Qualifying for Medi-Cal benefits is a major concern for many people. The rules can be confusing and the process of applying for Medi-Cal can be intimidating. How much property can you own and how much income can you have, and still be eligible for Medi-Cal long-term care benefits? How does Medi-Cal apply to married couples? These are important questions. It helps to understand that there are special eligibility rules for applicants who are married, and require nursing home benefits.
Spouses are considered financially responsible for each other
One of the first principals that applies to Medi-Cal eligibility is that spouses are financially responsible for one another. This means that any financial resources the “well spouse” or “community spouse” may have are regarded as being available to the applicant spouse, to help pay health care expenses before Medi-Cal contributes.
However, this principle is not applied without limitation. The community spouse is not held entirely responsible financially for the other spouse. This could lead to severe impoverishment of community spouses. The reality is, the cost of nursing home care can potentially consume a couple’s entire life savings, in just a few months. Therefore, Medi-Cal has put in place certain protections to avoid complete impoverishment of a community spouse, while still making them accountable, to a degree, for the care of their spouse.
How Medi-Cal treats the assets of a married couple
According to Medi-Cal, all assets owned by either spouse are available to the institutionalized spouse (the spouse in the nursing home), for purposes of Medi-Cal eligibility. Some assets are not counted, such as the couple’s residence, which will continue to be occupied by the community spouse. However, assets will not be excluded simply because they belong exclusively to the community spouse.
The Community Spouse Resource Allowance
The Community Spouse Resource Allowance is the amount of assets the community spouse will be allowed to keep, while Medi-Cal benefits are made available to the institutionalized spouse. In many states, the community spouse is allowed to keep the first $50,000 of all assets. So, if the couple only has $50,000 in countable assets, then the institutionalized spouse will immediately qualify for Medi-Cal as an applicant with less than $2,000 in resources.
Community Spouse Resource Allowance in California
The exact amount of the Community Spouse Resource Allowance differs from one state to the next. In California, the Community Spouse Resource Allowance in 2015 allows the community spouse to keep the first $119,220 in assets. If that spouse’s income is below the Minimum Monthly Maintenance Needs Allowance, which is currently $2,981, the community spouse may be able to keep more. There is a federal maximum and minimum amount for the Community Spouse Resource Allowance. In 1996, the minimum was set at $15,348 and the maximum was set at $76,740.
If you have questions regarding Medi-Cal eligibility, or any other Medi-Cal planning needs, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.