Dad Needs Assisted Living but Mom Still Lives at Home — Medicaid Protections for the Spouse

In this article

1. Start with the misunderstanding
2. What counts, and when
3. Her share of the savings
4. Her income stays hers
5. When the protected amounts are not enough
6. What to do this week
7. The part that works against us
8. Does this apply to assisted living

If your father needs assisted living and your mother still lives at home, Medicaid does not ask her to spend down to nothing. Federal law protects her in five places: a share of the couple's savings, her own income, a share of his income if she needs it, the house she lives in, and one car. Florida applies those protections through the Department of Children and Families (DCF), and the order you do things in matters more than any single number.

Start with the misunderstanding

The most common fear is that Medicaid will take the house and drain the savings of the spouse who is still healthy. That fear comes from the rules for a single person. For a married couple, Congress wrote a separate set of rules in 1988 so that one spouse's care does not leave the other with nothing. Medicaid.gov describes the purpose plainly: a certain amount of the couple's combined resources is protected for the spouse living in the community.

In Medicaid language, your father is the institutionalized spouse and your mother is the community spouse. The words are clumsy, but you will hear them on every call, so it helps to know them.

What counts, and when

Everything either spouse owns is added together at the start. Her name on the account, his name on the account, or both names: it makes no difference. This is a one time snapshot of the couple's resources, taken as of the beginning of the first continuous stretch of long term care, under 42 U.S.C. 1396r-5.

That is why you should write down the date care began, and why a hospital stay followed by a move to assisted living can matter. Keep the discharge papers and the move in date together.

Some things are left out of the count. The home she lives in and one vehicle are generally excluded, along with household goods and personal belongings. Retirement accounts and brokerage accounts are usually counted.

Her share of the savings

Federal law lets the community spouse keep a portion of the couple's combined countable resources. Florida sets the amount through its rule at Florida Administrative Code 65A-1.716, which points to the federal formula in the same statute. The federal figures are updated every year, so ask DCF for the current numbers on the day you apply instead of trusting an old article, this one included.

Whatever the couple owns above her protected share has to be spent down to the state's resource limit for him before Medicaid begins paying. Spending on his care, on her needs, on debts, on a prepaid funeral, and on repairs to the home all count as spending. Giving money to children does not. Gifts inside the look back window create a penalty, which we cover in the Florida Medicaid look back explained.

Her income stays hers

Medicaid looks at his income to decide what he contributes to his care. It does not count hers against him. If the pension check is in her name, it is her pension.

If her own income is below a state minimum, called the minimum monthly maintenance needs allowance, part of his income can be redirected to her until she reaches it. Florida's rule ties that minimum to 150 percent of the federal poverty level for a couple, plus an allowance when her housing costs run high. A family member living with her can also qualify for a small allowance from his income.

The practical effect is that his monthly contribution to the assisted living bill is smaller than his full income, and the part that is not used for the bill goes home to her.

When the protected amounts are not enough

Sometimes the protected savings do not earn enough to bring her up to the income minimum, or her housing costs are far above average. Federal law allows the couple to ask for a fair hearing to raise the protected amount of savings, or to raise her income allowance, when the standard figures leave her short. The right to that hearing is written into the same federal statute.

This is where an elder law attorney earns the fee. The hearing is decided on the record, so bills, statements, and a written budget for her household make the difference.

What to do this week

Work in this order.

The two helplines are listed on the Florida Department of Elder Affairs website, where you can confirm either number before you dial.

The part that works against us

Medicaid approval and a bed are two separate things. A community chooses whether to accept Medicaid, and one that does can still have no opening on the day you need it. Sugarmill Manor and The Gardens both accept Medicaid, but being approved does not put your father in a room, and the months between applying and being approved are private pay months.

Plan for those months before you sign anything. Ask what a month costs, what admission requires, and what happens to the stay if his money runs low.

Does this apply to assisted living

The spousal protections were written for nursing facilities. Medicaid.gov says they also reach certain people who receive home and community based services, which is how Florida pays for care in many assisted living communities. Whether your father's program carries the spousal rules is a question for DCF and your attorney by name, so put it on the list for steps 4 and 5. Our guide to how Florida Medicaid long term care works for assisted living explains how the program is structured, and Medicaid spend down for assisted living covers what the state counts.

If you are comparing communities, start with our page on assisted living that accepts Medicaid in Citrus County, or contact us and we will tell you what to gather.

Frequently asked questions

Will Medicaid take our house if my husband goes into assisted living?

Generally not while his wife lives there. The home a community spouse lives in is usually excluded from what Medicaid counts, along with one vehicle.

How much of our savings can the spouse at home keep in Florida?

A protected share of the couple's combined countable resources, set by federal formula and updated every year. Ask DCF for the current figure when you apply.

Does Medicaid count my wife's income against my care?

No. Her income is hers. If it falls below a state minimum, part of the institutionalized spouse's income can be shifted to her.

When are the couple's assets measured for Medicaid?

As of the start of the first continuous period of long term care. Write down that date and keep the hospital or move in papers.

Can the protected amounts be raised?

Yes. Federal law allows a fair hearing to raise the protected savings or the income allowance when the standard amounts leave the spouse at home short.

Sources

• Medicaid.gov, spousal impoverishment
• 42 U.S.C. 1396r-5, treatment of income and resources for certain institutionalized spouses
• Florida Administrative Code 65A-1.716, income and resource criteria
• Florida Department of Elder Affairs, contact and Elder Helpline

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Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.