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Using California’s Spousal Impoverishment Rule for Home and Community Based Services
This fact sheet may be useful to California residents seeking Medi-Cal benefits to cover the cost of in-home caregiving or other services at home. Medi-Cal is California’s version of the federal Medicaid program, providing health insurance to low-income or low-asset individuals. In addition to paying for nursing home care, Medi-Cal also covers the cost of in-home caregiving, assistance with household chores, and other “home and community-based services” (HCBS). Unfortunately, many Medi-Cal beneficiaries have difficulty accessing these benefits due to a high monthly Share of Cost; others may be ineligible for Medi-Cal entirely due to excess assets.
If you are interested in obtaining Medi-Cal to assist with in-home care expenses, but are worried that your income or assets may be too high, the “Spousal Impoverishment Protections” described below may help you.
What are the “Spousal Impoverishment Protections”?
The spousal impoverishment protections are Medi-Cal rules designed to prevent the impoverishment of one spouse, when the other spouse enrolls in Medi-Cal payment for nursing home care, or “Home and Community Based Services.” This means that certain married individuals can be eligible for Medi-Cal with more generous income and asset limits, enabling them to access services without depleting all of their resources.
Under the spousal impoverishment protections, Medi-Cal allows the spouse who isn’t receiving Medi-Cal, (the “well spouse”) to retain additional income and assets, without jeopardizing the eligibility for the Medi-Cal spouse. In 2019, the well spouse is permitted to retain a “Community Spouse Resource Allowance” (CSRA) of $126,420 in countable assets, in addition to the $2,000 in countable assets the Medi-Cal spouse may retain.
In addition to the CSRA, the well spouse is permitted to retain additional income without having to contribute it all to Share of Cost. The well spouse may retain all income in her own name and, if that income is less than $3,161 (the Minimum Monthly Maintenance Needs Allowance, or MMMNA, for 2019), he/she may receive an allocation from the Medi-Cal spouse’s income to reach $3,161.
What are Home and Community Based Services?
Home and Community Based Services (HCBS), sometimes called “Medi-Cal Waivers,” are programs that offer an alternative to nursing homes. HCBS programs offer a package of services and supports to Medi-Cal beneficiaries who would otherwise require care in a nursing home, but who prefer to remain at home. Some of the benefits offered through HCBS programs include: caregiving (“personal care services”), assistance with chores and meal preparation, protective supervision, in-home nursing care, case management, and home modifications. Availability of HCBS programs varies from county to county, and the services offered through each program vary as well.
HCBS programs in California include:
For more information about individual programs visit www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalWaiversList.aspx
Is In-Home Supportive Services (IHSS) an HCBS Program?
The answer is: it depends on which IHSS program you are enrolled in. IHSS has several different programs. A large percentage of people enrolled in IHSS are enrolled in the Community First Choice Option (CFCO), which is an HCBS program. If you are enrolled in IHSS’ CFCO program, then you are entitled to the spousal impoverishment protections.
IHSS recipients can call the county Medi-Cal office to verify whether they are enrolled in CFCO. Individuals enrolled in CFCO will have a “2k” Aid Code.
All County Letter 14-60 explains the eligibility requirements for the CFCO program: www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acl/2014/14-60.pdf.
Step by Step Instructions:
Example: John and Mary live at home, and John has Parkinson’s Disease. John needs a lot of care but wants to remain at home with Mary for as long as possible. John receives a pension of $2,500 per month. Mary receives a pension of $500 per month. They have savings of $50,000.
John applies to Medi-Cal under the spousal impoverishment protections. He has his doctor submit the Doctor’s Verification Form, and then calls the Multipurpose Senior Services Program (MSSP) serving his county to enroll.
Unfortunately, the MSSP program in John’s county has a waitlist. Even though John is on the waitlist for MSSP, he is still entitled to Medi-Cal under the spousal impoverishment protections. Once he is enrolled in Medi-Cal, he can use his benefits to receive needed Medi-Cal care, or enroll in additional Home and Community-Based Service programs. For example, he can now use his Medi-Cal benefits to apply for IHSS and receive in-home caregiving, with no Share of Cost.
A Share of Cost functions like a deductible. It is the amount of money you must pay out of pocket each month towards your healthcare costs, before you start receiving covered services through Medi-Cal.
Page Last Modified: August 13, 2019