Important Facts About Medi-Cal: Protections for the Healthy Spouse

The Medi-Cal law provides special protections for the spouse of a nursing home resident to make sure she has the minimum support needed to continue to live in the community.

The so-called “spousal protections” work this way: if the Medi-Cal applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the date of “institutionalization,” the day on which the ill spouse enters either a hospital or a long-term care facility in which he or she then stays for at least 30 days.

In general, the community spouse may keep one half of the couple’s total “countable” assets up to a maximum of $99,540 (in 2006). Called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order.

In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medi-Cal benefits. But what if most of the couple’s income is in the name of the institutionalized spouse, and the community spouse’s income is below $2,489.00 per month?

What if the well spouse needs more thatn $2,489.00 per month to meet his or her basic needs? The short answer is that the well spouse may be able increase his or her minimum monthly income. The well spouse will need to petition to increase his or her income allowance and upon a showing of need will be allowed to increase this amount. My office has increased this minimum income level to over $5,000.00 per month.