Making the decision to place a family member in a nursing home is a difficult challenge, but becomes even more difficult when the decision is made between spouses. This brings up the issue of money and how this type of care will be paid for. In addition, community spouses (the spouse that remains in the home) have great concerns about what happens to their own money once their spouse enters institutionalized care.
Spousal Options for Funding Nursing Home Care
Families must first decide how they will pay for nursing home care. Currently, these are the options for families when deciding how to pay for care:
1. Medicare - pays some nursing home costs after a hospital stay
2. Personal Funds - can become costly when nursing home costs average between $4,000-$6,000 per month
3. Long Term Care (Private) Insurance
4. Medicaid - pays the majority of nursing home costs for elderly with limited income
The concerns about the money available to a community spouse come into play when dealing with Medicaid. Medicaid is a federal and state program that pays nursing home costs based on certain eligibility requirements. The calculations for coverage are complex and have historically left spouses who remain in the home with little money to survive.
Spousal Impoverishment Rules
Because many community spouses were being left with no money after their husband or wife entered a nursing home, spousal impoverishment rules were established. These rules are meant to prevent community spouses from exhausting all of their financial resources in these situations.
When determining eligibility for Medicaid, a Protected Resource Amount (PRA) is calculated to determine the amount of the community spouse's available money. According to the Centers for Medicare and Medicaid Services (http://www.cms.hhs.gov), this amount is the greater of:
-Spousal Share (half of the combined spousal resources)
-Spousal resource standard for the state of residence
-Court ordered amount transferred to a community spouse for care
-Designated amount ordered by a state hearing officer to increase the community spouse's PRA to the state's standard
Once the PRA is established, this money belongs to the community spouse and is not available to the spouse in nursing home care.