Thursday, December 1, 2011

New Spousal Impoverishment and Aging Waiver Standards for 2012

The Centers for Medicare and Medicaid Services (CMS) has announced the new standard maximum spousal protected resource level for Medicaid Long Term Care benefits effective January 1, 2012. 

Community Spouse Allowance
In general, when your spouse is in a nursing home, or needs home care under Pennsylvania’s Aging Waiver or LIFE programs, he or she will not qualify for Medical Assistance (Medicaid) benefits until your savings are reduced to a certain level.  That permitted level of so-called "available resources" varies with each situation.  For nursing facility residents, Pennsylvania’s general rule is that the community spouse can keep ½ of the amount of available resources that were owned by the couple on the date of admission to the nursing facility.  However, this protected "Community Spouse Resource Allowance" is subject to a ceiling and a floor as noted below.

In addition to being allowed to keep the resource allowance, the community spouse is also entitled to have a certain level of income called the Minimum Monthly Maintenance Needs Allowance. The income allowance is also subject to a ceiling and a floor.  If the community spouse does not have the required level of income, the spouse may be allowed to keep some of the institutional spouse's income.  If the income diverted from the institutionalized spouse is still insufficient, the community spouse may be able to keep additional resources. 

Note that many community spouses protect additional resources through the purchase of a DRA compliant annuity (see my post “Medicaid Annuities protect your assets if your husband or wife needs a nursing home”).  The state typically does not object to the purchase of a properly structured DRA compliant annuity. You should seek the help of an experienced elder law attorney to learn more about using DRA annuities to protect your income and savings from your spouse’s nursing home costs.  

These community spouse resource and income allowances are adjusted annually.  Effective January 1, 2012, the new base standards will be as follows:
-       Minimum Community Spouse Resource Allowance - $22,728.
-       Maximum Community Spouse Resource Allowance -$113,640.
-       Maximum Community Spouse Monthly Income Allowance - $2,841.
Note: The Minimum Monthly Income Allowance is currently $1,838.75 - it will be adjusted on July 1, 2012. 

Federal Benefit Rate
The Social Security Administration has announced the SSI Federal Benefit Rate Standards for 2012 as follows:
-       Individual - $698.00 per month
-       Couple - $1,048.00 per month

PDA Aging Waiver Program
The Federal Benefit rate is used to determine qualification for many Medicaid public benefit programs including the Department of Aging Home Waiver and the LIFE programs. The income limit for the Aging Waiver and LIFE programs is equal to 300% of the SSI Federal Benefit rate for an individual. This means that effective January 1, 2012 the new income ceiling should be $2094 per month.  
Under Pennsylvania rules, individuals with income above this amount generally cannot qualify for the Aging Waiver program.

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