Medicaid Planning When a Spouse Enters a Nursing Home: Avoiding Costly Pitfalls to Preserve Spousal Income

Navigating the Community Spouse Resource Allowance, Monthly Maintenance Needs Allowance, Exempt Asset Requirements and More

Recording of a 90-minute CLE webinar with Q&A

Conducted on Wednesday, May 24, 2017
Recorded event now available

This CLE webinar will provide elder law counsel with the tools to assist their married clients in Medicaid planning when one spouse enters a nursing home. The program will discuss how to best leverage the community spouse resource and monthly maintenance needs allowances and how to comprehensively identify exempt assets and avoid spending down exempt resources. The program will discuss other approaches to adequately maintain assets and income for the healthy spouse.


The spend-down of assets for Medicaid qualification causes much confusion. Practitioners advising the senior population must understand new medical criteria, qualification standards for Medicaid, and how assets are classified.

Asset protection strategy implementation requires a working knowledge of how the spend-down is determined. Rules for married couples are particularly complex when one spouse enters a nursing home or long-term care facility. Counsel’s goal is to preserve as much income and assets for the healthy spouse as permitted under the law.

Key approaches include making countable assets unavailable and leveraging the use of the CSRA and MMMNA. Other strategies include the transfer of the sick spouse’s IRA/retirement funds to the healthy spouse, having a sufficient power of attorney, considering divorce as an asset-protection option, and revising the estate plan.

Listen as our distinguished panel of attorneys discusses tools to assist married clients in Medicaid planning when only one spouse enters a nursing home. The panel will provide tips for leveraging the CSRA and MMMNA, identifying exempt assets, and avoiding spending down exempt resources. The panel will also cover other strategies to maintain assets and income for the healthy spouse.


  1. Community spouse resource allowance: determine snapshot date
    1. Avoid purchasing exempt assets before date of admission if that is snapshot date
    2. Case study—spouses with less than max CSRA
    3. Case study—spouses with more than max CSRA
  2. Monthly maintenance needs allowance: using nonexempt assets to protect the spouse’s income
  3. Avoid spending down exempt resources
  4. Identifying earliest date for Medicaid qualification
  5. Identifying all exempt transfers
    1. IRA/retirement funds
  6. Sufficient power of attorney
  7. Divorce as a strategy
  8. Pre-planning vs. crisis planning
  9. Revising the estate plan
    1. Disinheriting the sick spouse
    2. Removing the sick spouse from fiduciary roles


The panel will review these and other key issues:

  • How can the CSRA be best leveraged for the married clients’ benefit?
  • How can the sick spouse’s IRA/retirement funds be transferred to the healthy spouse and still be used to pay the facility costs?
  • When is divorce a viable option in a spend-down strategy?
  • How does the strategy differ between nursing home pre-planning vs. crisis planning?


Michael J. Keenan, Atty
Keenan Law, South Glastonbury, Conn.

Mr. Keenan specializes in elder law, estate planning, special needs trusts and probate law. He has written articles for legal journals and periodicals on the topics of special needs trusts, estate planning and the termination of parental rights. He is a frequent speaker at professional organizations on the topics of elder law, estate planning and special needs trusts.

Shelley Dowell
Kentucky Elderlaw, Louisville, Ky.

Ms. Dowell assists older clients, their children and other family members with Nursing Home, Medicaid, asset preservation, asset distribution, probate, guardianship, and other issues. In addition, she drafts legal documents such as Wills, Powers of Attorney, Trusts, and Health Care Surrogates.


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Strohschein Law Group

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