Does Your Income Count If Your Spouse Goes Into a Missouri Nursing Home?

Your spouse is entering a nursing home, but your mortgage, utilities and groceries are staying with you. The first mistake is treating the two of you as one undivided monthly budget. Missouri must examine the couple's finances, but that does not mean every dollar of your income must follow your spouse into the facility.

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Build two columns before you sign anything. Label one column "spouse entering care" and the other "spouse staying home." Put every income source, account, debt and household bill under the person whose name appears on the statement. Keep jointly owned property in a third list. This is not the state's eligibility calculation. It is the map you need before the Family Support Division makes that calculation.

Who pays

Medicare is not the payer for an open-ended nursing home stay. If your spouse meets Missouri's financial and level-of-care requirements, MO HealthNet nursing home coverage can pay a participating facility for covered nursing facility care. Missouri calls this nursing home coverage or vendor nursing care. The facility must have a MO HealthNet certified bed, not merely say that it "accepts Medicaid." Ask the admissions office, "Is the specific bed being offered certified for MO HealthNet, and will you keep it available while the application is pending?" Missouri DSS describes the coverage and application route on its program page for seniors and people with disabilities.

For a married couple, federal spousal impoverishment rules protect a share of combined resources for the spouse who remains in the community. Depending on that spouse's own income and permitted expenses, part of the institutionalized spouse's income may also be allocated to the spouse at home. Only the amount left after permitted deductions is applied toward the resident's care. Medicaid.gov explains the distinction between the protected resource share and the monthly income allowance on its spousal impoverishment page.

Do not copy a dollar limit from an old handout. The resource allowance, income allowance and personal needs allowance can change. Call the Family Support Division at 855-373-4636 and ask for the figures that apply to the application being filed. Use these exact questions: "What is the current community spouse resource allowance? What is the current minimum monthly maintenance needs allowance? Which shelter costs can increase that allowance? What personal needs allowance will the resident keep?" Write the representative's answer, name and call reference in your file.

The papers

Start with the Application for MO HealthNet for the Aged, Blind and Disabled, form IM-1MA. Missouri's application page says an applicant who lives in a medical or nursing facility must also submit the supplemental form. On IM-1MA, report that your spouse lives in a nursing facility and list the household information requested. Do not omit the spouse at home simply because only one spouse is applying.

Add Appendix B, "Skilled Nursing Care," from the IM-1MA appendices packet. Its Declaration and Assessment of Assets asks what both spouses owned when the nursing home stay began, or when the need for qualifying in-home skilled care began. Missouri says this list is used to determine how much the spouse at home may keep. Both spouses sign the last page, and the instructions request proof of assets and a deed if the couple owns a home. Read the state's IM-1MA appendices packet before assembling the account records.

If you will speak with FSD but you are not already acting under valid legal authority, use Appendix C to name an authorized representative. That appointment lets FSD discuss the application with the named person. It does not make you an owner of the applicant's money and does not replace a power of attorney, guardianship or conservatorship. If you already hold one of those roles, the IM-1MA instructions tell you to provide the supporting legal document.

Make one evidence folder with statements for every checking, savings, investment and retirement account held by either spouse or jointly. Add deeds, vehicle titles, life insurance cash-value statements, burial contracts, trust papers and records of property sold or given away. Keep Social Security and pension award letters in the income section. Put health insurance premiums, rent or mortgage charges, property tax, homeowner's insurance and utility bills in a separate shelter-cost section. Do not retitle an account, add a child as owner, give money away or cash out a policy merely to make the columns look smaller. Medicaid reviews transfers for less than fair market value, and trusts have separate eligibility rules, as summarized on Medicaid.gov's eligibility policy page.

The runway

Ask the facility for a written ledger showing its private-pay charge, every payment received, the amount it expects the resident to contribute after approval and what happens to the account while MO HealthNet is pending. Do not rely on "Medicaid pending" as if it were a payment guarantee. Put the application submission receipt, every FSD request and every document you send in date order. Keep the envelope for each eligibility notice.

The financial approval is only one track. Missouri also requires a nursing facility level-of-care decision, and admission to a Medicaid certified bed involves screening. Ask the facility which staff member owns the screening and level-of-care submission, whether it has been sent, and how you will learn the result. The clinical answers belong to the facility and the evaluating professionals. Your job is to keep the financial file and confirm that the clinical track has an owner.

Before signing the admission agreement, circle every use of "responsible party," "guarantor," "joint liability" and "payment." A Medicare or Medicaid participating nursing facility cannot require a third party to personally guarantee the resident's bill as a condition of admission or continued stay. The Consumer Financial Protection Bureau explains that rule and the contract language to watch on its caregiver and nursing home debt page. Sign only in the capacity you actually hold, such as authorized representative or attorney-in-fact. If the contract says your own money is at risk, stop. That is the line where a lawyer takes over.

Free help

For the application, current financial limits and the status of a submitted file, call the Family Support Division at 855-373-4636. Ask the nursing home for the applicant's FSD case number and the name of the employee handling Medicaid-pending accounts.

For questions about the resident's rights, bills or communications with the facility, contact the Missouri Long-Term Care Ombudsman at 800-309-3282. The ombudsman advocates for residents but does not decide Medicaid eligibility and does not act as your lawyer.

If you need help locating aging services or benefits assistance, the federal Administration for Community Living lists the Eldercare Locator at 800-677-1116 on its help page. You can also use Local Help With Paying for Care for St. Louis contacts.

If the case involves a trust, a disputed transfer, a separation, conflicting ownership records, a demand that you personally pay, or a proposed change to title, stop before moving the money. The Missouri Bar's Missouri Lawyers Help page provides a lawyer search and links to discounted or pro bono services. Bring the two-column map, the IM-1MA packet, the admission agreement and every FSD notice. The lawyer should see the household as it exists, not a version reconstructed after an account has already been changed.