Part 3: “Get Informed on Elder Care Eligibility”
Originally published in the Stamford Advocate on January 10, 2010
Copyright Julie Jason 2010. All rights reserved.
When you are considering your elder care options, it pays to enlist help on eligibility issues. Don’t assume anything until you do.
Without the proper insight, you might do something against your interest. For example, take a cash-poor but house-rich couple. They may assume they have to sell their home to pay for long-term nursing home care. Perhaps not.
The Medicaid safety net may come into play, allowing the couple to keep their home.
Medicaid, or Title 19, is means-tested -- only those who have limited assets and income are eligible.
The limits for “counted” assets are very meager (currently, the spouse that does not need care, the “community spouse,” can only have up to $109,560 in assets; the spouse who needs care, the “institutionalized individual,” cannot have more than $1,600 in assets (that’s not a typo). The asset limit for a single individual is also $1,600.
However, and this is where it pays to be informed – not all assets are “counted.”
Not counted assets are exempt from the limitations; you can keep them and still qualify for Medicaid assuming you meet all other eligibility requirements.
Moreover, certain assets have greater weight than others based on who owns the asset (“Spousal Share” and “Community Spouse Protected Amount” or “CSPA”) and in some cases, how the asset is used (for example, who resides in the institutionalized individual’s residence). Eligibility is determined on a case-by-case basis upon application to the State of Connecticut’s Department of Social Services (DSS).
Terminology is important. The definitions below come from a DSS report entitled, “Long Term Care Issues and Medicaid,” prepared by DSS’s Adult Services, Bureau of Assistance Programs, a publication that you’ll want to get. (Call DSS at 860-424-5250 for a copy or go online to www.ct.gov and search for DSS.)
The spousal share is “the amount that can be protected . . . determined by adding together the counted assets of both spouses as of the date the institutionalized individual entered the facility and dividing the amount in half to establish a spousal share,” according to the report.
The spousal share is used in the calculation of the CSPA, which is the amount the community spouse can keep without crippling the institutionalized individual’s eligibility.
DSS defines the CSPA to be “equal to the greatest of the following amounts: A. $21,912; or B. the lesser of 1) the spousal share calculated in the assessment of spousal assets or 2) $109,560; or C. the amount established through a Fair Hearing decision; or D. the amount established through a court order.” These amounts are the 2009 dollar limits, which also apply for 2010, according to attorney Sharon Rosen, of the law offices of Joel D. Muhlbaum of Stamford.
Let me give you a few examples (adapted from the report) to show you how these limits work.
- Ted is the institutionalized spouse. He has no assets titled in his name alone. However, he and his wife, Alice, have a joint account savings account worth $125,000. Alice, the community spouse, also has $125,000 in the bank titled in her own name. That brings the total between them to $250,000. What are the “counted assets”? Answer: $250,000. Why $250,000? Ted and Alice’s assets are added together to determine counted assets. What is the “spousal share”? $125,000. That’s one-half of the counted assets. What is the “CSPA? Only $109,560. Why not $125,000 (the spousal share)? Because the CSPA is the lesser of the spousal share ($125,000) or $109,560. Would the answer be different if there were no joint account and all the assets were titled in Alice’s name alone? No. The spousal share would still be $125,000 and the CSPA would still be $109,560.
- John, who is the institutionalized individual, has $45,000 in a bank account titled in his name. His wife, Jane, the community spouse, has $55,000 titled in her name. They also have a joint account valued at $10,000. The total between them is $110,000. What is the spousal share? $55,000 (one half of the total). What is the CSPA? $55,000.
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Bob is going into a long term care facility; Bob and his wife, Carol, have a joint bank account worth $23,000; Bob has $1,000 in an account titled in his name; Carol has $2,000 in an account titled in her name. The total between them is $26,000. What is the spousal share? $13,000 (one-half of $26,000). What is the CSPA? $21,912 (since the spousal share is less than the minimum of $21,912, the minimum applies).
While I recommend getting information from DSS and other sources, let me warn you not to act on what you read without getting assistance from a reliable expert in the area.
To read Part 4 of this series, click here.
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