Q. My husband may need to go into a nursing home soon and I am looking into a Medi-Cal subsidy to help with the cost. In your recent post you wrote that Medi-Cal permits the well spouse to retain up to $115,920 in savings as a kind of safety net, and even more with planning. Is there anything comparable concerning income, as I will still have ongoing household expenses?
A. Yes. The Medi-Cal rules have been written to ensure that — in addition to a savings nest egg — you can also retain sufficient income to meet your own living expenses. The goal is to ensure that you are not impoverished by the cost of your husband=s care.
The rules do this by permitting an allocation of income from the nursing home spouse to the well spouse in an amount sufficient to meet the well spouse’s basic living expenses. Medi-Cal determines this basic amount on an annual basis and refers to it as the Minimum Monthly Maintenance Needs Allowance (MMMNA). In year 2016, the MMMNA has been set at $2,980.50 per month. Thus, if your own income falls below the MMMNA, the shortfall would be made up from your husband’s income before his co-pay is calculated.
An example illustrates how this works: Let’s suppose the husband is in a nursing home and has income of $2,500 per month, and the wife is living at home with income of $1,200 per month. The wife’s monthly income is less than the MMMNA by $1,780.50 ($2,980.50 — $1,200). She is therefore entitled to an income allocation of $1,780.50 from her husband to bring her up to the MMMNA. This allocation to wife thereby reduces the husband’s income to $719.50 ($2,500 — $1,780.50). Result: after the spousal allocation the wife has monthly income of $2,980.50 and the husband has income of $719.50.
Husband’s co-pay to the nursing home is based upon his now reduced income of $719.50 (less some further adjustments to cover the cost of his health insurance premiums and a modest Personal Needs Allowance of $35 per month), and his Medi-Cal subsidy pays the balance of his cost of care.
There is further good news: (1) if the wife needed a further allocation of her husband’s income to meet her own basic living expenses, she might petition a judge to increase the spousal allocation above the MMMNA, possibly up to the full amount of her husband’s remaining income; and (2) if wife’s own income were already greater than the MMMNA, she would automatically be entitled to retain all of it without the need to make any contribution toward her husband’s cost of care. By way of example, if wife were still working and earning, say, $4,000 per month, she could retain the entire $4,000 per month, and her own income would not be considered in determining her husband’s eligibility for Medi-Cal. However, in that situation she would not also be entitled to a spousal allocation from her husband, because her own income would already be greater than the MMMNA.
Remember: eligibility for a Medi-Cal nursing home subsidy depends upon a couple’s savings and other non-exempt assets being within the Medi-Cal resource ceilings, as described in another post. This asset test must first be satisfied and Medi-Cal eligibility established before the income rules described in this article come into play.