Florida has made another change to its Medicaid rules for nursing home benefits. The rule change applies to married couples when one spouse is in a nursing home and receiving Medicaid benefits. The spouse who is not in a nursing home is called the “community” spouse (or well spouse).
First, understand that Florida does not condition an applicant’s Medicaid eligibility on the community spouse’s income. There is no cap on the community spouse’s income, nor is the community spouse legally obliged to pay the nursing home bills of his/her spouse.
However, Florida sets a minimum standard for the amount of monthly income a community spouse needs to avoid impoverishment. This figure is called the Minimum Monthly Maintenance Needs Allowance. If the comunity spouse’s income falls short of the MMMNA, Medicaid allows a portion of the nursing home resident’s income that would otherwise go to the nursing home, to be diverted to the community spouse. The amount that may be diverted is the amount needed to elevate the community spouse’s income level to the MMMNA. Effective July 1, 2023, the MMNA has increased to $2,465 (up from $2,288.75). The MMMNA is based on federal poverty guidelines and is adjusted for inflation.
There are certain special circumstances – for example, high housing or utility expenses – when income may be diverted to bring the community spouse’s income as high as $3,715.50 (up from last year’s number of $3,435). This amount can be even higher if there is a court order of support for the spouse.
A practical example of MMMNA: Mr. Smith is married and resides in a nursing home. He is receiving Florida Medicaid benefits. His monthly income is $6,000. From that $6,000, he can pay his Medicare fees and other health insurance, and also take $160 per month for his Personal Needs Allowance. Mrs. Smith, the community spouse, has a gross monthly income of $2,000, which falls $465 below the MMMNA. Therefore, $465 of Mr. Smith’s may be diverted to Mrs. Smith each month. The remainder of Mr. Smith’s income will go to the nursing home.
There are many, many more rules for Medicaid eligibility in Florida that apply to applicant and spouse, and the rules are always in a state of flux. If it looks like your loved one does not qualify for benefits, do not count him/her out! There are several legal strategies that may allow your loved one to access benefits and to preserve a good portion of assets before you “spend down” and lose everything. Steps can often be taken even if your loved one is already in a nursing home – in fact, this kind of crisis planning is the norm for the majority of clients we assist. To schedule a consultation with The Karp Law Firm, call (561) 625-1100.
Learn more about Medicaid benefits for long-term nursing care.
