When most of a couple's income is in the name of the spouse who is receiving Medicaid, the spouse remaining in the community may wonder what they will live on. Medicaid has created some protections for them.
Although Medicaid limits the assets that the spouse of a Medicaid applicant can retain, the income of the community spouse is not counted in determining the Medicaid applicant’s eligibility. Only income in the applicant’s name is counted. Even if the community spouse is still working and earning, say, $5,000 a month, they will not have to contribute to the cost of caring for a spouse in a nursing home if the spouse is covered by Medicaid. In some states, however, if the community spouse’s income exceeds certain levels, they have to make a monetary contribution towards the cost of the institutionalized spouse’s care. The community spouse’s income is not considered in determining eligibility, but there is a subsequent contribution requirement.
When a Community Spouse Has Little to No Income
What if most of a couple's income is in the name of the institutionalized spouse and the community spouse's income is not enough to live on? In such cases, the healthy spouse at home is entitled to some or all of the monthly income of the institutionalized spouse. How much the community spouse is entitled to depends on what the local Medicaid agency determines to be a minimum income level for the community spouse. This figure, known as the minimum monthly maintenance needs allowance or MMMNA, is calculated for each community spouse according to a complicated formula based on their housing costs. The MMMNA may range from a low of $2,4.65 to a high of $3,853.50 a month (in 2024). If the community spouse's own income falls below his or her MMMNA, the shortfall is made up by the nursing home spouse's income.
Example: Joe and Sally Smith have a joint income of $2,600 a month, $1,900 of which is in Mr. Smith's name and $700 is in Ms. Smith's name. Mr. Smith enters a nursing home and applies for Medicaid. The Medicaid agency determines that Ms. Smith's MMMNA is $2,200 (based on her housing costs). Since Ms. Smith's own income is only $700 a month, the Medicaid agency allocates $1,500 of Mr. Smith's income to her support. Since Mr. Smith also may keep a $60-a-month personal needs allowance, his obligation to pay the nursing home is only $340 a month ($1,900 - $1,500 - $60 = $340).
In exceptional circumstances, community spouses may seek an increase in their MMMNAs either by appealing to the state Medicaid agency or by obtaining a court order of spousal support. Contact an elder law attorney to find out about these options when applying for Medicaid.
See also Medicaid's CSRA: Protecting a Healthy Spouse from Poverty.