Make the Most of the Season by Following These Simple Guidelines

When one spouse needs long-term care, the cost can swallow everything the couple has. Congress brought in the spousal impoverishment rules so that the healthy spouse is not left destitute paying for the other's care.

In 2014 those protections were extended beyond nursing homes to Medi-Cal Home and Community Based Services, which means they now reach families arranging care at home.

Medi-Cal looks at each spouse's income separately. The community spouse, meaning the one not receiving the benefit, keeps income paid in their own name and does not have to contribute it to the other spouse's cost of care.

Where the community spouse earns less than the monthly maintenance needs allowance, income can be moved across from the spouse receiving care to bring them up to it.

Where the community spouse earns more than the allowance, they do not receive an allocation, but their income does not count against the other spouse's eligibility either.

Jose and Virginia each have 2,000 dollars a month, and Jose needs care at home. Virginia earns less than the allowance, so she receives an allocation from Jose. That leaves him with a small amount of countable income, under the limit, and no shared monthly cost at all.

In the other direction, where the spouse at home is the higher earner, they keep everything they earn, and only the care spouse's own income is used to work out what they pay.

Say clearly on the Medi-Cal application that you are applying using the spousal impoverishment provisions, and identify the community spouse. If you are applying for care at home, say that too.

If you are turned down, ask for a fair hearing straight away. The Notice of Action tells you how, and if it does not, your county office will.

If you are already enrolled, it is worth asking whether these protections have been applied. Some families are entitled to have them backdated.

A lot of couples pay far more than they need to, simply because nobody told them this rule existed. If one of you is heading into care and the other is staying home, this is the first thing to ask about.