Community Medicaid for Two

When both spouses need long term care, they can apply together for Community Medicaid provided that they qualify as a “dual applicant.” As a couple applying for Community Medicaid, the spouses cannot have more than $40,821.00 in total countable resources. This typically includes bank accounts, brokerage accounts, non-qualified annuities, stocks, bonds and cash value of life insurance policies. The primary residence is exempt and the applicants may have qualified (retirement) accounts in any amount assuming distributions are being taken on a monthly basis. Finally, an irrevocable pre-arranged burial account in any amount is an exempt asset for each applicant.

For Community Medicaid the general rule for income is that dual applicant spouses may retain a monthly income of $2,268.00, plus a disregard of $20, bringing the total to $2,288.00. However, under this program any excess income can be directed to a Pooled Income Trust for the benefit of the Medicaid applicants and the monies deposited into that trust can be used to pay the household expenses. You cannot open a “joint” Pooled Income Trust, so either you open a trust for one spouse OR two trusts – one in each spouses’ name. As long as the correct overage is being deposited into a Pooled Income Trust, the excess income will be disregarded. For example, if one spouse has income of $2,000.00 and the other spouse has income of $1,500.00, as a couple the total income is $3,500.00, resulting in an overage of $2,804.00. The overage can be deposited into one Pooled Income Trust or divided into two separate Trusts. Depending on the specific circumstances and the amount of overage, it is usually decided on a case by case basis on which option is better for the dual applicants.

Once the couple becomes eligible for Community Medicaid and the applicants are approved, an evaluation is scheduled with a Managed Long Term Care Company (MLTC). The MLTC will determine how many hours per day, days per week, the couple is eligible to have a home health aide comes to the house. Each applicant is evaluated and usually the hours are combined to determine how often the aide will go to the house. It is important to understand that Medicaid will typically only authorize one aide per household. This means that the couple will not each get an aide but rather the one aide will care for both of them. Since the hours are being combined, usually couples have a better chance to qualify for more hours than an individual, but that is not guaranteed.

It is important to note that the Community Medicaid regulations have changed significantly in 2020 and it is important to consult an Elder Attorney in your area to discuss your specific needs and financial situation.