Nursing Home Medicaid for Married Couples—What if the Well Spouse is Still Working

This whole month we have been exploring Nursing Home Medicaid eligibility questions for Married Couples. The Medicaid rules are confusing, and this is especially true for married couples. In recent blogs and newsletters, we have addressed income issues for married couples when one spouse is seeking Nursing Home Medicaid. Adding to the complexity, let’s consider what changes if the well spouse is still working. For folks living with early onset dementia (or dementia that is diagnosed between ages 30 and 64), it is very likely that a spouse may still be working. We also know that stroke, traumatic brain injuries, and aneurysms affect people of all ages, and some of those episodes result in catastrophic disability, requiring continuous nursing care. Many of our families have a spouse living in the nursing home while the well spouse works a full-time job and maintains the family home. And for some of those families, we have had to ask the well spouse if continuing to work makes good financial sense. Knowing that the nursing home spouse can divert up to $3,022.50 of his/her income to the well spouse, working may mean that less income is diverted to the well spouse (and thus more to the nursing home). Take for example a married couple that has $6,200 in monthly income. The nursing home spouse makes $3,000 in retirement funds while the well spouse works for $3,200/month. In this case, if the well spouse keeps working, she is entitled to no spousal diversion and will get to keep all of her $3,200/month income. If she were to stop working, she could receive $2,950 (all of her spouse’s income minus his $50 personal needs allowance). So, working only makes her $250 more than not working. Should she keep working? It’s complex. From a financial standpoint, it makes more sense to stop working. However, the decision to keep working may be about more than just the dollars and cents—working may give a well spouse the necessary support, socialization, purpose and distraction necessary for his/her overall well-being. We support the whole person and not just their financial well-being. If you or someone you know is facing a similar situation and needs help with good decision-making, please take advantage of our complimentary phone consultation by calling us at (404)843-0121.


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