What would happen if your spouse or mom or dad went into a nursing home? How would you/they pay for it? The average cost for a semi-private room in a nursing home in Tennessee year is about $71,000 annually.
Let’s imagine that dad had a stroke or is disabled by dementia. Your mom is still alive and will need money to live on after your dad dies. Does she have to spend all her assets to qualify dad for Medicaid “TennCare”?
There is important information that we all need to know. It is not necessary for mom (under the law called the “Community Spouse”) to be completely impoverished in order for dad (the “Institutionalized Spouse”) to qualify for TennCare.
Here’s the history: Medicaid (called TennCare here in Tennessee) was passed by Congress in 1965 and designed to provide medical care for elderly, blind and disabled poor. Eligibility is sensitive to both assets and income.
Before 1988, all of a couple’s assets were required to be “spent down” so that the ill spouse could qualify for nursing home care. The couple’s only alternatives were utter impoverishment or divorce. There were articles in the newspapers about elderly women eating dogfood so that their husbands could get nursing home care.
In 1988, Congress passed provisions now known as the Spousal Anti-Impoverishment Act. If correctly applied, this law allows the Community Spouse to keep half of the assets with a minimum amount of $23,844 and a maximum of $119,220 (in 2015).
The Institutionalized Spouse must spend his half so that he only owns $2,000. But there are “Medicaid friendly” ways to spend down.
There are also legal ways to assist an unmarried senior to quality for TennCare.
TennCare is convoluted and ever changing. To take advantage of the laws and regulations, it is best to consult a lawyer who works with TennCare on a regular basis.
The bottom line is this: when someone who is not already impoverished goes into a nursing home it’s time to see a lawyer. Especially when that person has a living husband or wife, assets can be set aside to help the Community Spouse afford living expenses to pay for his or her own care in the future.