Financial Requirements for Nursing Home - Medicaid for Nursing Residents: Countable Resources

If an asset or resource is not exempt, it is a countable resource for purposes of determining Medicaid edibility for nursing home residents and include: cash, bank accounts, stocks, bonds, lump-sum payments, tax refunds, joint accounts where the applicant has unrestricted access, funds in 529 Education Savings Plans until distributed, and the value of non-exempt transferable life estates.  The entrance fee paid to a Continuing Care Retirement Community which provides multiple levels of care from independent living to nursing home care may or may not be a resource depending on the terms of the contract.

     The institutionalized spouse is the spouse enrolled or residing in a Medicaid waiver program such as PASSPORT, a nursing home, an assisted living, or other medical facility for at least 30 consecutive days.  The community spouse is the spouse living in the community even if he is receiving PASSPORT or assisted living services as long as the institutionalized spouse is in a nursing home or medical facility.  However, if both spouses are receiving PASSPORT or assisted living services, neither of them will be considered a community spouse for determining resources.

     In determining Medicaid eligibility, it does not matter in whose name resources are titled including assets subject to a prenuptial contract.  Though the institutionalized spouse can only keep $1,500 in assets, the community spouse can keep more.  Assets retained by the community spouse are termed the Community Spouse Resource Allowance. (CSRA)

     When a married couple applies for Medicaid, the department will conduct a resource assessment to determine the couple’s total countable resources, the amount of assets the community spouse can protect, and how much must be spent down to qualify for Medicaid.  This is the snapshot date.  It is the date the individual enters the hospital or nursing home and is expected to stay for a 30 day consecutive period.  If the nursing home resident leaves for less than 30 days but returns so he is institutionalized for at least a total of 30 days the qualifying period is reached.  The resources on the snapshot date will govern resource attachment regardless whether the couple requests a resource assessment or applies for Medicaid at another time.  Furthermore, the reason for the hospitalization does not matter.  Even if there is a subsequent institutionalization for a different reason- the key is the first institutionalization for 30 consecutive days (i.e. a period not interrupted by 30 days and which totals 30 days).

     Any assets transferred before the snapshot date will not be considered resources but will be reviewed under the improper transfer rules.  Assets transferred after the snapshot date will be considered resources subject to the improper transfer rules.

     The Community Spouse Resource Allowance (CSRA) is calculated by dividing in half  the couple’s total countable resources as of the snapshot date.  The CSRA is the greater of half of the assets or $113,640 (2012).  The balance is considered to belong to the institutionalized spouse.  If the institutionalized spouses portion exceeds $1,500, he will be denied Medicaid until the couple spend down their countable resources to an amount equal to the CSRA plus $1,500 belonging to the institutionalized spouse.

     Once the institutionalized spouse is eligible for Medicaid, jointly titled assets or assets in the name of the institutionalized spouse must be transferred into community spouse’s name.