Do I Have to “Spend Down” Everything to Qualify for Medicaid?

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My spouse is going to have to move to a nursing home. When spending down assets for the sick spouse to qualify for Medicaid, does it have to be done before sick spouse is sent to a nursing home or can it be done even after the sick spouse is admitted to a nursing home?

MarketWatch’s recent article entitled “Do I have to spend my assets before Medicaid will pay for my spouse’s nursing home?” cautions that the rules for Medicaid coverage of nursing home care are very complicated. Medicaid is the federal-state safety net program for healthcare, and it pays for nursing home care.

However, to qualify, nursing home residents must prove that they’re impoverished under Medicaid’s rules. These rules are different in each state.

In Texas, as in most states, to be eligible nursing home residents must have “countable” assets of fewer than $2,000. Almost all assets are counted against this limit except for the resident’s home, which isn’t countable provided its fair market value (less any mortgage) is less than $636,000.

If the nursing home resident is married, their spouse — known as the “community” spouse — is limited to half of whatever assets the couple owned together when the ill spouse moves to a nursing home up to a cap of $137,400 (in 2022) in countable assets. This is known as the community spouse resource allowance or “CSRA.”

“Spending down” is the process of spending savings until the couple’s assets are below the combined limit of $139,400. This spending can be for anything that benefits either spouse, whether it involves paying off debts, such as a mortgage or line of credit on the house, fixing up the house, buying a car, or even the healthy spouse taking a much-needed vacation.

The only thing they can’t do is give the money away. The sooner a couple spends down, the sooner the nursing home spouse will qualify for Medicaid coverage and the sooner they’ll be able to stop paying the nursing home out-of-pocket.

As is often the case with Medicaid planning, the best strategy will be different in different situations. You should consult with an experienced elder law attorney before starting the spend down process.

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Reference: MarketWatch (Oct. 22, 2022) “Do I have to spend my assets before Medicaid will pay for my spouse’s nursing home?”