If a married nursing home resident receives Medicaid long-term care benefits, his or her community spouse is entitled to retain a certain minimum level of income called the Minimum Monthly Maintenance Needs Allowance (MMMNA). If the community spouse's own income is insufficient to provide this income allowance, income can be diverted from the institutionalized spouse.
The minimum MMMNA is set by federal law and is adjusted each year to keep up with inflation. Pennsylvania makes the MMMNA adjustment on July 1st of each year.
As a result of the new guidelines, on July 1, 2012, the minimum MMMNA will be increased from $1,838.75 to $1,891.25 per month. This should be "rounded up" to a working figure of $1,892.00 per month. The actual MMMNA can be higher depending upon the monthly shelter related expenses incurred by the community spouse. The maximum income allowance during 2012 is $2,841.
Federal law also protects the resources of the community spouse. The protected resource amounts for 2012 (which are not linked to the new federal poverty level) are a minimum resource allowance of $22,728 and a maximum resource allowance of $113,640. It is important to note that a community spouse can usually protect resources in excess of the specified maximum through the purchase of a DRA compliant annuity.
Other programs with eligibility levels that are reliant on the federal poverty level (FPL) include the following programs that can help pay Medicare premiums for low income beneficiaries:
Qualified Medicare Beneficiaries (QMBs): Medicaid will pay all Medicare cost sharing (including Part B and any Medicare Part A premiums) for Medicare Beneficiaries with incomes up to 100% FPL and limited resources: The income limits for 2012 are $930.83/month for an individual; $1,260.83/month for a couple.
Specified Low-income Medicare Beneficiaries (SLMBs): Medicaid will pay the Medicare Part B premiums for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources: The income limits for 2012 are $1,117/month for an individual; $1,513/month for a couple.
Qualified Individual (QI): States may pay (based on funds available) Medicare Part B premiums for Medicare beneficiaries with incomes between 120% FPL and 135% FPL and limited resources: The income limits for 2012 are $1,256.63/month for an individual; $1,702.13/month for a couple.
Medicare Part D Low-Income Subsidy:
Medicare Part D is Medicare’s prescription drug coverage. Low income beneficiaries with limited resources may receive either a full or partial subsidy. A full subsidy is available for those who otherwise qualify and have incomes of $1,256.63/month for an individual and $1,702.13/month for a couple. A partial subsidy is available for those who otherwise qualify and have incomes of $1,396.25/month for an individual and $1,891.25/month for a couple.
The methods of calculating an applicants income can vary with the program. Some receipts that you might personally consider to be income may not counted in determining whether you qualify and a limited amount of your countable income may be disregarded. And the size of your family unit may impact your eligibility level for some programs. If you are in doubt as to whether you qualify for any of these benefits contact your state Medicaid agency. In Pennsylvania, interested persons can get further information and apply for benefits through their local County Assistance Office.
For further information you may wish to visit:
Pennsylvania Department of Public Welfare website (note that the figures on this page have not been updated from the 2009 figures).
2012 Poverty Guidelines: How Poverty Levels Affect Eligibility for Many Federal Public Benefit Programs, Center for Medicare Advocacy.
The MedicaidLong Term Care Eligibility Fact Sheet, Marshall, Parker and Associates.
Medicaid Annuities protect your assets if your husband or wife needs a nursing home, Marshall Elder and Estate Planning Blog.