In most cases where an individual receives Medicaid and is in a nursing home facility, the New Jersey Medicaid agency will require that the person’s monthly income be paid to the facility. The balance of the cost of long-term care will then be paid by Medicaid. The amount of a person’s monthly income to be paid to the facility is known as the “cost share”. For a single individual, New Jersey will expect that most of that person’s monthly income will be paid to the facility as his or her cost share.
The laws are different for a married couple. Both federal and state laws allow the healthier spouse to receive a portion, and sometimes all of the institutionalized spouse’s income, as spousal support. The amount of spousal support is based in part upon the healthier spouse’s monthly income. If the healthier spouse’s income is less than a minimum threshold set by Congress, then the difference will be awarded to the healthier spouse as spousal support.
The New Jersey Division of Medical Assistance and Health Services (DMAHS) recently issued a new directive to the New Jersey Medicaid agencies concerning the calculation of spousal support. The DMAHS issued Medicaid Communication No. 22-06. According to this directive from the DMAHS, the spousal support for the healthier spouse is based upon the difference between the healthier spouse’s monthly income and the new minimum threshold of $2,288.75. Prior to this change in the law the threshold was $2,177.50.
By way of illustration, if the healthier spouse has a monthly income of $988.75 then that spouse should receive a minimum amount of spousal support of $1,300.00. The difference between $2,288.75 and $988.75 is $1,300.00. Therefore, the healthier spouse should receive spousal support of at least $1,300.00.