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Medicaid Spousal Impoverishment

States can impose the most protective “spousal impoverishment” Medicaid eligibility rules. To prevent the high cost of long-term care from impoverishing the spouses of nursing home residents, federal law requires states to protect some assets and income of the non-institutionalized spouse (“community spouse”) through resource and income allowances.1

For more than two-decades, states have been required to use eligibility rules that prevent spouses from becoming impoverished in order for their partner to qualify for Medicaid-funded nursing-home care. For 5 years beginning in January 2014, states must extend the same financial protections to the spouses of recipients who receive Medicaid long-term care services at home or in the community.

Has the state chosen the greatest allowable protection for income and assets of the “community” spouses of nursing home residents under the Medicaid program?

States that have the highest resource and income allowances allowed by the federal government receive a "meets policy." States receive a "limited policy" if they have chosen the highest level of either allowance. States receive a "weak policy" if they have chosen a level below the maximum but above the federal minimum. States that offer the lowest level permitted receive a "no policy."

State Strength of Policy Change from 2007
Alabama Weak Policy Same
Alaska Meets Policy Same
Arizona No Policy Same
Arkansas No Policy Same
California Meets Policy Same
Colorado Limited Policy Same
Connecticut No Policy Same
Delaware Weak Policy Same
District of Columbia No Policy Same
Florida Limited Policy Same
Georgia Meets Policy Same
Hawaii Meets Policy Same
Idaho No Policy Worse
Illinois Meets Policy Same
Indiana No Policy Same
Iowa Limited Policy Same
Kansas No Policy Same
Kentucky No Policy Worse
Louisiana Meets Policy Same
Maine Limited Policy Same
Maryland No Policy Same
Massachusetts No Policy Same
Michigan No Policy Worse
Minnesota Weak Policy Same
Mississippi Meets Policy Same
Missouri No Policy Same
Montana No Policy Same
Nebraska No Policy Worse
Nevada No Policy Same
New Hampshire No Policy Same
New Jersey No Policy Same
New Mexico Weak Policy Same
New York Limited Policy Same
North Carolina No Policy Same
North Dakota Weak Policy Same
Ohio No Policy Same
Oklahoma Limited Policy Same
Oregon No Policy Same
Pennsylvania No Policy Same
Rhode Island No Policy Same
South Carolina Limited Policy Better
South Dakota No Policy Worse
Tennessee No Policy Same
Texas Limited Policy Same
Utah No Policy Same
Vermont Limited Policy Same
Virginia No Policy Same
Washington Weak Policy Same
West Virginia No Policy Same
Wisconsin Weak Policy Worse
Wyoming Meets Policy Same

Policy Indicator Counts
Meets Policy: 
8
Limited Policy: 
9
Weak Policy: 
7
No/Harmful Policy: 
27
Better: 
1
Same: 
44
Worse: 
6

Data Source: Eric M. Carlson, Matthew Bender and Company "Chapter Seven: Medicaid Payment for Nursing Facility Care, Part V. Appendices, 2009 State-Specific Chart of Resource and Income Allowances," in Long-Term Care Advocacy Section 7.401, 2009.

Footnotes

1 For the “community spouse resource allowance,” states must allow the community spouse to retain the greater of: (1) a minimum of $19,908 and a maximum of $99,540 in assets or (2) half the couple’s joint assets up to $99,540.  For the “income allowance,” the community spouse can retain his or her own income, but also has the right to retain some or all of the resident’s income, according to the state-established Minimum Monthly Maintenance Needs Allowance (MMMNA) that, according to federal law, must be at least $1,603 and no more than $2,489.  Hawaii and Alaska are set higher because of a higher poverty level. Eric M. Carlson, Long-Term Care Advocacy, "Appendix A: 2006 State-Specific Medicaid Resource and Income Allowances; Average Monthly Private Pay Rates,” Section 7401 (Albany, NY: Matthew Bender & Co., 2007); 42 U.S.C. § 1396r-5(d) (2008).

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