Medicaid and Married Couples

Q.: My husband had a stroke and his doctor recommends a nursing home placement. My neighbor said the nursing home will take all of our money if I admit my husband. Is that true?

A.: No. A nursing home cannot require you to assign your assets to it as a condition of admitting your husband to the facility.

Q.: Then how do I pay for my husband's care?

A.: Your husband might be entitled to a limited amount of Medicare benefits. If not, you would have to rely on private medical insurance, use your own funds, or apply for Medicaid.

Q.: Our medical insurance does not cover nursing home care. Our house is our biggest asset, but we still have a mortgage. Do I have to use all of our money before I can turn to Medicaid for help?

A.: No. You should consider Medicaid as a potential source of payment now rather than wait until your money is gone.

Q.: Do you mean I might be able to keep some of our money and still qualify my husband for Medicaid?

A.: Yes. The Department of Job & Family Services determines what the married couple owns, which is called the "pool of assets." Then the Department removes exempt assets from the pool. "Exempt assets" are those things, such as a car or a house, which would not affect your husband's Medicaid eligibility. The assets remaining in the pool are called "countable resources." Your husband's eligibility would be based on that figure.

Q.: So I can keep the exempt assets, but I have to spend the countable resources before my husband can receive Medicaid, right?

A.: The exempt assets would not have to be used for your husband's care. In addition, you would be entitled, at a minimum, to a resource allowance equal to one-half of the countable resources, subject to a floor of $19,020 and a ceiling of $95,100. For instance, if countable resources totaled $15,000, you would keep all of the money (the floor); if countable resources were $50,000, you would be entitled to $25,000 (one-half share); if there were $200,000 of countable resources, your resource allowance would be $95,100 (the ceiling). (Note:  These figures increases to $19,908 and $99,540 effective 1/1/2006.)

Q.: We have $100,000 in the bank plus our house. If I can only keep $50,000, what happens to our home and the rest of our savings?

A.: Your home is an exempt asset as long as you continue to live in it. In addition, you may be entitled to keep the other half of your savings.

Q.: That sounds great! How do I find out if I can keep the other $50,000?

A.: The Department of Job and Family Services calculates the amount of income you need to exist in the community. The calculation is based on a federal rule and takes into consideration your housing costs, such as your mortgage, taxes and insurance, and your own income. If your own income is insufficient to meet the income need calculated by the Department, then the State of Ohio might permit you to keep the other half of the countable resources and allow your husband to begin receiving Medicaid benefits.

Q.: If the State lets me keep all of our assets, what happens to our income when my husband starts receiving Medicaid?

A.: You keep your own income and, depending on the income need calculated by the Department, you might be able to keep some of your husband's income. Your husband is entitled to keep $40 of his monthly income, to transfer income to you if permitted by the Department, and to pay his monthly medical insurance premium, if any. Funds remaining after these deductions are paid to the nursing home as his "patient liability." Medicaid dollars cover the difference between the cost of his care and his patient liability, even if his patient liability is zero.

Q.: What happens if I cannot keep the other $50,000?

A.: It would have to be spent down to $1,500 before your husband could qualify for Medicaid.

Q.: If I have to spend the other $50,000, can I still keep some of my husband's income?

A.: Yes, if your own income is insufficient to meet the income need calculated by the Department.

The information contained herein is general and should not be applied to specific legal problems without first consulting with one of our attorneys.

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