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Are Well Spouses Legally Responsible For Medicaid Expenses of a Sick Spouse?

Researcher & Writer

February 09, 2016

The simple answer to this question is yes, "well" spouses are legally responsible for the Medicaid expenses of a sick spouse. This will include co-payments and expenses not covered by Medicaid. However, there are regulations in place to protect the well spouse’s quality of life and financial ability to live independently.

Long-term care for a sick spouse is very expensive and these costs continue to rise. The average nursing home in the United States currently costs between $5,000 - $8,000 per month, and that amount doesn’t include the cost of medications.

Previously, a "well" spouse would have to pay for their spouse's long-term care until essentially all of their savings and resources were gone. Afterward, they would be eligible for Medicaid to cover these expenses. This created a problem, though, as the well spouse still living in the community was left destitute and in need of government support simply to live.

Luckily, things have changed.

In 1989, the Spousal Impoverishment Standards were introduced to allow the well spouse still living in the community to maintain enough income and resources to continue living independently. When the ill spouse is placed in a nursing home for longer than 30 days, the date that they entered the nursing home is deemed the "Snapshot date". Snapshot date is the date used to assess assets for Medicaid eligibility as well as how much of the income and resources the well-spouse is allowed to maintain.

For example, say James has a stroke and goes to the hospital on November 30th and is transferred to a nursing home for rehabilitation. He goes back home to live with his wife the following January, but returns to the nursing home in May to stay because his level of needed care is more than his wife can handle.

At this point, the couple applies for Medicaid to cover the cost of the nursing home. In this situation, November 30th is the snapshot date. It was the original date James entered the nursing home. James and his wife will have to provide documentation of their assets on November 30th as well as their current assets to determine eligibility.

In each case, the well spouse will get to keep half of all their countable resources within a minimum of $23,844 and a maximum of $119,220. These minimum and maximum limits are adjusted each year to account for inflation. Additionally, there are certain resources not counted, and the well-spouse may have the ability to ensure certain assets are considered uncountable.

For starters, Medicaid does not consider the following assets:

The home the well spouse personally lives in
Rental properties as long as the rent being paid on the properties is at fair market value
One vehicle as long as it is used by the well spouse for health care or employment
Irrevocable prepaid funeral expenses
Retirement funds in the well spouse’s name
Household furnishings and goods

If the couple’s assets are too high to be eligible for Medicaid, they will need to do a "spend down" or convert it into a non-counted resource. For example, if James and his wife had $50,000 in the bank, his wife is allowed to keep $25,000 for herself. The remaining $25,000 needs to be spent or reallocated.

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