Applying for Medicaid can be complicated, especially when a married couple is trying to figure out long-term care for one or both spouses. With families having different concerns about health and finances, the process can sometimes feel stressful or overwhelming. We’re taking a look at what Medicaid is, how eligibility is determined, and what laws are in place to protect spouses.

Understanding Medicaid

Medicaid is a state program funded through federal funds that helps people with limited income or assets cover their health care costs and long term care expenses. (Medicare provides health coverage for the elderly, while Medicaid covers costs associated with long-term care placement). With Medicaid, those in long-term care services or nursing homes may be expected to pay a portion of their income toward their care; Medicaid then pays the difference between the patient’s income and the cost of the nursing home bed.  Currently, the cost of a nursing home bed in Georgia is $8,517.00.

Medicaid Eligibility for Married Couples

Couples who are applying for Medicaid must meet strict financial criteria. Medicaid will use the terms Institutionnalized Spouse (IS) and Community Spouse (CS) when considering an application in which one spouse is entering nursing care. Medicaid determines the IS’s eligibility for benefits based on the IS’s income and the couples joint assets.

Concerning income, if only one spouse is applying for Medicaid long-term care, the applicant or IS must have an income of less than $2,382 a month. (This is the income limit for 2021). If the IS has an income of greater than $2,382, the IS must establish a Qualified Income Trust account or re-allocate his income to the CS.  The IS may allocate all or a portion of his income to the CS until the CS reaches a monthly income of $3,259.50.  In determining income, Medicaid follows the “name on the check” rules, which means that whoever’s name is on the check is the owner of the income for the purposes of eligibility.

If both spouses are applying for Medicaid, the eligibility process becomes much more complicated. Georgia considers married couples as single Medicaid applicants and applies the rules as if the applicants are each single upon entering the nursing home.

Concerning assets, the following are excluded when determining Medicaid eligibility for married couples:

  • $132,380 for a married couple when one spouse is entering care; $3,000 of assets if the couple enter nursing care at the ssame time
  • The couple’s home (If one spouse is a CS)
  • Certain household goods and personal property
  • One vehicle (if one spouse is a CS)
  • Certain income-producing property (However, Medicaid will take a lien)
  • Life insurance cash value and/or burial expenses up to $10,000.00

If the couple own assets in excess of the limits, they would be ineligible for Medicaid at fuirst glance.   However, with proper planning and the help of an elder law attorney, when one spouse enters the nursing home, the other can protect all of their joint assets under Georgia Medicaid law. And, when both spouses enter long term care at the same time, they can protect over 50% of their combined assets.

Have Additional Questions? Contact Our Team of Medicaid Professionals

Applying for Medicaid as a married couple can be an overwhelming and complicated process. There are even more factors to consider outside of the scope of what we’ve provided so far, such as financial transfers, retirement distributions, Miller trusts, spouses who are currently employed, and couples who own multiple properties.

At Brian M. Douglas & Associates, families often tell us that they’re afraid that if they apply for Medicaid for their wife or husband, that they won’t have enough money left to live off of. They’re afraid that the nursing home bills will devastate their finances. But proper planning, and the correct application of the Medicaid rules can save the spouse at home everything they need to continue their lifestyle and make sure their spouse is getting the long term care they deserve.

If you have questions about the Medicaid application process, please reach out to us at (770) 933-9009 or via our contact page. We would be happy to help.