What are Community Spouse Resource and Income Allowances?
In general, when your spouse is in a nursing home or needs assistance with home care under a Medicaid Waiver program (like Pennsylvania’s Aging Waiver program) he or she will not qualify for Medicaid benefits until your combined financial resources are reduced to a certain level. That permitted level of so-called "available resources" varies depending on your financial circumstances.
For nursing facility residents, the 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 standard protected "Community Spouse Resource Allowance" is subject to a ceiling and a floor.The ceiling and floor amounts for 2014 are set out 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 Monthly Maintenance Needs Allowance. This 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.
What are the Resource and Income Allowances for 2014
These community spouse resource and income allowances are adjusted annually. Although the new figures have not yet been announced by the Centers for Medicare and Medicaid Services (CMS), by law they are based on the consumer price index for all urban consumers published by the Bureau of Labor Statistics (the CPI-U) for September of the prior year.
The Medicaid law established the initial community spouse resource allowance at levels of $12,000 minimum and $60,000 maximum for 1989 based on the CPI-U for September 1988. It provided that these levels be increased by the same percentage as the percentage increase in the CPI-U between September 1988 and the September before the calendar year involved.
The CPI-U for September 1988 was 119.8. The CPI-U for September 2013 was 234.149. This means that the CPI-U has increased 95.4499% over the period. For calculation purposes, I’ve rounded this percentage to 95.4%.
Because the September CPI-U has now been released, we can now project that effective January 1, 2014, the new standard community spouse allowances should be as follows:
· Minimum Community Spouse Resource Allowance = $23,448.
· Maximum Community Spouse Resource Allowance = $117,240.
· Maximum Community Spouse Monthly Income Allowance = $2,931.
Note: The current Minimum Monthly Income Allowance remains at $1,939 - it will be adjusted on July 1, 2014.
Readers should understand that the Community Spouse Resource Allowance is a starting point for planning. A community spouse can often protect resources in excess of his or her resource allowance through Medicaid planning techniques such as the purchase of a Medicaid qualified annuity. (Be sure to consult an experienced elder law attorney before purchasing an annuity for purposes of qualification for Medicaid benefits.)
The allowances discussed in this post can be calculated from the September CPI-U. But they have not yet been formally announced by the Centers for Medicare and Medicaid Services (CMS). It is possible that due to rounding CMS could ultimately announce figures that are slightly different than those above due to rounding. But my projections have been correct in the past and I have a high degree of confidence in them.
Thanks to my friend and fellow elder law attorney Robert Clofine of York, Pennsylvania, for being first to calculate these 2014 inflation adjusted figures.