Although a nursing home resident is only entitled to keep a small amount of “countable assets” ($2,000.00 in Illinois; $999.99 in Missouri), a “community spouse” (one who isn’t in a nursing home) is entitled to keep additional assets. 

In Missouri, the determination of the amount of assets the community spouse will be allowed to keep is determined by a “division of assets” process.  A form is completed showing the combined value of all of the couple’s assets, whether owned together or owned individually by either spouse, as of the date the spouse in the nursing home was admitted.  The rules then allow the community spouse to keep half of those countable assets, subject to a minimum of $21,912 and a maximum of $109,560 (as of July 1, 2009).  In some cases, a community spouse can be awarded a greater share of the assets by obtaining an administrative “fair hearing” or through court proceedings. 

In Illinois, the division of assets process is unnecessary and not used.  The community spouse is automatically entitled to keep assets up to the $109,560 maximum.

In either state, the spouse in the nursing home is only entitled to keep $30 of income per month.  However, the community spouse is entitled to keep additional income.  In Missouri, the minimum is $1,821.25 and the maximum is $2,739.  Income above the minimum is awarded when monthly shelter expenses exceed $525, utility costs exceed $262, or other extraordinary expenses can be shown.  In Illinois, the community spouse is automatically allowed the $2,739 maximum. 

However, the fact that a married couple’s assets and income fall within those allowances does not guarantee a determination of eligibility.  The “transfer penalties” which can cause ineligibility for benefits based on transfers of property to children or other third parties apply to married persons as well as single ones.  Further, a transfer of property by either spouse can affect the eligibility of the one who applies for benefits. 

Just about every married couple should consider Medicaid planning when one spouse enters a nursing home or that is likely to happen.  In almost every instance, an elder law attorney skilled in Medicaid eligibility planning can develop a plan for a married couple that will enable that couple to protect more – often substantially more – than the above rules would suggest.  The attorney can also help make sure that the couple does not unknowingly take actions that will cause problems at application time. 

In many instances, the planning strategies available specifically to married couples, and other Medicaid planning techniques available to single and widowed people as well as married ones, work best if they are applied in combination.  Every couple’s situation is different.  Even changing one fact can mean that what works best in one situation will not work nearly as well in another.