Tag Archives: medicaid numbers

Medicaid Numbers for 2018

The Medicaid numbers for 2018 were recently released.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

Community Spouse Monthly Income Allowance:

Minimum Monthly Maintenance Needs Allowance: $2,030

Maximum Monthly Maintenance Needs Allowance: $3,090

 

Community Spouse Asset Allowance:

Minimum Community Spousal Resource Allowance: $24,720

Maximum Community Spouse Resource Allowance: $123,600

Excess Shelter Standard: $609

Standard Utility Allowance: $513

 

Medicaid Numbers for 2017

The Medicaid numbers for 2017 were recently updated.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

Community Spouse Monthly Income Allowance:

Minimum Monthly Maintenance Needs Allowance: $2,030

Maximum Monthly Maintenance Needs Allowance: $3,023

 

Community Spouse Asset Allowance:

Minimum Community Spousal Resource Allowance: $24,180

Maximum Community Spouse Resource Allowance: $120,900

Excess Shelter Standard: $609

Standard Utility Allowance: $513

 

For the nursing home resident, the numbers are:

Monthly Personal Needs Allowance: $50

Resource Allowance for an Individual: $2,000

 

For purposes of calculating the penalty for gifts made within five years, the number is as follows:

Average Private Pay Rate in Ohio: $6,570

(In general, this means that for every $6,570 given away within the last five years, one month of nursing home coverage will be forfeited.)

Medicaid Releases Updated 2015 Numbers

The Medicaid numbers for 2015 were recently updated.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

Community Spouse Monthly Income Allowance:

Minimum Monthly Maintenance Needs Allowance: $1,967

Maximum Monthly Maintenance Needs Allowance: $2,981

 

Community Spouse Asset Allowance:

Minimum Community Spousal Resource Allowance: $23,844

Maximum Community Spouse Resource Allowance: $119,220

Excess Shelter Standard: $590

Standard Utility Allowance: $498

 

For the nursing home resident, the numbers are:

Monthly Personal Needs Allowance: $50

Resource Allowance for an Individual: $1,500

 

For purposes of calculating the penalty for gifts made within five years, the number is as follows:

Average Private Pay Rate: $6,327

(In general, this means that for every $6,327 given away within the last five years, one month of nursing home coverage will be forfeited.)

Medicaid Releases Updated 2014 Numbers

The Medicaid numbers for 2014 were recently updated.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

Community Spouse Monthly Income Allowance:

Minimum Monthly Maintenance Needs Allowance: $1,939

Maximum Monthly Maintenance Needs Allowance: $2,931

 

Community Spouse Asset Allowance:

Minimum Community Spousal Resource Allowance: $23,448

Maximum Community Spouse Resource Allowance: $117,240

Excess Shelter Standard: $582

Standard Utility Allowance: $463

 

For the nursing home resident, the numbers are:

Monthly Personal Needs Allowance: $45

Resource Allowance for an Individual: $1,500

 

For purposes of calculating the penalty for gifts made within five years, the number is as follows:

Average Private Pay Rate: $6,114

(In general, this means that for every $6,114 given away within the last five years, one month of nursing home coverage will be forfeited.)

What Is Division of Assets?

Division of Assets is the name commonly used for the Spousal Impoverishment provisions of the Medicare Catastrophic Act of 1988. It applies only to married couples. The intent of the law was to change the eligibility requirements for Medicaid in situations where one spouse needs nursing home care while the other spouse remains in the community (i.e. at home or in an assisted living facility). The law, in effect, recognizes that it makes little sense to impoverish both spouses when only one needs to qualify for Medicaid assistance for nursing home care.

As a result of this recognition, division of assets was born. Basically, in a division of assets, the couple gathers all of their non-exempt (countable) assets together in a review. See below for a list of exempt assets.

The non-exempt assets are then divided in two, with the community (or at home) spouse allowed to keep one-half of all countable assets up to about $115,920. The other half of the countable assets must be “spent down” until $1,500 remains for Ohio residents and $2,000 for Kentucky residents. The amount of countable assets which the at-home spouse gets to keep is called the Community Spousal Resource Allowance (CSRA).

Each state also establishes a monthly income floor for the at-home spouse. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). This permits the community spouse to keep a minimum monthly income ranging from about $1,939 to $2,898.

If the community spouse does not have at least $1,939 in income, then he or she is allowed to take the income of the nursing home spouse in an amount large enough to reach the MMMNA. The nursing home spouse’s remaining income (minus a personal needs allowance) goes to the nursing home. This helps avoid the necessity for the at-home spouse to dip into savings each month, which would result in gradual impoverishment.

Exempt Assets

• The Home up to around $500,000. The home must be the principal place of residence.

• Household and Personal Belongings, furniture, appliances, jewelry and clothing.

• One Vehicle and there may be some limitations on value.

• Burial Plot and Irrevocable Funeral Plans for you and your spouse.

• Life Insurance policies as long as the cash surrender value of all policies combined does not exceed $1,500. If they do exceed $1,500 in total cash surrender value, then the cash value in these policies is countable.

The bottom line is you must seek advice from someone who knows Medicaid law.

Medicaid Releases Updated 2013 Numbers

The Medicaid numbers for 2013 were recently updated.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

Community Spouse Monthly Income Allowance:

Minimum Monthly Maintenance Needs Allowance: $1,892

Maximum Monthly Maintenance Needs Allowance: $2,898

 

Community Spouse Asset Allowance:

Minimum Community Spousal Resource Allowance: $23,184

Maximum Community Spouse Resource Allowance: $115,920

Excess Shelter Standard: $568

Standard Utility Allowance: $456

 

For the nursing home resident, the numbers are:

Monthly Personal Needs Allowance: $40

Resource Allowance for an Individual: $1,500

 

For purposes of calculating the penalty for gifts made within five years, the number is as follows:

Average Private Pay Rate: $6,114

(In general, this means that for every $6,114 given away within the last five years, one month of nursing home coverage will be forfeited.)

MEDICAID SPEND-DOWN

There is a great deal of confusion regarding the spend-down of assets for Medicaid qualification.

For a single person, who can only keep $1,500 in Ohio and $2,000 in Kentucky, that individual may find him or herself won­dering what the money can be spent on without causing any Medicaid disqualification.

Similarly, for a married couple, the rules are even more complex. The community spouse, (i.e. the at-home spouse) may generally keep roughly one-half of the couple’s assets up to a maximum of about $113,640. Depending upon their resources, again the couple may have a substantial amount of money which needs to be spent before the nursing home spouse qualifies for Medicaid.

That is often where the confusion begins. That’s because there is so much misinformation about what kinds of things the money can be spent on.

For someone who is pursuing Medicaid eligibility, the following are the types of spend-down items, in no particular order, which should be considered:

1. Purchase pre-paid funeral plans. The rules regard­ing funerals are complicated so you should only deal with a funeral home knowledgeable in this type of planning.

2. Make home improvements. Home improvements are often an excellent use of funds in a Medicaid spend-down. For instance, the community spouse might fix the roof, get a new air conditioning system, new carpeting, new furniture, etc. The intention here is to fix the house up so that, hopefully, no other home repairs will need to be done during the lifetime of either spouse. That is especially important since the community spouse will have to spend down one-half of his or her assets and may no longer have the resources necessary for large expenditures later.

3. Buy household goods or personal effects. Once again the intention is to have the community spouse get the types of things which are needed to keep the household running without major expenditures down the road.

4. Attorney, Accountant and other Professional Fees. Paying professional fees can be an effective way to access expert advice, while also helping achieve your spend-down.

These are, of course, not the only items that qualify. The main rule to keep in mind is that whatever goods or services are purchased must be done at fair market value.

Also, don’t let anyone tell you that anything spent must be done solely for the benefit of the nursing home-spouse. However, please bear in mind, that in the case of a married couple, the spend-down may only begin 30 days after the nursing home stay has started.

Medicaid Releases Updated 2012 Numbers

The Medicaid numbers for 2012 were recently updated.

For a nursing home Medicaid recipient with a spouse living in the community, the numbers are as follows:

  • Minimum Monthly Maintenance Needs Allowance: $1,839
  • Maximum Monthly Maintenance Needs Allowance: $2,841
  • Minimum Community Spousal Resource Allowance: $22,728
  • Maximum Community Spouse Resource Allowance: $113,640
  • Excess Shelter Standard: $552
  • Standard Utility Allowance: $599
For the nursing home resident, the numbers are:
  • Monthly Personal Needs Allowance: $40
  • Resource Allowance for an Individual: $1,500

For purposes of calculating the penalty for gifts made within five years, the number is as follws:

  • Average Private Pay Rate: $6,023

Medicare Skilled Nursing Facility Co-Insurance

  • (Days 21 to 100 per benefit period): $ 144.50