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Lifting the Veil on a Complex Process

The Medicaid process for married couples is complicated.  The complexity stems from what to do about the spouse who does not need long-term care - the Community Spouse - or more importantly, how much that spouse is allowed to keep.  For a single person the spend-down is straightforward:  for a single person in Pennsylvania, he or she is allowed to keep a maximum of $2,400 or $8,000 in resources, depending on his or her income.  In Ohio, the resource allowance is $2,000.

While a couple's calculation is more complicated, the stress can be much relieved through the help of an experienced Elder Law attorney.  In all situations, there is a maximum allowance of resources that a Community Spouse is allowed to keep, but not every spouse is entitled to that maximum allowance.  Each situation is unique, and it is imperative you understand how these rules affect your circumstances.  Without proper planning, families may wind up spending significantly more than they should have, and they could have received government benefits sooner than they realized.

Spending Down

Unfortunately, far too many families are inaccurately told they must spend one-half of their assets down on nursing home expenses before they will obtain Medicaid eligibility.  However, this is not entirely how the rules work.  In fact, there are many ways to help expedite a spend-down through certain expenses that are allowable for either spouse.  We advise families on appropriate expenses to consider making sure they use all of Medicaid's rules to their advantage.  Some examples of appropriate expenses include pre-paying funeral arrangements, making improvements to the primary residence for the Community Spouse, or purchasing a more reliable vehicle for the Community Spouse to drive.

What About the Couple's Income?

When one spouse enters a nursing home and eventually ends up on Medicaid, that spouse, likely, will still be responsible for paying a portion of his or her income to the nursing home - often referred to as Patient Liability.  In Pennsylvania, a nursing home resident on Medicaid is entitled to a personal needs allowance of $45 of his or her income per month (in Ohio it's $50 per month) - the rest of the income goes to the nursing home.  In a couple's situation, there could be instances where the Community Spouse is entitled to a portion of his or her spouse's income, but those rules are dependent upon such variables as the Community Spouse's income and monthly household expenses.

It is not uncommon for a Community Spouse to need to adjust from a two-income household to a one-income household.  This change could be significant.

Let Us Help

Fortunately, we work with these circumstances all the time, and we are able to help maximize not only the income that a Community Spouse can keep, but also in certain circumstances we can help preserve larger portions of the family's assets from ever being spent down.  In addition, planning options can often reduce the time it takes to obtain Medicaid benefits while preserving such assts.  Our government system is not designed to be friendly to families who find themselves in these crises - without a clearer picture, you may be led to think you have to spend more than you have to, or told you are out of options.  Please don't think you have to carry this burden alone.  Let us help so you can go to focusing on what's most important - being the spouse, or child, or sibling, or friend, or cheerleader, to you loved one who needs care.

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