NJ Medicaid raises spousal maintenance allowance; options still exist to increase the share of resources

Effective July 1, the State of New Jersey Division of Medical Assistance and health Services (DMAHS) has raised the Minimum Monthly Maintenance Allowance (MMMNA) for the spouse of a person who is on Medicaid. For residents of nursing homes, the general rule is that all of the resident’s income must be turned over to the facility as a cost-share, except for authorized deductions which include support of a spouse if the spouse’s own income is less than the Maintenance Allowance. The NJ MMMNA is now $1,991.25. The relevant regulation is N.J.A.C. 10:71-5.7, and here is the new MedCom No. 15-09, dated July 1m 2015.

15-09_2015_Community_Spousal_Maintenance_Allowance

In calculating the amount of this spousal support deduction, an excess shelter allowance is provided if shelter costs are in excess of $597.38. Also, if the spouse pays for utilities, a utility allowance of $491.00 per month is added to the base MMMNA.

Typically, these calculations are not done until after the applicant has been found to be resource-eligible (“after the spend-down”). This does not mean that all the excess assets have to be spent on the nursing home, and there are techniques available which we use regularly, that preserve substantial assets for support of the spouse.

Also, in some cases, the combined income of the spouses will not be enough to provide the spousal support amount. There is a special regulation for those cases, in which the community spouse can keep more assets than usual because the income is too low. N.J.A.C. 10:71-5.7(d) and N.J.A.C. 10:71-8.4. This is based on the federal statute at  42 USC 1396r-5(e)(2)(C). These issues have to be addressed at the earliest possible time,  before the couple embarks on a spend-down. This protection of extra assets can only be obtained by going through a hearing process at the NJ Office of Administrative Law. New Jersey is an “income-first” state, which means that before the extra resources can be set aside for or transferred to the community spouse, all income must be made available. The U.S. Supreme Court dealt with this issue in  Wisconsin Dep’t. of Health v. Blumer, 534 U.S. 473 at 484, 151 L. Ed.2d 935 at 946, 122 S. Ct. 962 at 969, 151 L. Ed.2d 935 (2002).

First, the income of the community spouse is applied toward their maintenance amount. Then, the income that the institutionalized spouse is earning or receiving (such as pension or Social Security retirement) at the time of the fair hearing is considered. If there is a pending receipt of income based on a prior award notice, that income would also be taken into account (such as where they had received notice that they would be receiving Social Security Disability income as of a certain date). If there is still a “gap,” there is a basis to ask for an increase in the community spouse resource allowance or CSRA to set aside additional resources for the community spouse.

Call us for legal advice on Medicaid eligibility and asset protection, and to prepare your medicaid applications and appeals … 732-382-6070

2015 Medicaid numbers now available

http://medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/downloads/2015-ssi-and-spousal-impoverishment-standards.pdf

Starting January 1, 2015, the Community Spouse Resource Allowance (CSRA) for the community spouse of a married Medicaid applicant is being raised to $119,220 from $117,240.00.  This is the amount of countable available resources that the community spouse can have as of the date they want eligibility for their applicant-spouse (the home and one car are still considered non-countable). Does that mean that every excess dollar has to be “spent down” on nursing home care? Hardly. If you have moved your loved one to a nursing home and are being steered to someone such as a Medicaid application preparer who tells you that this is what’s necessary before an application can be filed, you should seriously consider getting personalized legal advice about your options.

The $19,220 is the CSRA maximum The “floor” under the CSRA is $23,844, so if the assets are quite limited, the community spouse does not have to “spend down” below this amount.

The Income Cap Limit which triggers the need to establish a Qualified Income trust (QIT) in New Jersey for the Medicaid applicant (see my prior posts) will be $2,199 gross monthly income.

The community spouse is entitled to have a Minimum Monthly Maintenance Needs Allowance for income support. This amount was raised on 7-1-2014 and remains in effect. The minimum is $1,966.25  and the maximum is $2,980.50. Several variables play into this calculation. Then the community spouse’s available income is applied first, and if there is a shortfall, a deduction is made from the applicant-spouse’s income to allocate some income to the community spouse. There are special rules in cases where the combined incomes are below the MMMNA. Seek legal advice at the earliest possible date before the assets are spent down, to protect your interests

Call for an appointment about Medicaid eligibility and applications … 732-382-6070

Medicaid rules enable some spouses to keep extra assets

Did you know that there is a way for low-income community spouses of Medicaid applicants to hold onto extra assets? We have had the opportunity in an array of cases over the years to obtain greater protection for such spouses. Ordinarily, the combined available marital assets must be “spent down” to a certain level before an application for Medicaid can be filed to pay for the nursing home care. N.J.A.C. 10:71-4.8. The community spouse’s share is the CSRA. Also, the community spouse is entitled to a minimal basic level of income, called MMMNA. N.J.A.C. 10:71-5.7. If her income is less than that, some of her spouse’s income will be deducted and allocated to her each month. If the combined incomes are insufficient for this, extra assets can be reserved through a Hearing at the Office of Administrative Law.

One of my cases was N.F. vs. Monmouth County Board of Social Services,

OAL docket no:HMA-12006-09, DMAHS Final Agency Decision dated May 11, 2010. The Community spouse resource allowance was increased by $69,411.50 per N.J.A.C. 10:71-4.8(a)(5) and 5.7(d), because the combined income of the spouses was insufficient to provide the community spouse  with the Minimum Monthly Maintenance Allowance.

Attorney: Linda S. Ershow-Levenberg, Esq.