When a nursing home resident is receiving Medicaid long-term
care benefits, most of their income must be paid to the nursing home each month
and applied to the cost of their care. This is sometimes referred to as the
resident's "patient pay liability."
But, if the nursing home resident is married, this patient
pay liability may be impacted by community spouse income protections found in
federal and state law.
The community spouse is entitled to retain a certain minimum
level of income called the Monthly Maintenance Needs Allowance (MMNA). If the
community spouse's own income is insufficient to provide this allowance, income
can be diverted to the community spouse from the institutionalized spouse.
The MMNA is set at 150% of the federal poverty level for a family of two plus an excess shelter allowance, if applicable. The Pennsylvania MMNA is adjusted on July 1st of each year to keep up with inflation adjustments to the poverty level. For the period July 1, 2014 until June 30, 2015 the minimum allowance has been $1,967 per month.
In January 2015 the Department of Health and Human Services announced that the 2015 federal poverty guideline for a family of two is $15,930. (It’s higher if you live in Hawaii or Alaska). This means that effective July 1, 2015 Pennsylvania should increase the community spouse minimum MMNA to $1,991.25 per month.
The MMNA is set at 150% of the federal poverty level for a family of two plus an excess shelter allowance, if applicable. The Pennsylvania MMNA is adjusted on July 1st of each year to keep up with inflation adjustments to the poverty level. For the period July 1, 2014 until June 30, 2015 the minimum allowance has been $1,967 per month.
In January 2015 the Department of Health and Human Services announced that the 2015 federal poverty guideline for a family of two is $15,930. (It’s higher if you live in Hawaii or Alaska). This means that effective July 1, 2015 Pennsylvania should increase the community spouse minimum MMNA to $1,991.25 per month.
Pennsylvania
usually “rounds
up” amounts under one dollar so the working allowance will likely be set at
$1,992 per month.
A standard monthly shelter allowance is built into the
minimum MMNA. The actual MMNA allowance can be higher than the minimum if the
community spouse has high housing cost and is entitled to an “excess shelter
allowance.”
The MMNA can also be increased in situations where the
community spouse can show “exceptional circumstances resulting in significant
financial duress.” 42
U.S.C. § 1396r-5(d)(2)(B). Several Pennsylvania appellate court cases have
dealt with the issue of whether a community spouse has such exceptional
circumstances. See Davis
v. DPW (776 A.2nd 1026 (Pa.Cmwlth. 2001) and Kuznick
v. DPW (5A.3d 832) (Pa.Cmwlth. 2010).
The MMNA can also be increased by judicial court-ordered
support under 42
U.S.C. § 1396r-5(d)(5). An increase in the MMNA via judicial order does not
require a showing of “exceptional circumstances resulting in significant
financial duress.”
The minimum income allowance rules are part of the federally
mandated “spousal impoverishment” protections that were enacted in 1988 to
limit the potential for impoverishment of spouses of nursing home
residents.
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