As longevity increases and the effects of diseases like dementia spread, the need for nursing home care will continue to rise.  Nursing home Medicaid is a program funded by the Federal government and administered by the Department of Community  Health that covers nursing home costs for those who  have a medical need for such services.  Along with having a medical need for such services, applicants for nursing home Medicaid must satisfy income and asset requirements.
When one spouse needs nursing home care and the other spouse does not, there are methods of getting the one spouse onto Medicaid that can be used if the couple has assets over the limit allowed for receipt of nursing home Medicaid.  For 2017. a couple where one of the spouses needs a nursing home can have up to $121,220 in countable assets in their name and qualify to receive Medicaid. For a list of what assets count fork Medicaid, see other blog posts.  If the couple  has assets higher than this limit, planning techniques are available to restructure the assets of the couple to qualify the spouse needing nursing home care for Medicaid.  The strategies involve temporarily reducing the assets of the couple, getting the spouse on Medicaid, and then giving the assets back once the spouse is on Medicaid.  As there strategies are extremely complex, it is advisable to seek the guidance of an experienced elder law attorney when completing such planning.
After the one spouse is on Medicaid, planning then shifts to looking at planning options for the spouse who does not currently need nursing home care.  If the spouse is reasonably healthy and can be expected to go for five years or more before needing Medicaid, we will consider doing trust planning  to qualify such spouse for nursing home Medicaid.  If there is a strong likelihood that the spouse will need nursing home Medicaid within the next five years, then other spend down techniques are considered to get both of the spouses on Medicaid.  Additional Medicaid spend down is needed as when the second spouse goes onto Medicaid, the combined resources of the couple can only be $3,000.  As Medicaid law can be very complex, it is advisable that anyone considering Medicaid planning seek the advice of an experienced elder law attorney.