Important New York Court Decision Regarding Medicaid Spousal Income Support

Koldin Law Center E-Mail Newsletter
September 12, 2008

This edition of the Koldin Report E-Newsletter reviews an important Court decision that allows the healthy spouse to keep more of the ill spouse’s income.

Under the Medicaid law, when the ill spouse is in a Nursing Home receiving Medicaid coverage, the healthy spouse is allowed a monthly income allowance in 2008 of $2,610.

Let’s assume, for example, that the husband is in a nursing home and the wife is at home. The wife has a monthly income from Social Security of $1,000 and the husband has a monthly income from Social Security and Pension of $3,000.

Under the law, since the wife’s income is $1,000, she is entitled to receive $1,610 of her husband’s income to bring her up to the $2,610 allowance level. The balance of the husband’s income of $1,390 must be applied towards the cost of his nursing home bill.

If the wife could not meet her expenses with the $2,610 allowance, under New York and Federal law, she could ask for a Fair Hearing to request her income allowance be increased above $2,610. Under the law, she must demonstrate that she has “exceptional circumstances”.

New York State, in its Fair Hearing Decisions on this issue, held that “ordinary” expenses such as mortgage payments and real property taxes are not considered “exceptional circumstances” justifying an increased income allowance.

On September 2, 2008, an Appellate Court reversed New York State’s interpretation of the law and has held that “ordinary” expenses such as housing expenses, utilities, automobile, Medicare, food, clothing, medical care and home maintenance are all valid bases for obtaining an increased monthly income allowance.

The Court noted that the intent of Congress under the Medicaid law was to enable the healthy spouse to have enough income and resources to live with independence and dignity.

It remains to be seen whether New York State will appeal this Court decision.

If your spouse is in a Nursing Home and you are having difficulty paying your expenses, the Koldin Law Center, P.C. is available to review your options. There is no fee for the initial consultation. This newsletter is not intended to provide legal advice, but is intended to alert you that you may have legal options even when you are in a nursing home.

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