Ask Jaleh: How Does a Married Person Qualify for Medicaid Coverage, for Skilled Nursing Care?

 

 

Video Summary

 

How does a married person qualify for Medicaid coverage for skilled nursing care?  Well the requirements for a married person are very similar to that of a single person.  First and foremost the applicant must be 65 years of age or older or must be a disabled adult.  The individual must be a citizen of the United States or a permanent resident.  You also must be a resident of the state of Florida but the residency requirement simply means that you must be in the state of Florida in a skilled nursing facility or in a care facility at the time the application is made.

 

You also must be medically needy and need skilled nursing care.  Well how is this determined, most people ask?  The Department of Children and Families has a special unit known as the Cares Unit that will come out to do a medical assessment after the application for Medicaid is received.  They will then determine whether or not the individual meets the criteria for the medical necessity portion that is required to receive Medicaid coverage for skilled nursing care.

 

There is also income and asset requirements similar to that of a single person.  The gross monthly income of the applicant cannot exceed $2,163.00 per month.  If the gross monthly income does exceed $2,163.00 per month, the good thing for a married couple, is that the applicant may defer a portion of their income to their spouse in order to qualify.  The combined total of both the applicant and the spouse cannot exceed $4,000.00 income per month.  If it does exceed $4,000.00 per month, we can set up a qualified income trust also known as a Miller Trust in order to qualify for eligibility to meet the income requirement.

 

There is also an asset limit for the applicant in a married situation.  In the married couple situation the individual cannot have more than $2,000.00 in countable assets.  However, the community spouse, also known as the non-institutionalized spouse, can maintain assets of up to $117,240.00.  And this obviously is the spouse that is at home.  Assets owned by either spouse must be pooled and the care giving or community spouse is entitled to certain exempt or non-available assets which include the personal residence.  Now again, the personal residence cannot have an equity value of more than $500,000.00.  They can also maintain a vehicle, one vehicle, any age, can be a luxury vehicle, and also a second additional vehicle which cannot be a luxury vehicle and must be seven years or older.

 

They also could maintain life insurance policies but the cash value or surrender value could not be greater than $2,500.00 for those life insurance policies.  And they can also maintain burial funds or an irrevocable, prepaid funeral contract.  The irrevocable prepaid funeral contract cannot be – excuse me.  It can be for any amount but the prepaid burial account cannot exceed $2,500.00 and this account can be used for pretty much anything associated with the burial expenses such as flying family members down from out of state, flower arrangements or anything that you may need in the process of a burial.

 

Also, the institutionalized spouse is allowed to keep personal needs allowance in the amount of $105.00 each month to pay for things such as toothpaste, hair care products, anything that may be necessary, toiletries for the institutionalized spouse.  And that has changed significantly as for many years it was $35.00 and in 2014 it did go up to $105.00 so people are very, very happy about that.

 

There is a lot of information regarding qualifications for married couples and I would love to give you more information.  Please contact our office if you have any further questions.  My phone number is 727-847-2288.