the Spousal Share, which | | | | spouse's income that is actually made available to |
| is one-half of the couple's combined resources. | | | | the community spouse. If the community spouse |
| To determine whether the spouse residing in a | | | | has income of his or her own, the amount of that |
| medical facility meets the state's resource | | | | income is deducted from the community spouse's |
| standard for Medicaid, the following procedure is | | | | monthly income allowance. Similarly, any income of |
| used: From the couple's combined countable | | | | family members, such as dependent children, is |
| resources, a Protected Resource Amount (PRA) | | | | deducted from the family monthly income |
| is subtracted. | | | | allowance. |
| The PRA is the greatest of: | | | | Once the above items are deducted from the |
| The Spousal Share, up to a maximum of | | | | institutionalized spouse's income, any remaining |
| $109,560 in 2009; | | | | income is contributed toward the cost of his or |
| The state spousal resource standard, which a | | | | her care in the institution. |
| state can set at any amount between $21,912 | | | | For free information on long-term care insurance |
| and $109,560 in 2009; | | | | visit the Consumer Information Center of the |
| An amount transferred to the community spouse | | | | American Association for Long-Term Care |
| for her/his support as directed by a court order; | | | | Insurance. |
| or | | | | |