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Current federal law protects the financial interests of spouses of certain Medicaid beneficiaries by allowing the spouse of a nursing facility resident to keep a minimum share of the couple’s combined income and assets. Section 2404 of the Patient Protection and Affordable Care Act (PPACA) addresses the institutional bias that applies these spousal protections only to nursing home residents by extending the protections to spouses of Medicaid beneficiaries who receive home and community-based services.
On May 7, 2015, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states on the implementation of section 2404 of the Affordable Care Act. For the five -year period beginning January 1, 2014, states will be required to apply the spousal impoverishment standards in determining eligibility for married Medicaid applicants who are eligible for services under Medicaid 1915(c) waivers, 1915(i) or (k)Medicaid state plan amendments.
The expanded spousal impoverishment protections help ensure the financial solvency of the Medicaid beneficiary’s spouse by providing the spouse with guaranteed minimum income and asset allotments, the levels of which are adjusted annually. Many times, a married older adult chooses nursing home care because they cannot afford home and community based services for their spouse that needs services to remain in their home. This temporary change to the Medicaid eligibility requirements will help more married older adults utilize Medicaid home and community based services.