Must I Pay My Income to the Nursing Home if My Husband is on Medicaid?

 In Long-Term Care Planning
Medicaid spousal impoverishment rules

Photo by Ignat Kushanrev on Unsplash


I have a pension of $3,000 a month from STRS- California. It is our main income. My husband will probably need long-term care in a year or so. We have no LTC insurance. If he applies for Medi-Cal would I be able to keep the pension, is it exempt, or will it be counted as income for both of us?


You will be able to keep your pension. Under the Medicaid (Medi-Cal in California) rules, when one spouse of a married couple goes to a nursing home, the couple’s assets are in effect lumped together in determining the nursing home spouse’s eligibility for coverage and they are permitted to keep about $132,000 (in 2021) and the family home. However, their income is treated separately. The healthy (so-called “community”) spouse can keep her income and the nursing home spouse pays his income (less a small personal needs allowance) to the nursing home.

There is an exception to this rule when the community spouse’s income is low. Under the spousal-impoverishment rules, the Medicaid agency calculates a base income for each community spouse based on a formula that takes into account her housing costs. If her own income is less than the resulting amount, then she can receive as much of the nursing home spouse’s income as necessary to make up the difference. Fortunately, if her income is over this amount she has no obligation to pay that excess income to the facility.

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