Medical assistant planning for couples


Handling the issues that surround a loved one who needs skilled nursing care can be very confusing, overwhelming, and expensive. There can be so many issues that it may be difficult to know where to begin and how to get help.

First, the care needs must be addressed to make sure that your loved one has been discharged to a nursing home that will be able to accommodate all of his or her needs.

Second, the needs of the spouse at home (“Community Spouse”) need to be reviewed to make sure that he or she is financially able to remain in the family home.

Even at this point of crisis, there are plans which can be put in place to ensure that the Community Spouse can retain some of the nursing home spouse’s (“Institutionalized Spouse’s”) income to pay his or her own bills at home, despite the fact that the Medicaid rules state that the Institutionalized Spouse’s income must be used to pay for his or her care. The Institutionalized Spouse’s share of their finances must be spent down to a certain level in order to qualify for Medicaid. There are a number of items that are allowable expenses besides the cost of nursing care: prepaid funerals, house repairs, and a new car for the Community Spouse, to name a few. In addition, any money remaining over the limit could be redirected to increase the Community Spouse’s income.

Gifting is also a common problem in qualifying for Medicaid. The state has created a penalty for gifting that will result in a period of ineligibility for Medicaid. The period of ineligibility will depend on the amount of the gift given. Be aware that there are different rules regarding gifts for the IRS and Medicaid. Gifting will be discussed in more detail in my next article.

* Jessica F. Greene, CELA,* LL.M. in Elder Law is certified as an Elder Law Attorney by the National Elder Law Foundation. Keystone Elder Law P.C. integrates the legal, financial, and care management issues of seniors and their families to allow for a comprehensive and holistic approach to meeting their varied and ever-changing needs. We serve as guides and advocates through the maze of legal, financial, and health care regulations pertaining to each family’s unique situation. Services include Medicaid and long-term care planning, wills, trusts, powers of attorney, and estate administration.