NJ Medicaid guidelines – When there is a community spouse

By Neil Stern
I am often asked many questions about New Jersey adult Medicaid. People want to know about Medicaid guidelines. They stress over whether or not their loved ones will be eligible.

Some of the common questions I’m asked relates to scenarios where there is a community spouse. This means that one spouse has been institutionalized for care while the other spouse stays home in the community. Some of the common questions include the following:

When applying for Medicaid for my spouse, can I keep my house?
I’ve been told that all our money needs to be spent on his care before we become eligible for New Jersey Medicaid. Is this true?
How much of my savings can I keep for my self and still have my spouse approved for Medicaid benefits?
May I keep my spouse’s social security check and pension?
Is my money and my spouse’s money considered one pool for Medicaid purposes? Or can they be separated?
To answer some of these common questions, let me tell you a story about a sweet elderly couple I recently helped. I will call them Sue and Ed.

Sue and Ed married in the late nineteen fifties. They settled down in NJ and have owned their home in Monmouth County for the last half century.

They both earn money every month through their social security and pension benefits. Although Sue’s income is a very small amount, they have always managed financially since Ed’s social security and two pensions total over $3,700 monthly.

Recently, Ed’s health has been declining. In fact, things got so bad that there was no way for Sue to continue caring for him at home. In May 2011, Ed fell for the third time and broke his collar bone. Ed was hospitalized and then transferred to a local nursing facility in Monmouth County New Jersey.

Although the couple had over $70,000 in savings, they both realized that Ed was going to be in the facility for a while. They were worried that the cost of living in a facility would quickly deplete their savings. Thankfully, they were wrong.

The $70,000 they had in savings was accruing a low interest rate in two separate savings accounts. One account was in Ed’s name while the other was in Sues. They also had a modest checking account that was used for their living expenses. There were no life insurance policies, CD’s or annuity’s.

After spending the day with her husband, Sue reached out to the business office at the nursing home. They told her that she would need to “spend down” and then apply for NJ Medicaid benefits. They also referred her to Senior Planning Services for Medicaid guidance and advice. They explained to her that Senior planning Services can help her obtain Medicaid eligibility if she qualified. Naturally, sue was overwhelmed and scared.

I got the call from Sue in November. Sue was frantic. By that time, her husbands care had already drained their savings to $40,000 and Ed still needed to be cared for in the nursing home. In fact, it was unlikely that he would be able to leave.

She knew she was not going to lose her home, but she was very concerned with the prospect of losing her savings. Another concern was about her husband’s income. She had been told by a neighbor that upon Medicaid eligibility all her husband’s income would be paid to the nursing facility! In essence, she worried how she would live without her husband’s income. After all, it had been his pensions and social security benefits that had always covered the bills.

I began to calm her down by explaining that she would not be left destitute! We spent forty five minutes discussing Medicaid guidelines and how it would impact her and her husband. I explained that although her account and her husbands account are considered one for Medicaid purposes, she could still keep approximately $35,000. In fact, it was more then likely that Ed was eligible for Medicaid benefits as early as the following month. This information was vital to Sue, and it saved her from needlessly draining her entire savings.

I explained to her that as a community spouse, she would be able to keep half of the money based on the “snap shot” date. The snap shot date analysis would be based on their complete financial situation on the first day Ed had been institutionalized. I also confirmed that she was correct and that she would continue to live in her home.

As I mentioned, she was very frightened that she would be losing Ed’s income. I reassured her that there are times when a community spouse may keep some or all of the other spouse’s income.

Based on variables such as Sues shelter expenses and her own monthly income, I determined that a large part of Ed’s income would go to her. Imagine Sue’s relief when I outlined how I would ensure that she did not lose even one penny that she was entitled to.

Sue was comforted with the knowledge that I would manage the entire Medicaid application for her.

More importantly, I did obtain the maximum dollar amount that she was entitled to. We got the approval, and now sue no longer worries about Medicaid or spend downs. She spends her time with Ed and that’s how it aught to be.

Clearly, had she not called me, there would be many problems for Sue to deal with. Aside for all the money she would have lost and never recovered, she would be responsible for the gathering of all required Medicaid documents. Suffice it to say, that the outcome would be different.
Boy, am I sure glad she called

At Senior planning Services, Our experienced case workers guide families and educate seniors about the Medicaid application process. My advice- take advantage of the rules that favor you. Be sure that you get every cent that you are entitled to. Why? Because it’s yours. You earned it and you need it. In fact, perhaps now more then ever.

For your free Medicaid consultation call Senior Planning Services toll free at 855.S.PLANNING (855. 775.2664) or email us at Consultations@senior-planning.com