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Spousal Impoverishment: The Ugly Truth About Who Pays for Long-Term Care

There’s another layer of complex rules for married couples when hoping to get the government's help paying for long-term care if one spouse is still living independently. States are treating such “well” spouses in dramatically different ways and Virginia's rules are especially onerous.

 

Marriage is a wonderful institution when it works. In fact, a good marriage means a lifetime of living happily with another. What happens though in cases where as couples live longer and longer, one spouse’s health fails?  It is important to understand the unique challenges ill health might pose for couples especially if one spouse is trying to maintain a home while the other spouse is living in a long term care facility.  In Virginia, because of its very strict interpretation of the federal Medicaid rules, spousal impoverishment could be a real possibility.  Our practice is especially skilled at helping our clients avoid this pitfall.

Against the backdrop of the in sickness portion of the vows, one difficulty that arises was addressed recently in a Wall Street Journal article titled Long-Term Care and Couples: Who Pays?. That difficulty is the phenomenon of the “well spouse,” the “ill spouse,” and Medicaid.  Practically speaking, if one spouse becomes chronically sick and needs long-term care, will the other spouse be driven into poverty?

Marital assets, whether owned by the husband or the wife, are part of the equation when it comes to determining Medicaid eligibility. Medicaid is the joint federal/state government program to provide means-tested health care assistance to those who qualify.

With both federal and state coffers bleeding red ink (with a few state exceptions), Medicaid money is tight, especially in terms of long-term care coverage — whether married or single. As the Wall Street Journal article notes, however, some states are treating the “well spouses” more generously than others regarding how much wealth they may retain while the “sick spouses” are receiving taxpayer support through Medicaid.

I recommend reading the original article. Also, consider purchasing long-term care insurance so Medicaid does not become part of your future. In any event, a consultation with a qualified Elder Law Attorney would be prudent to evaluate your options.

Reference: The Wall Street Journal (April 2, 2012) “Long-Term Care and Couples: Who Pays?

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