Medicaid Law’s Special Protections for Spouses


 

Georgia nursing home Medicaid continues to confuse families and professionals. One of the most confusing aspects is how the rules apply to a nursing home resident that is married vs. single.

Nursing home Medicaid laws are different for single individuals than for married individuals. In many ways, Medicaid laws are more generous for those with a spouse still at home. In general, the rules usually allow a married individual to get on Medicaid without spending all of his/her assets and income.

In an effort to protect the well spouse, Georgia laws and regulations apply different asset limits, allow for spousal diversions, and delay Medicaid estate recovery for married couples when one spouse is in the nursing home. Medicaid does not want the well spouse to be impoverished by his/her ill spouse’s nursing home costs.

Different Asset Limits for Spouses

Married couples can keep up to $128,420 in assets and still qualify for Medicaid. Compare this to the individual asset limit of $2,000. In addition to this increase in asset limits, Medicaid allows for transfers of assets to occur between spouses penalty-free. So, a nursing home spouse can transfer all of his/her assets to the community spouse without worrying about the dreaded look-back period.

Whether single or married, a nursing home resident can apply for Medicaid while still owning a home and a car. He/she can also have a qualified retirement plan and up to $10,000 in a prepaid burial plan. These are all considered to be exempt assets.

Spousal Diversions and Income Limits for Spouses

When looking at income, Medicaid only looks at the nursing home resident’s income. The well spouse’s income is not considered for Medicaid eligibility. If, however, the well spouse makes less than $3,160.50 in monthly income, he/she may be entitled to keep a portion of the nursing home spouse’s income in order to bring him/her up to the $3,160.50 amount. 

Many of our married clients are concerned that all of their spouse’s income will go to the nursing home if they need nursing home care. Our average clients make $3,500/month in income (the husband has about $2,750 and the wife $750). Georgia allows the well spouse to have a monthly maintenance needs allowance of $3,160.50. So, for either spouse in this situation, the husband or the wife would get to keep a portion of their nursing home spouse’s income. The wife would keep $2,410.50 of her husband’s income; and the husband would keep $410.50 of his wife’s income.

Delayed Medicaid Estate Recovery for Spouses

Lastly, Medicaid allows spouses to avoid or delay Medicaid estate recovery. As we mentioned above, spouses are allowed to transfer assets to their community spouse without worrying about a transfer penalty or being subjected to the look-back period. Doing so may help a family avoid Medicaid estate recovery altogether.

If a family does not take steps to avoid estate recovery, the state does allow the process to be delayed for married couples. Medicaid will avoid placing a lien on the house until after the community spouse also dies. So, if the nursing home spouse dies first and owes money to the state, the state will not seek reimbursement until the other spouse also dies. In this way, Medicaid estate recovery is delayed for married beneficiaries.

In most cases, being married can help an individual to qualify for nursing home Medicaid in Georgia while not depleting his/her assets entirely. The laws can be confusing, and mistakes can be costly. If you are curious about how Medicaid eligibility rules can apply to you, please call our office for a complimentary phone consultation at 404-843-0121 or contact us here.