Regarding spousal impoverishment, how can I insure that my wife can qualify for Medicaid without totally depleting all of our assets?

Oh my goodness, did she have a stroke? 74 is still very young. Pretty overwhelming with lots of things to consider I'm sure. As the community spouse you will not have to impoverish yourself for your wife to be accepted for Medicaid. You are still living in the community and need to pay for things. How much you an keep depends on your states CSRA - community spouse resource allowance. Most states have the max set at 109K. You need to find out what it is in your state and then how much you are over it. On the face of it, you will be over the limit so something will need to be done so that you can stretch the $ out over your lifetime. Personally I'd take all your financials (including what it costs for mortgage, insurance, taxes,etc) and spend your time & money to work with a elder law attorney to come up with a plan that works for how Medicaid is managed in your state. Oh, the term "community spouse" has nothing to do with community property either, it is just the term used to describe that there is a still living at home and in the community.

It is CRITICALLY important that you see someone before you apply for Medicaid or other programs for her. For community spouse situations, there is the "snapshot day" - usually the date of application or date of admission and your financials are based and fixed on what i$ there on that date.

One thing you can look into now is the car situation. You are allowed A CAR if you are a couple on Medicaid. If you gift or donate the extra car, there would be a transfer penalty based on the Blue Book value of the car. You don't need to deal with this happening - what works well is to turn in both cars and then get a single new car that works best for your situation (like if there will be a wheelchair or you need a small SUV rather than a sedan) and will be dependable for years & years.

What also works well for the community spouse if they are young (really 72 is young) and in good health and can likely live for a decade more than the ill spouse, is to spend-down their assets to pay off the mortgage completely. 115K legit spend-down done. Now you do have to make sure that all the paperwork on the house is done and filed, etc BEFORE the snapshot day. I bet the attorney will suggest you do this. Another thing that is often done for couples where 1 likely will need a facility soon and the other not, is to sell the current house and then buy a new house that will better suit the needs of the community spouse.

ANother thing to find out about is what services would be made available to her that would be paid for by Medicaid. Most Medicaid $ are spent for skilled nursing services in a NH setting. At home care usually is on some type of Medicaid waiver or Medicaid diversion program. Some states do alot of waivers while other states don't. If your state is narrow in it's approach to at-home care paid by Medicaid waivers, then you are going to have to private pay for the services anyways, so no benefit to applying to Medicaid. It's all lots to think about and realistically it's worth having a good elder law attorney to help. Good luck.

I don't know the answers to all of your questions, but here are resource links to medicaid that may answer some, if not all your questions:

http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html

And, regarding spousal impoverishment:
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Downloads/SSI-SpouseImpovStandards.pdf

Hello ronba1,

This article may also help clear up some confusion:

Spending Down to Medicaid Doesn't Have to Impoverish Both Spouses: https://www.agingcare.com/articles/medicaid-spend-down-for-spouses-158628.htm

Thanks for your helpful insight. It looks like my next step will be contacting a elder care attorney.