What's Your Question About Nursing Homes?

Question

My husband is seriously ill and I’ve been taking care of him at home for six years now. My doctor says that I need to have surgery. I can’t take care of my husband at home any more right now. We don’t have much. If he goes into the nursing home, will Medicaid take everything we own?

Answer

Many people are worried about what to do if they have to put their spouse in a nursing home. One of their concerns is finances. They want to know how much money and resources they are allowed to have. You need information about Medicaid eligibility for married couples. Here are the basics.

Kentucky Medicaid looks at finances in two categories: resources and income. (Resources mean liquid assets; money you can get your hands on including the cash surrender value of life insurance policies.)

We will start with a brief look at resources. Currently, an "institutionalized resident" is allowed to keep $2,000 in resources in his/her name. However, the "community spouse" (the one not in the nursing home) is allowed to keep a different sum of money. Any money the couple has over certain limits must be used to pay the nursing home bill. [Note: The community spouse has up to six months after the Medicaid application has been approved to get everything into his/her name only. Staff at the Department for Community Based Services (DCBS) can offer guidance in this matter.]

The amount of resources which can be transferred to the community spouse by the nursing home resident is calculated by the worker at the DCBS office. In order to determine eligibility, a calculation is done to see whether or not the resident has available resources in excess of $2,000. The resources of the community spouse and those resources which the resident has transferred to the spouse (or indicated the intent to transfer to the community spouse within six months of the date of a previous application) are not considered available to the nursing home resident. However, there are limits on the number of resources that the resident may transfer to the community spouse. The community spouse resource allowance is equal to one-half of the couple’s combined countable resources with a minimum allowance of $21,912 and a maximum allowance up to $109,560.

For example: If together the couple has $100,000, then $50,000 can be kept by the community spouse and $2,000 can be kept by the spouse in the nursing home. This leaves $48,000 which is available to pay the bill at the nursing home. Other things may also be purchased with this money such as funeral expenses, necessary upkeep to a home, or personal items for the resident. When that $48,000 is gone, then Medicaid program will kick in.

There are only a few ways a nursing facility resident can use resources which put them over the Medicaid limit. It would be wise to talk to a financial planner, attorney, or benefits counselor before disposing of any resources to make sure that any transfers are appropriate and will not disqualify the person from Medicaid.

Income is another story. The "community spouse" may be allowed to get as much as $2,739 per month in income from the institutionalized spouse, but no less than $1,750 depending upon the couples’ joint income. These calculations will be made by the DCBS worker, based on information the community spouse provides at the time of application. The worker looks at joint income as well as shelter allowance needs. Money not allocated to the community spouse or to the institutionalized spouse is considered available to pay to the nursing home. Under Medicaid rules, the "institutionalized spouse" is allowed $40 per month for personal needs while in a facility.

Resource and income limits usually change each year based on inflation.