Reference If people are married, and only one spouse needs nursing home care, the spouse who stays at home is called the "community spouse". When this happens, the spouse entering the nursing home can have up to $2,000 in countable assets. And, the "community spouse" gets some resources that are protected. To figure out how much in assets the community spouse can keep, figure out the value of one-half of the couple's property not counting their homestead, household goods, personal goods, one car, and burial funds. The community spouse may keep one-half of all the other property of the couple, but not less than $23,184 nor more than $115,920. The community spouse can also have $2,898 a month to live on. This is called the spousal allowance or monthly minimum needs allowance. If the community spouse’s income is more than $2,898 a month, there is no need for the spousal allowance. If there is a dependent, the dependent allowance is $1,892 per month. This means the dependent of the person in the nursing home can have $1,892 per month to live on. If the dependent’s income is more than $1,892 a month, there is no need for dependent allowance. The protected resources amount can be increased when the income of the community spouse is lower than the minimum monthly maintenance needs allowance. When this happens, the spouse in the nursing home can give income to the spouse in the community. But to do this you have to have a fair hearing. A fair hearing takes place after the applicant has applied for nursing home Medicaid and has been denied. The applicant must request a fair hearing asking that the protected resource amount be increased for the community spouse. An applicant should contact a Benefits Counselor with the local Area Agency on Aging or a lawyer to help with a fair hearing. The request for a fair hearing must be made within 90 days after the Health and Human Services Commission denies a person’s application for Medicaid. What is “applied income”? After aperson is eligible for nursing home Medicaid, “applied income” is calculated byan HHSC worker. “Applied income” is thepart of a person’s income that has to be paid to the nursing home. “Applied income” is calculated for anunmarried individual as follows: find the net earned and gross unearned income,deduct a “personal needs” allowance of $60, and deduct medical expenses such asMedicare premiums
and health insurance
. Whatis left is the “applied income” that is paid to the nursing home. Incurredmedical expenses are expenses the nursing home resident has to pay for Medicareand other health insurance premiums, deductibles and coinsurance, and medicalcare and services recognized by state law but not covered by Medicaid. Th efollowing is an example of applied income calculations. The nursing home resident has income of $1,600 and has incurred medical expenses of $200 permonth. Community Spouse (CS) has income of $1,800 per month. $1600 (nursing home resident’s income) - $ 60(personal needs allowance)+ $1,800 (community spouse’s income) $3,340 Total income Subtract $2,898 for spousal monthly maintenance needs allowance. $3,340 -$2,898 $ 442 Then, subtract $200 forincurred medical expenses. $442 -$200 $242 The nursing home is paid $242.The remainder of the applicant’s income, goes to the community spouse.