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Spousal Impoverishment Protections in Managed Long Term Care Evelyn Frank Legal Resources Program David Silva and Valerie Bogart June 2014 ELFRP@nylag.orgELFRP@nylag.org 212-613-7310
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Spousal Impoverishment Budgeting Spousal impoverishment budgeting, previously only for nursing home and waiver programs, is now available to married couples where one spouse is in MLTC. If applicant has a community spouse, he/she may shelter up to $2,931/mo. of joint income (and up to $74,820 of assets). It works almost the same as for nursing home, but with some minor variations. 2 N.Y. Dep’t of Health, G ENERAL I NFORMATION S YSTEM M ESSAGE : S POUSAL I MPOVERISHMENT AND T RANSFER OF A SSETS R ULES FOR C ERTAIN I NDIVIDUALS E NROLLED IN M ANAGED L ONG T ERM C ARE, GIS 13 MA/018 (September 24, 2013). Posted at http://www.health.ny.gov/health_care/medicaid/publications/gis/13ma018.htm http://www.health.ny.gov/health_care/medicaid/publications/gis/13ma018.htm
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Example Sam needs MLTC. His income is $2,080 gross. His wife, Mary, has Social Security of $1500. Sam pays for Part B ($105/mo.) and a Medigap premium ($161/mo.) BEFORE – Mary would have done a spousal refusal so her income would not be counted. She risked being sued for support. Sam needed to use a pooled trust to deposit his spend-down of $985/mo. $2,080 -266 (Part B + Medigap deductions) -829 (Medicaid income level for 1 + $20 disregard) $ 985 Spend-down – put into pooled trust 3
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Example budget with spousal impoverishment Applicant’s Gross monthly income (Sam) $2,080 Personal Needs Allowance (amount he keeps for himself) - 383 Community Spouse Monthly Income Allowance (CSMIA) MMMNA = ($2,931) minus Mary’s Income ($1,500) =- 1,431 Health insurance premiums (Medicare Part B) - 105 (Medigap) - 161 Excess income – No Spousal Refusal $0 4 N.Y. Dep’t of Health, Medicaid Update Vol. 30, No. 3 at 5-9 (March 2014); N.Y. Dep’t of Health, G ENERAL I NFORMATION S YSTEM M ESSAGE : S POUSAL I MPOVERISHMENT B UDGETING WITH P OST -E LIGIBILITY R ULES FOR I NDIVIDUALS P ARTICIPATING IN A H OME AND C OMMUNITY -B ASED W AIVER P ROGRAM, GIS 12 MA/013 (April 16, 2012); N.Y. Dep’t of Health, M EDICAID R EFERENCE G UIDE : I NCOME at 278-282 (June 2010).
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Example -- con’d In the preceding example, Mary had $1500 of her own income. If the “community spouse,” Mary, had no income of her own, Sam could have $1500 more income, which would in turn be allocated to Mary as her MMMNA (Minimum Monthly Maintenance Needs Allowance). This means his income could be $3,580/month and he’d have: No spend-down, and No spousal refusal necessary. Figures change depending on amount of his Medigap, if any, and amount of her income 5
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Spousal Impoverishment - Choices Married applicants have a choice of budgeting: 1.Spousal Impoverishment budgeting –Use if Applicant’s income > $829. If combined net income < $3312, then no spend-down and no spousal refusal. Can’t use pooled trust. –ASSETS – may use Spousal Impoverishment limits 2.OR Budget applicant under old method as if s/he were Single, and ignore spouse’s income. –Use if Applicant’s income < $829 –If non-applying spouse’s income > MMMNA ($2,931/mo.), this choice is better, because spouse’s income is ignored. S/he will not have to do a spousal refusal. Can still use pooled trust if applicant’s income is high. –ASSETS – Must use regular community asset limits 6
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For More Info See NYLAG article - http://www.wnylc.com/health/entry/165/ - has links to state directives:http://www.wnylc.com/health/entry/165/ MARCH 28, 2014 - in NYS DOH Medicaid Update March 2014, Vol. 30 No. 3 at pp. 5-8. http://www.health.ny.gov/health_care/medicaid/program/u pdate/2014/mar14_mu.pdf http://www.health.ny.gov/health_care/medicaid/program/u pdate/2014/mar14_mu.pdf NYS DOH GIS 13 MA/018 Spousal Impoverishment and Transfer of Assets Rules for Certain Individuals Enrolled in Managed Long Term Care. Posted at http://www.health.ny.gov/health_care/medicaid/publication s/pub2013gis.htm http://www.health.ny.gov/health_care/medicaid/publication s/pub2013gis.htm 7
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