How Medicaid Long Term Care Eligibility is Impacted by Marital Status

Summary
Marital status, whether one is single or married, impacts the eligibility criteria to which a Medicaid applicant is subject. Single individuals have more restrictive financial limits, while married couples are permitted more generous limits in order to allow a spouse to continue living independently. It can be further complicated by other factors, such as age, state of residence and type of Medicaid. Our Medicaid Eligibility Requirements Finder is the easiest way to obtain your specific requirements.

 

Why and How Eligibility Criteria Vary with Marital Status

To understand how and why eligibility criteria varies with marital status, one must first understand the three types of Medicaid long term care programs and the locations in which care is provided.

1. Nursing Home Medicaid – is provided only in a nursing home and beneficiaries must pay all their monthly income to Medicaid.
2. Home and Community-Based Services (HCBS) Medicaid Waivers – are provided to beneficiaries in their homes or “communities” such as assisted living residences. Persons are permitted to retain their income to pay for their housing costs.
3. Aged, Blind, and Disabled (ABD) Medicaid – is provided at home or in assisted living and offers a lower level of support than waivers. Individuals are permitted to retain their income for their housing costs, but income limits are lower than with waivers.

Medicaid has different financial criteria for single and married applicants to allow a healthy spouse to continue living independently when a spouse that requires care enters a nursing home. Otherwise, since spouses typically share income and a spouse entering a nursing home must surrender all their income to the nursing home, a healthy spouse would have no money on which to live.

This is referred to as “spousal income protection”. These protections change across the 3 types of Medicaid long term are programs described above, as where the Medicaid beneficiary lives changes. They could live at-home, in assisted living or in a nursing home or because of this, both spouses’ living expenses change.

 

Spousal Protections

A key component to understanding how marital status relates to Medicaid eligibility is knowing the spousal protections put in place, also known as spousal impoverishment rules. While these rules may not impact the applicant’s eligibility directly, they can play a role in how couples strategize and prepare their finances. Spousal protection regulations help prevent non-applicant spouses from going into poverty, while also ensuring that the applicant meets the criteria for coverage.

Minimum Monthly Maintenance Needs Allowance (MMMNA)

If the spouse of a Medicaid applicant makes little or no money, then the Medicaid applicant may transfer some of their monthly income to their spouse to meet MMMNA guidelines. For the majority of the country, the maximum value allowed is $3,435 (2022). However, in certain circumstances, non-applicant spouses can receive more than the MMMNA depending on shelter costs, such as rent, taxes, and mortgage. Learn more about the MMMNA.

 

Community Spouse Resource Allowance (CSRA)

CSRA works similarly to MMMNA but regulates assets instead of income. Medicaid has an asset limit, meaning an applicant can’t have more than a certain amount of value in their assets. Usually, this amount is about $2,000 (2022). However, the CSRA allows assets up to a certain amount to be held by the non-applicant spouse. In 2022, in most states the maximum that can be held by the non-applicant spouse is $137,400. The actual amount is dependent both on the state and the couple. Learn more about the CSRA.

 

2022 Eligibility Criteria

The eligibility criteria for Medicaid long term care is largely determined by marital status and, if married, if one or both spouses is applying.

 For Medicaid purposes, widowed and divorced persons are considered single. Re-married persons are considered married.

Single Applicant

Eligibility requirements are most straightforward when a single applicant is applying for Medicaid. Numbers may vary slightly from state to state. Generally, a single individual is eligible for either Institutional Medicaid or HCBS when they make less than $2,523 per month (2022). However, there are exceptions. For example, California has no income limit on Institutional Medicaid, but only allows you to keep $35 per month and has a limit of $1,481 for HCBS Waivers. In Connecticut, the applicant’s income must be less than the cost of the nursing home for Institutional Medicaid, and Delaware has a 2022 limit of $2,102.50 for both HCBS and Institutional Medicaid.

When a single individual is applying for ABD Medicaid, there is less consistency. However, the monthly income limit usually ranges from about $841 to $1,133 depending upon the state.

 

Married with One Applicant

Eligibility requirements get more complex when one spouse in a married couple applies. Usually, the income of the non-applicant spouse is not counted. Therefore, for most states, the applicant spouse must make less than $2,523 per month as of 2022 to qualify for Institutional Medicaid or HCBS. This is the same limit that exists for single applicants. However, remember that income can be transferred from the applicant spouse to the non-applicant spouse to help supplement their income up to a specific value. This value will vary from state to state, but it is most commonly the maximum value for 2022 is $3,435.

Again, ABD Medicaid shows more variance in income limits than the other two types of Medicaid. In 2022 it ranges from about $1,100 to $1,500. There is also an important distinction to make here. For Institutional Medicaid and HCBS, only the income of the applying spouse is considered. However, for ABD Medicaid, the income limit combines both spouses’ incomes, even if only one is applying for Medicaid. As such, MMMNA rules do not apply.

 

Married with Two Applicants

For both Institutional Medicaid and Medicaid Waivers, each spouse is generally allowed an income limit of $2,523 per month; this is the same limit when only one spouse or single individuals apply. In some states, the limit is combined. This means that the standard $5,046 (2022) does not need to be allocated evenly to both spouses. For example, one spouse could make $3,000 per month, and the other could make $2,046. Please note, this amount may be different based on the specific income limits in each state.

The most common income limit for ABD Medicaid in 2022 for two spouses applying together generally ranges from $1,100 to $1,500.