Since 1965 Medicaid has been the primary federal program to pay for the cost of nursing home care when someone cannot afford to pay for that care personally. In 1983 Congress expanded the Medicaid program to pay for home and community based services (HCBS Medicaid) as an alternative to paying for nursing home care services (NH Medicaid). But it wasn’t until 2013 that Medicaid expenditures, for the first time, were greater for HCBS Medicaid than they were for NH Medicaid. Given that most people prefer to have services in their home than enter a nursing home for care, why did it take so long for HCBS Medicaid to become more popular? The short answer is Obamacare. With the adoption of the Affordable Care Act in 2010, Congress required states to provide the same strong financial protections for the spouses of married individuals applying for HCBS Medicaid as they were required to provide for spouses of married persons applying for NH Medicaid. Prior to 2010 states could treat these two classes of spouses differently, and often did.
What’s newsworthy here is that this Obamacare rule was set to expire on January 1 of this year, and has been extended only until March 31. If Congress does not act to make equal financial treatment of these two classes of Medicaid spouses permanent before then, it is possible that many states will stop treating them the same later this year—and as a result, HCBS Medicaid will once again become a much less attractive option for married couples when one spouse needs care.
The substance of the spousal financial protection rules that might change on March 31, 2019 are hard to summarize in a newsletter, but we would be happy to explain the details in person, as well as their potential consequences on you or your family members. Anticipating and preparing for these rule changes now will undoubtedly save those affected a great deal of time and money, and provide all parties concerned with peace of mind.