Medicaid Income Issues

Medicaid Income Issues

Florida rules for long-term nursing care are complicated but Medicaid income issues are particularly difficult. State and Federal regulations both control the application process. Among the rules of importance for married couples is the Minimum Monthly Maintenance Needs Allowance, or MMMNA.

What is the Minimum Monthly Maintenance Needs Allowance?

In Medicaid terms, the well spouse who is living at home and is not in institutionalized care is the “community spouse.” We also use the term “well spouse.” The community spouse’s income has no bearing on the applicant spouse’s eligibility for Medicaid benefits. The community spouse gets to keep all of his or her personal income, no matter how much. The problem is when the community spouse has very little income. How can the well spouse keep up the house if the applicant spouse’s income gets diverted to pay nursing home bills? The MMMNA is the monthly income Florida considers to be the minimum amount the community spouse needs to live at home with undue hardship. It is the lowest monthly income that will avoid “spousal impoverishment.” If the community spouse’s income falls below the MMMNA (currently $2,155 as of July 1, 2020), Medicaid allows a portion of the applicant’s income to be diverted to the community spouse, thus bringing his or her income up to that level.

An Example of how the Medicaid Income Issue of MMMNA Works

Let’s say Medicaid applicant John is currently in a long-term care nursing home. He has been covered under the Medicare rehabilitation benefit but his coverage days are running out. After getting advice from a Florida elder law attorney, he applies for Florida Medicaid benefits.

John’s gross monthly income is $1500 in Social Security and $1000 in a private pension, for a total of $2500 monthly. His wife, Mary, has only one source of personal income: Social Security, at $800 gross per month. Her income is thus $1355 less than the Minimum Monthly Maintenance Needs Allowance MMMNA ($2155-$800 = $1355).

Assuming John is qualified in all other ways to receive Medicaid benefits for his nursing home care, Medicaid will allow some of his income to be diverted to Mary to bring her income up to the MMMNA level. Thus, $1355 of John’s monthly income will go to Mary, raising her monthly income to $2155.

Under certain circumstances, based upon either the cost of maintaining the home or a court order of support for the community spouse, Mary may be entitled to an even greater amount of John’s income.

John’s remaining income must go the nursing home, except for $130, which he may keep for personal needs. He may also continue to pay for his supplemental medical insurance (and receive a corresponding credit).

Why More Families are Seeking Medicaid benefits for Long-Term Nursing Home Care

As our population ages, more and more of us are experiencing chronic illnesses, for example, Alzheimer’s Disease. That means increasing numbers of families are faced with the dilemma of paying for long-term care. Long-term care is not intended to make a person “better” or “well.” It is designed to provide help with a person’s daily life needs such as bathing, toileting, eating, etc. That is why long-term care is often referred to as “custodial care.”

Although Medicare will pay for acute nursing home care following a hospital stay, it will not pay for custodial care. Frequently families realize this only when they are in crisis mode and a family member is in, or about to enter, a long-term care nursing home. Needless to say, it is a shocking discovery, giving the costs involved. Long-term care can wipe out a middle-class family’s savings in no time. According to the 2019 Genworth Cost of Care study, the median cost of a private room in a long-term nursing facility is $112,639 per year. A semi-private room doesn’t provide much financial relief: the median cost is $102,565 annually. It’s little wonder that middle class families are turning to Medicaid to try to preserve some of their hard-earned assets.

Alternatives for Spend-down

As pervasive as the myth that Medicare pays for custodial nursing care is the myth that you have to go broke to qualify for Medicaid. Burzynski Elder Law has helped thousands of families qualify for Medicaid benefits while saving significant assets. Be sure to consult with us or another experienced elder law firm for advice in this highly complicated and highly technical area of law. All steps we recommend are above-board. We do not hide money or risk denials or penalties by shady practice. We simply use the existing framework that the State and Federal rules allow to protect as much as possible of the family finances.

You should be aware that misrepresentations on a Medicaid application can result in criminal charges. Do not risk doing it alone. You should also know that it is illegal in Florida for a non-attorney to assist with Medicaid planning, per the Florida Supreme Court ruling in 2015. Medicaid planning requires a high level of legal knowledge, and involves drafting sophisticated legal documents. A non-attorney who claims to offer these services is engaging in the unlicensed practice of law, a third degree felony. Seeking help from such an unqualified individual can be a costly mistake, and may be illegal as well.

Beside the MMMNA there are many more criteria for qualifying for Medicaid benefits for long-term nursing care. If you need more information, call us at 239-434-8557 or visit our website.

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