Health Care

questions & answers

Question: What are rules for Medicaid recipients with regard to the other spouses rights? I'm planning for if I would have to go to a Nursing Home.

Answer:

The state of Arizona Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS). In the AHCCCS Eligibility Manual, Appendix 7A,  the spousal impoverishment amendments to the Medicaid Act (42 .U.S.C. § 1396r-5) allow one spouse to retain sufficient property and income to live on (this person is referred to as the “community spouse”) when the other spouse requires institutional level care.

The laws provide that at the time the spouse enters a nursing home or other institution (called the “institutionalized spouse”) the Medicaid agency must do an assessment of the resources owned by both spouses. At that time, the agency determines how much of the joint resources the community spouse may keep. This is called the community spouse resource allowance. Keep in mind that the Arizona Long Term Care System (ALTCS) only allows the community spouse to keep one-half of the total assets of the couple, up to a maximum of $101,640. All assets of the couple are counted, regardless of whether there is a premarital agreement in place or not. There are also rules concerning how much income the institutionalized spouse can have and still be eligible for benefits. Since the spousal impoverishment protections are only available to the non-institutionalized spouse (the community spouse), one of the spouses must meet the federal definition for institutionalized spouse.

Federal law defines an institutionalized spouse as a person who is in a medical institution or nursing home or at the state’s option a person who qualifies for home and community based services (HCBS). Arizona has opted to include in its definition of institutionalized spouse persons who qualify for HCBS. No application for ALTCS is needed to obtain a resource assessment. For information on how to proceed and office locations, call 602-417-7000 or 1-800-654-8713. For information on nursing homes, contact the local Area Agency on Aging for your region. (see Arizona Resources within this site). Information may also be obtained by visiting the Arizona Department of Economic Security aonline or calling 602-542-4791.

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