I Can’t Afford Nursing Home Care for My Spouse. What Do I Do?

Nursing home care is expensive and the reality is that most middleclass Americans cannot afford to pay for the care for an extended period of time. Often they need families to turn to state assistance, such as Medicaid (MassHealth in Massachusetts), to assist with the exorbitant cost of care. So, the greater question is how and when a family should begin the process of qualifying for MassHealth to begin paying for the care.

Many spouses believe that they will have to spend all of their savings before MassHealth will begin paying for nursing home care for their spouse. They are concerned that they won’t have enough for themselves to continue living in the community. The MassHealth rules attempt to create a balance between the needs of the spouse living in the community and the need to reduce the expense which is ultimately being paid by the taxpayers for the needs of the nursing home spouse. Certainly the balance is not perfect, but it does protect some assets and some income for the needs of the spouse living in the community.

When evaluating the assets of a couple at the time one person applies for MassHealth, the MassHealth rules treat all the assets as belonging to the couple whether owned individually or jointly. The rules on trusts are more complicated, but in general, they assume that if either member of the couple has access to funds in the trust then all of the trust is also countable as an asset.

Under the current MassHealth rules, the spouse living in the community is permitted to keep $117,240 of assets plus the ownership of the family home as long as certain conditions are met, such as, the community spouse is living in the home at the time of the application and the equity in the home is less than $750,000.

In addition, the spouse living in the community is permitted to keep all of the income which is in his or her name. For example, if the wife is living in the community and she has social security equal to $1,000 per month and a pension of $1,500 each month, the wife is permitted to keep the full $2,500 of income. If the husband is in the nursing home and he receives $2,000 in social security and a pension of $1,500 then all of his income will be paid to the nursing home for his care less certain limited deductions.

If the wife in the community does not have income in her name or enough income in her name then the MassHealth rules permit some of the nursing home spouse’s income to be allotted to the wife so that she has “enough” income to continue to live in the community. The minimum amount which is considered “enough” for the community spouse is $1,938.75 per month of total income. This amount is called the Minimum Monthly Maintenance Needs Allowance (MMMNA) for the community spouse.

All of the information above is general information and should not be considered legal advice. However, it is important to note that consultation with an attorney before the need to apply for MassHealth may be able to make adjustments to permit the spouse living in the community to keep more assets or income through the use of various annuities, trusts, or realignment of assets. Although the options are much more limited after a spouse has applied for MassHealth, there may still be options available to protect some assets. Consultation with an attorney is the best way to maximize the income and assets available to the spouse still living in the community.