2019 medicaid changes

The Centers for Medicare & Medicaid Services (CMS) has released the 2019 federal guidelines for how much money the spouses of individuals institutionalized in a nursing home and applying for Medicaid may keep, as well as related Medicaid figures.

Income and Asset Limit for Applicant:

In 2019, if the institutionalized spouse’s gross income is less than $2,313 a month, the applicant is permitted to keep up to $8,000 in assets. If the institutionalized spouse’s gross income is $2,313 or more, their countable assets must be below $2,400 to be eligible for Medicaid.

Community Spouse Resource Allowance:

In addition to the assets the institutionalized spouse is allowed to keep, as discussed above, the spouse of a Medicaid recipient (called the “community spouse”) is allowed to retain one-half of the countable assets as of the date of admission to the skilled nursing facility, up to a maximum amount set by the federal guidelines.  In 2019, the community spouse may keep as much as $126,420 in countable assets without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. This amount that the community spouse is permitted to keep is called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2019 will be $25,284. Pennsylvania allows the maximum amount as set by CMS.

Monthly Maintenance Needs Allowance:

Under Pennsylvania law, the community spouse is entitled to retain all of his or her own income, regardless of how much it is.  In addition, if the community spouse’s income is less than the amount set by the state as the minimum amount needed to live on (called the Minimum Monthly Maintenance Needs Allowance, or MMMNA), then some of the applicant spouse’s income can be allocated to the community spouse to make up the difference.  The maximum monthly maintenance needs allowance (MMMNA) for 2019 will be $3,160.50. The minimum monthly maintenance needs allowance remains $2,057.50  until July 1, 2019. In addition, the community spouse can receive more than the MMMNA by way of court order, where expenses justify it.

Home Equity Limits:

In 2019, a Medicaid applicant’s principal residence will not be counted in Pennsylvania as an asset by Medicaid unless the applicant’s equity interest in the home is more than $585,000.

The substantial home equity rule does not apply where the Medicaid recipient has a community spouse. Additionally, it does not apply where the nursing home resident has a child under age 21, a blind child, or permanently and totally disabled child is lawfully residing in the individual’s home.

The new spousal impoverishment numbers (except for the minimum monthly maintenance needs allowance) take effect on January 1, 2019.

For a more complete explanation of Medicaid eligibility, the rules regarding countable assets, the community spouse resource allowance, and the monthly maintenance needs allowance, please contact OWM Law and ask to speak with an Elder Law Attorney at  610-323-2800.

For a complete list of the 2019 CMS SSI and Spousal Impoverishment Standards please click here.

Written by Rebecca A. Hobbs, Esquire, CELA

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