Important Facts About Medicaid: Protections for the Healthy Spouse.

The Medicaid law provides special protections for the spouse of a nursing home resident to make sure he or she has the minimum support needed to continue to live in the community.

The so-called “spousal protections” work this way: if the Medicaid applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the date of “institutionalization,” the day on which the ill spouse enters either a hospital or a long-term care facility in which he or she then stays for at least 30 days.

In Georgia, the community spouse may keep the first $109,560 of the couple’s total “countable” assets (in 2009). Called the “community spouse resource allowance,” or "CSRA", this is the most that a state may allow a community spouse to retain without a hearing or a court order.

In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medicaid benefits. But what if most of the couple’s income is in the name of the institutionalized spouse, and the community spouse’s income is not enough to live on? In such cases, the community spouse is entitled to some or all of the monthly income of the institutionalized spouse. How much the community spouse is entitled to depends on what the Medicaid agency determines to be a minimum income level for the community spouse. This figure, known as the minimum monthly maintenance needs allowance or MMMNA, is calculated for each community spouse according to a complicated formula based on his or her housing costs. The MMMNA in Georgia is $2,739.00 per month (in 2009).

If the community spouse’s own income falls below his or her MMMNA, the shortfall is made up from the nursing home spouse’s income. (In some states, the community spouse is permitted to increase the MMMNA by retaining more resources, as discussed in Long-Term Care Planning, “Increased CSRA”.) Example: Mr. and Mrs. Smith have a joint income of $2,000 a month, $1,500 of which is in Mr. Smith’s name and $500 is in Mrs. Smith’s name. Mr. Smith enters a nursing home and applies for Medicaid. Since the MMMNA is $2,739 in Georgia, and Mrs. Smith’s own income is only $500 a month, the Medicaid agency allocates all $1,500 of Mr. Smith’s income to her support. In exceptional circumstances, community spouses may seek an increase in their MMMNAs either by appealing to the state Medicaid agency or by obtaining a court order of spousal support