Long-term care for a loved one can be expensive. A short stay in a rehabilitative center or a more permanent transition to a nursing facility can rapidly exhaust assets. When private insurance isn’t available, the government provides a safety net through Medicaid.

Medicaid is a health insurance program for individuals with low income and limited resources. Medicaid was created under Title XIX of the Social Security Act of 1965 and is often called “Title XIX.” Medicaid eligibility has two components: 

  1. The applicant must have less than $2,000 in countable resources.  
  2. The applicant must have a monthly income of no more $2,349 from all sources. 

A spouse’s income is not considered available to the spouse who applies for Title XIX. The spouse who doesn’t need care (the “community spouse”) can keep part of the applicant’s income if the community spouse’s income is less than a certain dollar amount that is determined yearly. This “minimum monthly maintenance needs allowance” is $3,160.50 per month in 2020.  

When the couple applies for Medicaid, their resources are assessed. The couple’s resources, regardless of ownership, are combined. The assets are then divided evenly between the spouses and adjusted so that the community spouse has a minimum amount of assets. The community spouse can retain the “Spousal Share,” no greater than $128,640 in 2020. Once resource eligibility is determined, any resources belonging to the community spouse are not considered available to the spouse in the facility. 

In order to become Medicaid-eligible, an applicant must have less than $2,000 in countable resources. The recipient is allowed to retain one vehicle, personal property, and a homestead. Medicaid applicants often need to “spend down” resources following the attribution of resources.

The State employs a five-year look-back period when determining Medicaid eligibility. If the applicant transferred assets for less than fair market value at any time within sixty months of application, the value of the transferred asset will be imputed to the applicant. For example, an applicant cannot give away or re-title assets and then immediately apply for Title XIX benefits. There are certain exceptions, including one that allows a family member to retain a home.

Applying for Medicaid for a spouse is daunting and it is vital to get experienced help if you need it.