Do We Really Have To Go Broke To Go On Medicaid Long-Term Care?

That’s one of the biggest questions we get once folks find out that Medicare doesn’t cover long-term care. Do we really have to go broke to broke in order to get Medicaid assistance for long-term care? Well, the answer is Sort of…

Medicaid is the country’s largest public payer of long-term care. If you are eligible for Medicaid, it will cover nursing home care and other expenses that Medicare does not cover. Medicaid may also cover some home healthcare services.

Medicaid eligibility rules vary by state, so be sure to check the rules in the state where you live. However, generally, if your income is higher than the state’s Medicaid eligibility level, you may still be eligible for Medicaid coverage. In several states, people can qualify for Medicaid after spending their income and assets on nursing home and other health care expenses. This is called Medicaid “spend down.” In addition, some people enter a nursing home as private-pay patients, but become eligible for Medicaid over time because of the high cost of such care. Generally, states let nursing home residents covered by Medicaid keep $2,000 in assets and an income of about $30 per month.

But in The Huffington Post, elder law attorney Ann Margaret Carrozza points out a little-known provision which could save many families from going broke on long-term care:

In an effort to protect the well spouse from complete financial ruin, anti-spousal impoverishment laws were enacted on the federal level in the late 1980s. In 2012, the well spouse (or community spouse) is permitted to retain up to $113,640 in assets while his or her spouse is covered under the Medicaid program. What if an individual has more than this? Enter- Spousal Refusal.

Spousal Refusal laws prevent the Medicaid program from refusing to provide coverage to an eligible individual just because his or her spouse is ‘refusing’ to cover the cost of the necessary care. This is not the end of the story! Each state’s Medicaid law requires an applicant to assign to the program his or her rights to enforce support obligations against all responsible parties including a spouse.

The reality of spousal refusal is very different from the politically motivated sound bites decrying multi-millionaires on Medicaid. If, for example, my husband has a stroke and we apply for Medicaid for him, I may decide to declare spousal refusal in order to protect my nest egg of $300,000. Am I doing this because I am a mean witch? Not necessarily. In every case I see, spousal refusal is declared because the well spouse is sick to her stomach at the very real prospect of hemorrhaging through the couple’s life savings.

Spousal Refusal: I Take Thee In Sickness And In Health, Except…

Spousal refusal isn’t available under every state Medicaid, but if you’re facing the prospect of going broke in order to get Medicaid long-term care for your spouse, it’s certainly worth a try!

Is someone in your family on Medicaid long-term care? Tell us about it in our Medicaid discussion forum!

Related posts:

1. Medicaid and Long-Term Care: The Medicaid "Spend Down"
2. Long-Term Care Awareness Month: Have You Talked to Your Mother About Her Long-Term Care?
3. Do You Know How Much Long-Term Care Will Cost You?
4. Healthcare Reform: Long-Term Care and Healthcare for Seniors
5. Healthcare Reform: CLASS Program for Long-Term Care Dropped