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DE Medicaid - Spousal Impoverishment - Long Term Care

In 1998, Federal legislation changed the way Medicaid calculates a couple's resources so that the spouse of someone in Long Term Care would not become impoverished. This policy allows for resource and income allowances for the spouse who is living in the community.

To be considered as a spousal impoverishment case, one spouse must be institutionalized or receiving Home and Community Based Waiver Services (HCBWS) -- or planning to be institutionalized or applying for HCBWS -- and one spouse must be living in the community and not be receiving HCBWS.

Community Spouse's Income

Eligibility: Income received by the community spouse is not counted when determining financial eligibility for the applicant.

Patient Pay: In determining the amount the individual in long-term care must pay to the medical provider (the "patient pay" amount), the community spouse's income is taken into account. If the community spouse has income less than the needs allowance, then an amount of the individual's income up to the needs allowance amount is disregarded. The community spouse's needs allowance is $2,610 effective January 1, 2008.

Community Spouse Resource Allowance

The Community Spouse Resource Allowance is the amount of resources equal to whichever is greater:

·      $25,000.00 (current state spousal share, effective since 1993); or

·      1/2 of the value of the couple's combined countable resources as of the beginning of the first continuous period of institutionalization on or after 9/30/89, but no more than current maximum resource allowance ($104,400 effective 01/01/2008, previously was $101,640).

Resource Eligibility

If at the time of application a couple's combined resources are less than the sum of $2,000 plus the Community Spouse Resource Allowance (see above), the applicant may be found eligible for Medicaid.

If the couple's resource total is above that amount, they should receive a calculation summary and a target amount for the total. When the case is within the limits, the applicant would have to reapply.

Example 1:

(Using 2006 figures) - If a couple had $204,440 in resources when the husband became institutionalized, then the Community Spouse Resource Allowance would be the maximum allowable, $99,540. If, by the time they apply for Medicaid, they had spent $100,000 of the resource amount on the husband's care and other expenses, they would have resources of $104,440.

To see if the husband is resource-eligible, subtract $99,540 and $2,000 from $104,440. That leaves $2,900 that they still have to spend down before he is resource-eligible for Medicaid.

Example 2:

(Using 2006 figures) - If a couple had $120,000 in resources when the husband became institutionalized, then the Community Spouse Resource Allowance would be the one/half of that amount, or $60,000. If, by the time they apply for Medicaid, they had spent $30,000 of the resource amount on the husband's care and other expenses, they would have resources of $90,000.

To see if the husband is resource-eligible, subtract $60,000 and $2,000 from $90,000. That leaves $28,000 that they still have to spend down before he is resource-eligible for Medicaid.

See also:

DE Medicaid - Covered Groups

DE Medicaid - Eligibility

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Sources:

http://www.dhss.delaware.gov/dhss/dss/ltcspousalimpoverishment.html
and Administrative Notices DMMA-12-2007, DMMA-04-2006, A-24-2005, A-12-2004, and DSS Policy Manual Section 20620.3

Back to:

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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