In order to be eligible for Medi-Cal, applicants are required to have limited income and assets. Any assets you own, with very few exceptions, must be used to pay for medical expenses. What does that leave for spouses of Medi-Cal recipients? Many people become concerned about how they can continue to support themselves if their spouse is placed in a nursing home, while receiving Medi-Cal benefits. There is help available, including the Medi-Cal Monthly Maintenance Needs Allowance.
Support for spouses of Medi-Cal recipients
The healthy spouse, is typically referred to as the “community” spouse. The community spouse is the one who remains at home, while the Medi-Cal recipient is in a nursing facility. Community spouses have certain rights to benefits, as well. A very important benefit for spouses is the Medi-Cal Monthly Maintenance Needs Allowance. If your husband needs to go to a nursing home for long-term care, any pension or Social Security income he receives will go towards the costs of the nursing home care. But if you rely on that income for your daily needs, the monthly maintenance needs allowance is available to help replace that income.
How much is the maintenance needs allowance in California?
Medi-Cal is a federal program, which is jointly administered with each state. State governments have some discretion in determining certain aspects of its Medi-Cal program. There are federal guidelines which set limits on benefits. In 2014, the maximum monthly maintenance needs allowance a state is allowed to provide is $2,931. In California, the Monthly Maintenance Needs Allowance in 2014 is the same amount. However, if a community spouse’s income is greater than the needs allowance, that spouse would not qualify for the allowance.
Other resources for community spouses of Medi-Cal recipients
The laws governing Medi-Cal provide additional protection for the spouses of Medi-Cal recipients, to ensure they have the minimum support needed while their spouse is receiving long-term care benefits. In addition to the Monthly Maintenance Needs Allowance, the Community Spouse Resource Allowance (CSRA) may also be available.
How is the Community Spouse Resource Allowance determined?
To be eligible for Medi-Cal benefits, a nursing home resident can have no more than $2,000 in assets. If married, then the “countable” assets include those of the healthy spouse as well. Medi-Cal determines the amount of these assets as of the date when the ill spouse enters a hospital or long-term care facility, for a period of at least 30 days. The healthy spouse is typically allowed to keep half of the couple’s total “countable” assets. In California, that amount is $117,240 as of 2014.
Is the community spouse’s income protected?
The income of the community spouse, as opposed to assets, is not counted in determining a Medi-Cal applicant’s eligibility. Only income in the applicant’s name is counted. This means, a working community spouse will not be required to contribute to the cost of long-term care, when they stay in a nursing home is covered by Medi-Cal. In some states, however, if the community spouse’s income exceeds certain levels, that spouse does have to make a monetary contribution towards the cost of care for the spouse in the nursing home.
If you have questions regarding Medi-Cal planning, or any other estate planning needs, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.
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