Florida Elder Law & Estate Planning Blog

Florida Medicaid Rules For The Well Spouse’s Income

Medicaid Spousal Allowance

Florida rules for long-term nursing care are complicated and are actually a combination of both state and federal regulations. Among the rules of great importance for married couples is the Minimum Monthly Maintenance Needs Allowance, or MMMNA.

What is the Minimum Monthly Maintenance Needs Allowance?

In Medicaid jargon, the well spouse who is living at home and is not in institutionalized care, is the “community spouse.”  The community spouse’s income has no bearing on the applicant spouse’s eligibility for Medicaid benefits. The community spouse gets to keep all of his/her personal income, no matter how much.

But what happens when the community spouse has little or no income of his/her own? In that case, the MMMNA is a very relevant issue. The MMMNA is the monthly income Florida considers to be the minimum amount the community spouse needs to live at home without undue hardship. Put another way, it is the lowest monthly income that will avoid “spousal impoverishment.”

If the community spouse’s income falls below the MMMNA (currently $2,155 per month effective July 1, 2020), Medicaid will permit a portion of the applicant’s income to be diverted to the community spouse, thus bringing his/her income up to that level.

An example of how the Minimum Monthly Maintenance Needs Allowance works

Let’s say Medicaid applicant John is currently in a long-term care nursing home. He has been paying the nursing home out of his own funds. He is now running out of money, so so he applies for Florida Medicaid benefits.

John’s gross monthly income is $1,500 in Social Security benefits and $1,000 in a pension, for a total of $3,500. His wife, Betty, has only one source of personal income: Social Security, at $800 gross per month. Her income thus is $1,355 below the Minimum Monthly Maintenance Needs Allowance ($2,155 – $800 = $1,355).

Assuming John is qualified in all other ways to receive Medicaid benefits for his nursing home care, Medicaid will allow some of his income to be diverted to Betty to bring her income up to the MMMNA level. Thus, $1,355 of John’s monthly income will go to Betty, raising her monthly income to the MMMNA.

Under certain circumstances, based upon either the cost of maintaining her home or a court order of support for the community spouse (not alimony), Mary may be entitled to an even greater amount of John’s income.

John’s remaining income must go to the nursing home, except for $130, which he may keep for personal expenses. He may also continue to pay for his supplemental medical insurance.

Why more and more families are seeking Medicaid benefits for long-term nursing home care

As our population ages, more and more of us are experiencing chronic illnesses, for example, Alzheimer’s Disease. That means increasing numbers of families are faced with the dilemma of paying for long-term care. Long-term care is not intended to make a person “better” or “well.” It is designed to provide help with a person’s daily life needs, such as bathing, toileting, eating, etc. That is why long-term care is often referred to as “custodial care.”

Although Medicare will pay for acute nursing home care following a hospital stay, it will NOT pay for custodial care.  Frequently families realize this only when they are in crisis mode and a family member is in, or about to go in to long-term care nursing home. Needless to say, it is a shocking discovery, given the costs involved. Long-term care can wipe out a middle-class family’s savings in no time. According the the 2019 Genworth Cost of Care study, the median cost of a private room in a Florida long-term nursing facility is $112,639. A semi-private room doesn’t provide much financial relief: the median cost is $102,565 annually. It’s little wonder that middle class families are turning to Medicaid to try to preserve some of their hard-earned assets.

You don’t have to always go broke to get Medicaid benefits

As pervasive as the myth that Medicare pays for custodial nursing care, is the myth that you have to go broke to qualify for Medicaid. The Karp Law Firm has helped thousands of families qualify for Medicaid benefits while saving significant assets. Be sure to consult with The Karp Law Firm or another highly experienced elder law attorney for advice in this highly complicated and highly technical area of law. All steps we recommend are above-board. Don’t go it alone, as mistakes can result in an extended period of ineligibility and denial of benefits. Also, any misrepresentation on a Medicaid application can result in criminal charges!

You should also be aware that it is illegal for a non-attorney to assist with Medicaid planning, per the Florida Supreme Court ruling 2015. Medicaid planning requires a high level of legal knowledge in this area of law, and involves drafting sophisticated legal documents.  A non-attorney who claims to offer these services is engaging in the unlicensed practice of law, a third degree felony. Seeking help from such an individual can be a costly mistake, and may be illegal as well.

Besides the MMMNA, there are many more criteria for qualifying for Medicaid benefits for long-term nursing care. To see an overview, click here.