CMS Releases Spousal Impoverishment Standards, Income Caps, and Home Equity Limits for 2023

The Centers for Medicare and Medicaid Services (CMS) issued revised Spousal Impoverishment Standards, Income Caps, and Home Equity Limits for 2023.  These standards, caps, and limits govern Medicaid eligibility determinations.

Spousal Impoverishment Standards

The spousal impoverishment thresholds will increase 8.2 percent over 2022’s figures.

The official spousal impoverishment allowances for 2023 are as follows:

• Minimum Community Spouse Resource Allowance: $29,724.
• Maximum Community Spouse Resource Allowance: $148,620
• Maximum Monthly Maintenance Needs Allowance: $3,715.50

The Minimum Monthly Maintenance Needs Allowance for the lower 48 states will rise to $2,288.75 ($2,861.25 for Alaska and $2,632.50 for Hawaii) until July 1, 2023.

Income Cap (in applicable states): $2,742

Home Equity Limits:

Minimum: $688,000

• Maximum: $1,033,000

You can access the complete chart of the 2023 SSI and Spousal Impoverishment Standards from CMS.

CMS releases CSRA and Home Equity Limits for 2019

The Centers for Medicare and Medicaid Services (CMS) released the Community Spousal Resource Allowance and Home Equity Limits for 2019.  The official  allowances for 2019 are as follows:

• Minimum Community Spouse Resource Allowance: $25,284;
• Maximum Community Spouse Resource Allowance: $126,420;
• Maximum Monthly Maintenance Needs Allowance: $3,160.50;
• Minimum Monthly Maintenance Needs Allowance:  $2,057.50.

The aforementioned Minimum Monthly Maintenance Needs Allowance is for the lower 48 states; the specific allowance for Alaska is $2,572.50 and for Hawaii is $2,366.25.  The Minimum Monthly Maintenance Needs Allowance is the current allowance until July 1, 2019.

The Home Equity Limits are:

• Minimum: $585,000;
• Maximum: $878,000.

The new figures can be found here.

ProSeniors keeps and maintains a complete list of most limits and allowances for various government programs and benefits available to seniors, which list you will find here.     

Congress Considering Removing Medicaid Eligibility Planning Opportunities- Spousal Income Annuities Targeted

Congress is considering making it harder to qualify for Medicaid if a community spouse has an annuity.  The change is part of an effort to close what Congress considers "loopholes" in Medicaid law.

The proposed bill aims to prevent married couples from using assets to purchase an annuity for the community spouse, so that the institutionalized spouse can apply for Medicaid. The bill would count half of the income from a community spouse's annuity as income available to the institutionalized spouse for purposes of Medicaid eligibility. The House Energy and Commerce Committee held a hearing on February 1, 2017, to consider the changes.  It is unclear how eligibility will be changed since income can not be "liquidated" to pay for care.  Regardless, the proposed changes would mean that married couples would have one less tool available to create an adequate safety net for a community spouse affected by nursing home spend down.  

Along with limiting spousal annuities, Congress is also considering bills to count lottery winnings as income and require Medicaid applicants to prove U.S. citizenship or residency before receiving benefits.

For more information about the proposed legislation, click here.

New York Spousal Refusal to Contribute to Care Creates Implied Contract to Repay Benefits

In what appears to be a first of it's kind decision, a New York trial court has entered a judgment against a woman who refused to contribute to her spouse’s nursing home expenses, finding that because she had adequate resources to do so, an implied contract was created between her and the state entitling the state to repayment of Medicaid benefits it paid on the spouse’s behalf. Banks v. Gonzalez (N.Y. Sup. Ct., Pt. 5, No. 452318/15, Aug. 8, 2016).  The decision is being reported by ElerderLawAnswers.com.

According to the site, Evelyn Gonzalez’ spouse was admitted to a nursing home and received $28,235.56 in Medicaid benefits from the Department of Social Services of the City of New York.  At the time of her spouse's Medicaid application, Ms. Gonzalez’ assets exceeded the state's Community Spouse's Resource Allowance (CSRA).  However, she signed a "Spousal Refusal" declaration refusing to make her income or resources available to pay for her spouse’s care.  

Spousal Refusal is an aggressive strategy where the community spouse seeks to keep all of his or her assets by simply refusing to support the institutionalized spouse, and is generally not used except in where the states have adopted the federal law in this area, or where a federal court has upheld this right.  Under the law, if a spouse refuses to contribute his or her income or resources toward the cost of care of a Medicaid applicant, the Medicaid agency is required to determine the eligibility of the nursing home spouse based solely on the Medicaid applicant's income and resources, as if the community spouse did not exist.  In 2005, a federal appeals court upheld the right of the wife of a Connecticut nursing home resident to refuse to support her husband. The husband was able to qualify for Medicaid coverage, and assets that he had transferred to his wife were not counted in determining his eligibility.   Morenz v. Wilson-Coker (2nd Cir., No. 04-4107-CV, July 14, 2005).

After a letter to Ms. Gonzalez demanding repayment of the cost of Medicaid benefits paid on behalf of her spouse went unanswered, the Department of Social Services of the City of New York filed suit.  s. Gonzalez did not respond to the summons and complaint, nor to the agency’s motion for default judgment.

The Supreme Court of New York, New York County, granted the motion and entered a default judgment against Ms. Gonzalez for the cost of benefits provided to her spouse.  The court noted that in cases such as this where Ms. Gonzalez has the income and resources but refuses to contribute to her spouse’s care, state law creates an implied contract between her and the state allowing recovery of the cost of the benefits provided during the preceding 10 years.

Value of Assets That Spouses of Medicaid Recipients May Keep Rises for 2015

Medicaid law provides special protections for the spouse of a Medicaid applicant to ensure the spouse has the minimum support needed to continue to live in the community while the the Medicaid recipient receives long-term care benefits, usually in a nursing home.

One of the most important protections is the "community spouse resource allowance" or CSRA. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in assets (the amount may be somewhat higher in some states). In general, the community spouse may keep one-half of the couple's total "countable"assets up to a maximum that changes each year. This is the “maximum CSRA,” the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is called the “minimum CSRA.”

The federal government just announced the new spousal impoverishment figures for 2015, which include the minimum and maximum CSRA:

• Minimum Community Spouse Resource Allowance: $23,844
• Maximum Community Spouse Resource Allowance: $119,220

Here's an example of how the CSRA might work:

If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 -- $2,000 for the applicant and $50,000 for the community spouse.

Some states, however, are more generous toward the community spouse. In these states, the community spouse may keep up to $119,220 (in 2015), regardless of whether or not this represents half the couple's assets. For example, if the couple had $100,000 in countable assets, the community spouse could keep the entire amount, instead of being limited to half.

For more about the CSRA, click here.

For more about Medicaid's protections for the healthy spouse, click here.

For more about Medicaid's treatment of assets, including what is "non-countable," click here.

Staying Eligible for Medicaid after the Death of a Spouse

When one member of a couple moves to a nursing home, it is not uncommon for families to expect that spouse will be the first to die, and then plan accordingly.  Such short-sighted planning fails to consider what happens if a Medicaid recipient's spouse dies first.  If planning steps aren't taken, the death of a spouse can affect the nursing home resident's assets and eligibility for Medicaid.

In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in assets (the amount may be somewhat higher in some states). The Medicaid applicant's spouse (called the "community spouse") can keep more assets. In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $115,920, depending on the state (in 2013). Often when one spouse seeks to qualify for Medicaid, he or she transfers assets to the community spouse.

The death of a Medicaid recipient's spouse can affect the amount of assets the Medicaid recipient has, and therefore his or her Medicaid eligibility. For example, suppose a community spouse dies, and her will leaves her estate to her husband, who is in a nursing home and receiving Medicaid. The additional assets will make the husband ineligible for Medicaid. Even if the community spouse's will did not leave anything to her husband, most states allow a spouse to claim a share of the estate. Medicaid can assess a penalty even if the husband does not claim his share.

The couple's house can also present a planning challenge. Most spouses own property jointly. If the community spouse passes, the Medicaid recipient will own the house. Depending on the state, the nursing home resident may have to prove either an intention to return home or a likelihood of returning home in order for the house not to count as an asset. If the resident sells the house, the proceeds from the sale will make the resident ineligible for Medicaid.

To prevent a community spouse's death from affecting the institutionalized spouse’s Medicaid eligibility, it is important that the community spouse update his or her estate plan. There are steps the community spouse can take to protect the spouse in the nursing home, including setting up a trust for the management of assets. To find out the plan that would work best for you, contact your attorney. 

For more about Medicaid’s rules, click here.  For more about Medicaid planning, click here.

Key 2014 Dollar Limits for Medicaid Long-Term Care Coverage Released

The Centers for Medicare & Medicaid Services (CMS) has released the 2014 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep and the limit on how much a home can be worth for its owner to still qualify for Medicaid.

The Centers for Medicare & Medicaid Services (CMS) has released the 2014 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep and the limit on how much a home can be worth for its owner to still qualify for Medicaid.

In 2014, the spouse of a Medicaid recipient living in a nursing home (called the "community spouse") may keep as much as $117,240 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2014 will be $23,448.

Meanwhile, the maximum monthly maintenance needs allowance for 2014 will be $2,931. This is the most in monthly income that a community spouse is allowed to have if her own income is not enough to live on and she must take some or all of the institutionalized spouse's income. The minimum monthly maintenance needs allowance – the income level below which a state may not allow a community spouse to fall if income from the institutionalized spouse is available -- is $1,938.75 in the lower 48 states ($2,422.50 for Alaska and $2,231.25 for Hawaii).  This figure took effect July 1, 2013, and will not rise until July 1, 2014.

In determining how much income a particular community spouse is allowed to retain, states must abide by this upper and lower range. Bear in mind that these figures apply only if the community spouse needs to take income from the institutionalized spouse. According to Medicaid law, the community spouse may keep all her own income, even if it exceeds the maximum monthly maintenance needs allowance.

Home Equity Limits

Medicaid will not cover long-term care services for applicants whose homes are valued above a certain limit.  For 2014, that limit is $543,000, although states have the option of increasing this equity limit to $814,000. But the house may be kept with no equity limit if the Medicaid applicant's spouse or another dependent relative lives there.

These new figures (except for the minimum monthly maintenance needs allowance) take effect on January 1, 2014.

For more on protections for the healthy spouse, click here.  For more on Medicaid’s asset rules, click here.