In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in "countable" assets (the figure may be somewhat higher in some states). Medicaid law also provides special protections for the spouses of Medicaid applicants to make sure they  have the minimum support needed to continue living in the community while their husband or wife is receiving long-term care benefits. 

In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $137,400 (in 2022). This is the community spouse resource allowance (CSRA), the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $27,480 (in 2022). Some states are more generous to the community spouse. In these states, the community spouse may keep up to $137,400 (in 2022), regardless of whether or not this represents half the couple's assets. Unfortunately, Tennessee is not one of those states.

Medicaid agencies must pick a date to use to analyze the applicant's assets. The date that the agency chooses can affect how much money the applicant must spend down before qualifying for benefits and how much a spouse is able to keep. It is called the "snapshot" date because Medicaid is taking a picture of the applicant's assets as of this date.

The snapshot date is usually the date of "institutionalization," the day on which the Medicaid applicant enters either a hospital or a long-term care facility in which he or she then stays for at least 30 consecutive days. States use as the snapshot date either the first day of the month the applicant entered the facility or the actual date of entry. If the applicant enters a hospital or nursing home, stays for 30 days, goes home, and then reenters a hospital or nursing home, the snapshot date is the date the applicant entered the hospital or nursing home for the first stay. 

Not all Medicaid long-term care applicants are in an institution. If the applicant is applying for Medicaid home care through a waiver program, the snapshot date is usually either the date of the application or the date the applicant is determined to need a nursing home level of care.  

On the snapshot date, the Medicaid agency counts up all of an applicant's and his or her spouse's assets, excluding the couple's house. Then depending on the state's CSRA, the agency determines how much the community spouse can keep. If any assets above $2,000 remain, then that money must be spent down before the applicant will qualify for benefits. 

Example: If a couple has $100,000 in countable assets on the snapshot date and the state allows the spouse to keep half the couple's assets up to the maximum CSRA, the Medicaid applicant will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 -- $2,000 for the applicant and $50,000 for the community spouse. If the state allows the spouse to keep the entire amount of the maximum CSRA, then the community spouse could keep the entire amount and the applicant would not be required to spend down assets. 

Proper planning can help a couple determine when the best time to apply for benefits based on the snapshot date and maximize the assets the couple can keep. Give us a call if you or a loved one needs help qualifying for Medicaid (referred to as Tenncare in Tennessee).