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Navigating MassHealth as a "Community Spouse"

Q: Although I continue to live in our home, my wife now lives at a nursing facility nearby.  While I’m delighted that I’ll still be able to see her every day, I’m also really worried about the cost—and I’m worried that she’s worried, too. The last thing I want is for my wife’s health to deteriorate because she’s stressed out over my financial health.   Anything to bring us both piece of mind?

Answer: First, let’s take a moment to focus on the good: your wife is receiving the high-quality care that she needs, and you’re able to visit her every day.  What a relief this must be!

Of course, when you and  your wife decided it was the best course for her to move into a nursing facility, I’m sure you faced a great deal of anxiety over the decision – both emotional and financial. If your wife has MassHealth coverage, however, some of the financial burden has been relieved: MassHealth covers long-term care, and protects your assets as well.  So the short answer is, you and your wife can both stop worrying about going bankrupt from the cost of her long-term care.  MassHealth offers some protection for your financial well-being.

Income: It is important to note that your income, as the spouse remaining in the community (MassHealth refers to you as “the community spouse”), is not counted when determining MassHealth eligibility for your wife in the nursing facility.  Only the income in your wife’s name is counted.  Even if you are working and earning, say, $4,000 a month, your income does not count toward cost of caring for your wife in a nursing facility if she is covered by MassHealth. As the community spouse, you can keep most of your own income, no matter how much that totals. 

MassHealth will determine a “minimum monthly maintenance needs allowance” level for you that takes into account your housing costs and reflects the minimum you need to live independently in the community.  That “monthly maintenance” ranges up to a maximum of $2,931.  If your monthly income alone is not enough to meet the “minimum monthly maintenance needs allowance” MassHealth set for you, you are eligible to divert some income from your wife in the nursing facility to meet that minimum.  If your housing costs are particularly high, you may be able to divert an additional percentage of your wife’s income.

MassHealth also determines a “Patient Paid Amount” for your wife.  This is the amount/percentage of your wife’s income must go to pay for her care in the nursing home. 

Assets: For MassHealth to cover your wife’s nursing facility care, your wife must have assets that amount to less than $2,000. While that may sound low to some people, remember that property such as your house, your car, or prepaid burial are exempt from that $2,000 – so most likely, we’re talking about cash and savings, unless you own real estate in addition to your home. Because you are “the community spouse,” you are allowed to hold half of your marriage’s communal assets—up to $117,240, not including your house, your car, or prepaid burial.  (But note that, if, for example, you sell your shared home, MassHealth does have the authority to recover money they’ve spent on your wife’s care from that sale’s assets; this is known as “estate recovery.”  If you have a lot of assets to protect, you may want to consult a certified Elder Law Attorney first. )

This is most certainly a stressful time for you and your family, and the MassHealth guidelines can be complicated.  If your loved one needs to go into a nursing facility, please contact our SHINE program by calling 781-388-4845 to speak with a counselor.  The SHINE counselors will work with you for free to navigate the requirements of Medicare, and screen you to see if you may qualify for MassHealth.

And don’t forget that MassHealth covers home-based care for people who would rather live at home. Our experts can answer your questions about home-care, personal care, and other care planning issues, as well. Please call Mystic Valley Elder Services’s main office at 781-3324-7705 to get started.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

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