The rules with regard to Missouri Medicaid, known as MoHealthnet, change all the time. This article discusses key changes for 2016.
SPOUSAL PROTECTIONS FOR THE COMMUNITY SPOUSE*
*The term “Community Spouse” and we refer to the community spouse as the Non-Medicaid Spouse (the spouse staying put and not needing Medicaid) and the institutionalized spouse as the Medicaid Spouse.
Community Spouse Resource Allowance (CSRA)
Minimum: $23,844 / Maximum: $119,220
The CSRA is the amount of non-exempt assets that a non-Medicaid spouse is allowed to keep. In Missouri, an individual is allowed a maximum of $999.99 in assets to qualify, and a couple is allowed to have a maximum of $2,000.* Now, the non-Medicaid spouse is usually allowed to keep 50% of the non-exempt assets (i.e. not the house / not personal property) up to a maximum (as noted below) of $119,220. This is called the CSRA.
Increased CSRA is permitted but only after all of Medicaid spouse’s income is assigned to non-Medicaid spouse. Missouri is an inc0me-first state for Medicaid purposes.
Example: A couple has $100,000 in non-exempt assets (let’s say $25,000 in cash in bank accounts, $50,000 in a retirement account and $25,000 in the cash value of a life insurance policy) on the date wife enters a nursing home. She will not be immediately eligible for Medicaid because they will be allowed $999.99 for her and the husband will be allowed a maximum of $51,000.01.
Annuities? Annuities are allowed if they are actuarially sound, but state must be named second or contingent beneficiary.
Minimum Monthly Maintenance Needs Allowance (MMMNA): Income of the Medicaid spouse that can be kept by the non-Medicaid spouse. The remaining income goes to offset the cost of the nursing home stay of the Medicaid spouse.
Minimum: $1,991.25 / Maximum: $2,981.00
Example: John and his wife Jane have joint income of $2,500 per month, $1,500 of which is income of John, $1,000 of which is income of Jane. John has to go into a nursing home on Medicaid. MoHealthnet determines that Jane’s MMMNA is $1,500, based on her housing costs. Since Jane only gets income of $1,000, Medicaid allots $500 of John’s income to Jane for her support. Thus, John will qualify for Medicaid and pay $1,000 of his income per month to offset the costs ($1,500 – $500). Jane will live on $1,500 per month.
AVERAGE COST OF NURSING HOME STAY IN MISSOURI
According to the state of Missouri, the average cost of nursing home care is $4,889 / month or $160.73 / day. From what I have seen as a practitioner, the quality of the facility and therefore the costs vary widely throughout the state. In the St. Louis area, for example, there are very nice facilities in St. Louis County and St. Charles County that routinely have at least a year wait for a Medicaid bed. There are typically less beds but less demands in outlying counties like Warren, Lincoln and Franklin County.
INCOME CAP
Missouri is not an income cap state for Medicaid purposes. In Missouri, this means that the non-Medicaid spouse can
ESTATE RECOVERY
Has the state expanded the definition of “estate” beyond the probate estate? No. This means that the state can only recover for benefits provided from assets included in a probate proceeding after the Medicaid spouse (the one receiving benefits) passes away. If there is not probate opened, there is no estate recovery.
Has Missouri included a hardship provision in its estate recovery plan? No, it has not.
Future blog articles will cover this topic in greater detail.
HOME EQUITY LIMIT
In Missouri, the equity in a home is an exempt asset and does not count against the $999.99 / $2,000 asset limit, so long as the equity does not exceed $552,000, with some exceptions.
For more information about Missouri Medicaid, click the following link: http://dss.mo.gov/fsd/msmed.htm
