When navigating the intricacies of Medicaid, particularly when planning for long-term care, you'll encounter terms that might be unfamiliar yet profoundly influential. One such term is "community spouse." As your local Troy elder law attorney, I'm here to demystify this concept and its implications for Medicaid eligibility and benefits.

What is a 'Community Spouse'?

A "community spouse," sometimes referred to as the "well spouse," is the husband or wife of a nursing home resident who is applying for Medicaid to help pay for the costs of long-term care. The community spouse is referred to that way under the Medicaid laws because he or she continues to live in the community (as opposed to a nursing home or other long-term care facility). This distinction is significant because Medicaid recognizes the financial needs of the community spouse and offers certain protections to prevent impoverishment.

Key Provisions for the Community Spouse:

1. Protected Spousal Amount: This is a certain amount of the couple's combined assets that the community spouse is allowed to retain without affecting the other spouse's Medicaid eligibility. The specific amount can vary by state and change yearly, so it's vital to check current limits. In Michigan in 2023, the Protected Spousal Amount ranges from $29,724.00 to $148,620.00. In many states, the Protected Spousal Amount is referred to as the Community Spouse Resource Allowance or CSRA.
2. Monthly Income Allowance: Recognizing that the community spouse might need support, Medicaid allows a certain amount of the institutionalized spouse's income to be allocated to the community spouse. This is to ensure the well spouse has sufficient funds for their living expenses. The 2023 income allowances for Michigan ranges from $2,288.75 to $3,175.00 per month.
3. Court Adjustments: If the standard Protected Spousal Amount and income allowances are insufficient to meet the community spouse's needs, it might be possible to obtain a higher allowance through a court hearing.
4. Spousal Refusal: In some states, the community spouse can refuse to support the institutionalized spouse. While this allows the institutionalized spouse to qualify for Medicaid, it's essential to note that states can sometimes pursue the community spouse for payment. Spousal refusal is not a strategy utilized in Michigan, perhaps in large part because there are many other legal techniques we can utilize that provide an excellent result for the community spouse.

Planning Considerations:

Medicaid planning with a community spouse can be complex, but it's vital to maximize the protections available. Proper planning can:

• Ensure the community spouse maintains a comfortable standard of living by increasing the community spouse income allowance.
• Secure quality care for the institutionalized spouse.
• Preserve family assets to the greatest extent possible. In the overwhelming majority of cases, we can protect all of the assets for the community spouse, not just the Protected Spousal Amount.

Consult with a Troy Elder Law Attorney

Understanding and navigating the rules related to the community spouse in Medicaid can be challenging. As an experienced Troy elder law attorney, I am able to provide guidance tailored to your unique situation.

If you're considering Medicaid planning or have concerns about the community spouse rules, don't hesitate to reach out. Contact me at (248) 469-4261 or use the “contact us” form on the right for a comprehensive consultation and be sure to mention this article for a focused discussion on your specific needs.