1. Spousal Impoverishment Protections in Managed Long Term Care Evelyn Frank Legal Resources Program David Silva and Valerie Bogart June 2014 ELFRP@nylag.orgELFRP@nylag.org 212-613-7310

2. Spousal Impoverishment Budgeting Spousal impoverishment budgeting, previously only for nursing home and waiver programs, is now available to married couples where one spouse is in MLTC. If applicant has a community spouse, he/she may shelter up to $2,931/mo. of joint income (and up to $74,820 of assets). It works almost the same as for nursing home, but with some minor variations. 2 N.Y. Dep’t of Health, G ENERAL I NFORMATION S YSTEM M ESSAGE : S POUSAL I MPOVERISHMENT AND T RANSFER OF A SSETS R ULES FOR C ERTAIN I NDIVIDUALS E NROLLED IN M ANAGED L ONG T ERM C ARE, GIS 13 MA/018 (September 24, 2013). Posted at http://www.health.ny.gov/health_care/medicaid/publications/gis/13ma018.htm http://www.health.ny.gov/health_care/medicaid/publications/gis/13ma018.htm

3. Example Sam needs MLTC. His income is $2,080 gross. His wife, Mary, has Social Security of $1500. Sam pays for Part B ($105/mo.) and a Medigap premium ($161/mo.) BEFORE – Mary would have done a spousal refusal so her income would not be counted. She risked being sued for support. Sam needed to use a pooled trust to deposit his spend-down of $985/mo. $2,080 -266 (Part B + Medigap deductions) -829 (Medicaid income level for 1 + $20 disregard) $ 985 Spend-down – put into pooled trust 3

4. Example budget with spousal impoverishment Applicant’s Gross monthly income (Sam) $2,080 Personal Needs Allowance (amount he keeps for himself) - 383 Community Spouse Monthly Income Allowance (CSMIA) MMMNA = ($2,931) minus Mary’s Income ($1,500) =- 1,431 Health insurance premiums (Medicare Part B) - 105 (Medigap) - 161 Excess income – No Spousal Refusal $0 4 N.Y. Dep’t of Health, Medicaid Update Vol. 30, No. 3 at 5-9 (March 2014); N.Y. Dep’t of Health, G ENERAL I NFORMATION S YSTEM M ESSAGE : S POUSAL I MPOVERISHMENT B UDGETING WITH P OST -E LIGIBILITY R ULES FOR I NDIVIDUALS P ARTICIPATING IN A H OME AND C OMMUNITY -B ASED W AIVER P ROGRAM, GIS 12 MA/013 (April 16, 2012); N.Y. Dep’t of Health, M EDICAID R EFERENCE G UIDE : I NCOME at 278-282 (June 2010).

5. Example -- con’d In the preceding example, Mary had $1500 of her own income. If the “community spouse,” Mary, had no income of her own, Sam could have $1500 more income, which would in turn be allocated to Mary as her MMMNA (Minimum Monthly Maintenance Needs Allowance). This means his income could be $3,580/month and he’d have: No spend-down, and No spousal refusal necessary. Figures change depending on amount of his Medigap, if any, and amount of her income 5

6. Spousal Impoverishment - Choices Married applicants have a choice of budgeting: 1.Spousal Impoverishment budgeting –Use if Applicant’s income > $829. If combined net income < $3312, then no spend-down and no spousal refusal. Can’t use pooled trust. –ASSETS – may use Spousal Impoverishment limits 2.OR Budget applicant under old method as if s/he were Single, and ignore spouse’s income. –Use if Applicant’s income < $829 –If non-applying spouse’s income > MMMNA ($2,931/mo.), this choice is better, because spouse’s income is ignored. S/he will not have to do a spousal refusal. Can still use pooled trust if applicant’s income is high. –ASSETS – Must use regular community asset limits 6

7. For More Info See NYLAG article - http://www.wnylc.com/health/entry/165/ - has links to state directives:http://www.wnylc.com/health/entry/165/ MARCH 28, 2014 - in NYS DOH Medicaid Update March 2014, Vol. 30 No. 3 at pp. 5-8. http://www.health.ny.gov/health_care/medicaid/program/u pdate/2014/mar14_mu.pdf http://www.health.ny.gov/health_care/medicaid/program/u pdate/2014/mar14_mu.pdf NYS DOH GIS 13 MA/018 Spousal Impoverishment and Transfer of Assets Rules for Certain Individuals Enrolled in Managed Long Term Care. Posted at http://www.health.ny.gov/health_care/medicaid/publication s/pub2013gis.htm http://www.health.ny.gov/health_care/medicaid/publication s/pub2013gis.htm 7