Pursuing an Upwardly Revised Community Spouse Resource Allowance

prepared by Alan Wasserman, current as of May 2022

One of the more powerful tools available for preserving a couple’s assets when one spouse needs long-term care is the ability to seek an upward revision to the community spouse resource allowance (CSRA). When a married person turns to the Medicaid program for help paying for long-term care, the general rule requires the couple to first spend down their assets to their CSRA, which is one-half of the total countable assets the couple had as of the date long- term care started. (For 2022, the maximum CSRA is $137,400, and the minimum CSRA is $27,480. Low asset couples may, therefore, be able to establish Medicaid eligibility with little or no spenddown, whereas the general rule requires high asset couples to spend down at least half of their countable assets.)

Medicaid has different programs available that provide health coverage for:

• Children under age 19
• Parents or other related adults with children under age 19
• Pregnant women
• Women diagnosed with breast or cervical cancer or pre-cancer
• People aged 65 or older
• People who are blind or disabled (using Social Security criteria)

It’s a task that few of us look forward to: arranging for help to be there if, as senior citizens, we
are no longer able to care for ourselves. For 1.4 million seniors, that care comes in a nursing home
where most residents have their bills paid by the government through the Medicaid program. For
millions of others, that care comes from family members or paid providers, in homes or assisted living
facilities...

This video explores the questions many of us may have about Medicaid and how it can help pay for long term care costs. If you are unsure about how Medicaid works, what it can cover, who can qualify, or similar questions, this video may benefit you. 

En español

Please find attached below a brochure created by Idaho Legal Aid Services, Inc. about Medicaid Long-Term Care Benefits. 

The Idaho Department of Health and Welfare has created a Medicaid Protection FAQs page on their website to explain Medicaid dis-enrollments and how you can protect your access to Medicaid benefits. For more information on how to protect your Medicaid access, please see their Frequently Asked Questions page here: https://healthandwelfare.idaho.gov/medicaidprotection.

Medicare is a multi-part federal health insurance program managed by the federal government. A
person applies for Medicare through the Social Security Administration, but Medicare's rules are
written by another federal agency, the Centers for Medicare and Medicaid (CMS), and Medicare
claims are processed by private insurance companies, called "Fiscal Intermediaries" and
"Medicare Carriers," that vary from state to state.

Medicaid helps pay for health care for people who fit within certain categories (such as being a
child or elderly or disabled or pregnant) and whose income and assets fall within certain limits
(which vary depending on which category a person fits within). Idaho's Medicaid program
covers many items and services, including the full range of long-term care. People who have
Medicare coverage may also qualify for Medicaid. When they do, Medicaid pays for their
Medicare premiums, deductibles, and co-payments, as well as for many health care items, such
as dental care, not covered by Medicare.

What is Medicaid? Medicaid is a government program that pays for a broad range of health care, including hospitalizations, phhysician care, medications, and long-term care. Medicaid is administered by the Idaho Department of Health and Welfare, and an application for Medicaid may be submitted to any Department of Health and Welfare office.

As they plan for the time when they may need long-term care, consumers are likely to face some difficult and uncomfortable questions. What would I do if I were no longer able to care for myself? Would someone in my family take care of me, or would I seek care elsewhere? And how would caregivers get paid?...