How to Use the Medicaid Desk Reference

How to Use the Medicaid Desk Reference

Disclaimer: With Medicaid, VA, and insurance regulations frequently changing, past blog posts may not be presently accurate or relevant. Please contact our office for information on current planning strategies, tips, and how-to's.

It is always helpful to have a “cheat sheet” on hand to quickly reference your state’s Medicaid planning figures when advising a new client or preparing a new case. That’s where our Medicaid Desk Reference comes in. Keep reading to learn how to use this crucial tool!

What is the Medicaid Desk Reference?

The Medicaid Desk Reference is intended to provide a state-specific roadmap for developing your client’s personalized spend-down plan. A quick review of this essential tool will help you answer common questions such as:

  • How many assets can my client keep?
  • What is the length of time my client will be considered ineligible due to a previous gift?
  • Is the community spouse eligible for an income shift?

Most states update their figures at least twice per calendar year in January, July, or October, though some states may issue updates to their state figures outside of these common times and without any prior notice.

It’s important you stay up to date on any changes to your state-specific Medicaid planning figures.
Click here to sign-up for your free Agent Access account now to stay in the know!

Now, let’s dig into the terms on the Desk Reference.

Divestment Penalty Divisor

The Divestment Penalty Divisor is a state-specific figure that is constructed based on the average monthly private-pay rate for nursing home facilities in that state. It is used to calculate how long a Medicaid applicant would be ineligible for benefits if they made gifts during the lookback period.

Individual Resource Allowance

This figure dictates the amount of countable assets that a Medicaid applicant can retain while still qualifying for Medicaid benefits. This allowance is $2,000 in most states.,

Resource Allowance for a Couple

In the event that both spouses reside in a nursing home at the same time, they will not each be entitled to retain their own Individual Resource Allowance. Instead, they will be entitled to a separate resource allowance amount to be shared between the two of them.

Personal Needs Allowance

The Personal Needs Allowance is the amount of income that a Medicaid recipient is entitled to each month that can be used for their personal expenses such as toiletries, clothing, or haircuts. This figure varies by state and can range from $30-$200, depending on the state.

Community Spouse Resource Allowance (CSRA)

The Community Spouse Resource Allowance (CSRA) dictates the amount of countable assets that the community spouse is entitled to retain when qualifying the institutionalized spouse for Medicaid benefits. Any excess assets that exist beyond this resource allowance must be spent down. Your state may take one of two approaches to this number:

Standard CSRA States:

In states where a standard CSRA figure is implemented, the couple must spend down any excess countable assets that exceed this limit in order to qualify the institutionalized spouse for Medicaid benefits.

Minimum/Maximum CSRA States:

Other states impose a minimum/maximum asset range that the couple must adhere to. In these states, the community spouse is entitled to retain one-half of the couple’s assets as of the “snapshot date,” or the first date after which the Medicaid applicant spent 30 consecutive days in a facility. The amount that the community spouse can retain may not exceed the maximum nor fall below the minimum.

Learn More: Pre Snapshot Date vs. Post Snapshot Date

Monthly Maintenance Needs Allowance (MMNA)

This figure determines the amount of income that the community spouse may be entitled to receive from the institutionalized spouse each month. If the community spouse’s income is less than the MMNA, they may be entitled to receive a portion or all of the institutionalized spouse’s income. Similar to the community spouse resource allowance, there are two approaches:

Standard MMNA States:

In these states, if the community spouse’s income is less than the standard MMNA figure, they will be entitled to an income shift of the difference from the institutionalized spouse’s income.

Minimum/Maximum MMNA States:

In other states, the community spouse may be entitled to an income shift from the institutionalized spouse that exceeds the minimum MMNA, depending on their total shelter expenses. The community spouse will always be entitled to the minimum, but they may be eligible to receive more if they have shelter expenses that are above a certain threshold, not to exceed the maximum MMNA.

Shelter Standard

The Shelter Standard represents the amount of shelter expenses that the community spouse is responsible for each month. It is required for the MMNA calculation in Minimum/Maximum MMNA states.

Standard Utility Allowance

Since monthly utility costs can fluctuate from month-to-month, the Standard Utility Allowance is a standardized figure that is used by the state Medicaid agency in place of a community spouse’s actual utility costs. This figure can vary by state and is used to help calculate a community spouse’s total shelter expenses.

Funeral Expense Trust Limit

In order to be considered exempt for Medicaid purposes, the face value of an Irrevocable Funeral Expense Trust must typically be below $15,000, in most states. Many states also require that a Letter of Goods and Services accompany the contract.

To determine if your state requires a Letter of Goods and Services, contact our office at 800-255-1932 and ask to speak with one of our skilled Benefit Planners today.

Life Insurance Limit

If the face value of the life insurance policy is less than the state-specific limitation, the cash value of the policy is considered an exempt resource for Medicaid purposes. In most states, this limitation is $1,500, although this value may vary by state.

Home Equity Limit

The Home Equity Limit is a standardized limit that applies to the amount of equity that an individual who is seeking Medicaid benefits can retain in their home. The limit does not apply when a community spouse or minor or disabled child is occupying the home.

 Learn More: How Does a Reverse Mortgage Affect Medicaid?

For more information about how you can use your 2022 Medicaid Desk Reference, click here to view our free webinar, presented by Vice President of Sales and Marketing, Thomas Krause, J.D.