Medicaid Planning and the Healthy Spouse

As we begina a new year, it’s a good time to reflect on the importance of Medicaid planning. If you are married, understanding how Medicaid rules impact a healthy spouse is vital for protecting assets and ensuring a comfortable standard of living.

This post will provide an overview of Medicaid planning and the provision for the community spouse.

Why Medicaid Becomes Relevant

Medicare is a familiar safety net for many seniors. However, Medicare is a health insurance program and DOES NOT cover long-term custodial care, which includes assistance with daily activities in a nursing home or at home. This gap can leave families exposed to significant expenses if long-term care becomes necessary.

Medicaid, unlike Medicare, does cover long-term care costs, including nursing home expenses and in-home custodial care. However, Medicaid is a need-based program with strict financial eligibility requirements that can complicate access for middle-income families.

Nursing Home Costs in Oklahoma

Nursing home costs in Oklahoma are substantial. In 2024, the average cost for nursing home care in Oklahoma City is just under $97,000 annually.  With the length of stay exceeding one year for many residents, these costs can deplete a family’s savings quickly.

This makes Medicaid planning an essential strategy for protecting assets and ensuring care is available when needed.

Medicaid Rules and the Healthy Spouse

Medicaid eligibility focuses on the applicant’s income and countable assets. However, special provisions exist to protect the financial security of a healthy spouse who remains at home, known as the “community spouse.”

Countable Asset Limit

The Medicaid applicant must meet a strict countable asset limit, which is $2,000 in Oklahoma. However, certain assets, including a primary residence, are exempt from this calculation.

In 2025, the home equity limit is $730,000. Importantly, if a community spouse continues to reside in the home, there is no equity limit for Medicaid eligibility.

Community Spouse Resource Allowance (CSRA)

To protect the community spouse, Medicaid allows them to retain a portion of the couple’s countable assets, referred to as the Community Spouse Resource Allowance (CSRA). For 2025, the CSRA ranges from a minimum of $31,584 to a maximum of $157,920.

Monthly Maintenance Needs Allowance (MMNA)

Income rules for Medicaid also include protections for the community spouse. Typically, the institutionalized spouse’s income must go toward the cost of care. However, the community spouse can retain a portion of the institutionalized spouse’s income under the Monthly Maintenance Needs Allowance (MMNA).

For 2024, the maximum allowance has been $3,948, and there is no minimum allowance in Oklahoma though there are minimums in some states.

Planning Ahead: Medicaid Trusts

An essential aspect of Medicaid planning is preparing in advance to meet financial eligibility requirements. One strategy involves creating a Medicaid trust.

A Medicaid trust is an irrevocable trust designed to shelter assets from being counted for Medicaid eligibility purposes. Assets placed into this trust are no longer accessible to the grantor, but the trust’s income may remain available for their use until Medicaid benefits are needed.

This type of planning requires foresight due to Medicaid’s five-year look-back period. Any transfers to a Medicaid trust made within five years of applying for benefits can trigger penalties, delaying eligibility. For this reason, proactive planning is critical.

Medicaid Estate Recovery

Another key consideration is Medicaid’s estate recovery program. After the death of a Medicaid beneficiary, the state may seek to recover the cost of care from the beneficiary’s estate.

For married couples, the community spouse’s rights are protected. Medicaid estate recovery cannot target the primary residence while the surviving spouse remains alive.

However, if the home is still part of the estate after the death of the community spouse, it may be subject to recovery. Transferring the home into a Medicaid trust can shield it from estate recovery, ensuring it remains within the family.

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After helping his own family deal with a lengthy probate and the IRS following his father’s untimely death in a farm accident, Larry Parman made a decision to help families create effective estate plans designed to reduce taxes, minimize legal interference with the transfer of assets to one’s heirs, and protect his clients’ assets from predators and creditors Read More!

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