What is the CSRA and How is it Calculated? (Part 1)

CSRA stands for community spouse resource allowance, that amount of money that a healthy spouse can keep and still qualify the ill spouse for Medicaid.  Sounds simple but if misunderstood and misapplied, it can cost the healthy spouse tens of thousands of dollars in lost assets and additional nursing home bills.  Allow me to explain.

 First, let’s review the asset rules.  We know that a Medicaid applicant must spend down his/her countable assets (generally, a home, car and a few other items are non-countable or exempt and most everything else is countable) to below $2000 by the end of the month in order to be eligible for Medicaid the following month.  However, what happens in the case of a married couple where one spouse needs Medicaid?  We can’t simply shift all the assets over to the healthy spouse to get the sick spouse under $2000.  That’s because Medicaid treats the married couple as one unit.  It does not matter which one “owns” the assets.

 They add up all the countable assets and divide in half.  The healthy spouse gets to keep one-half of the countable assets, but only up to a maximum limit of $113,640.  This means that if the couple has $150,000, the healthy spouse can keep $75,000.  If they have $250,000, the healthy spouse can only keep $113,640, not $125,000.

 Sounds pretty simple, but then you may ask, “at what point in time is this calculation made?”  After all, investments and bank accounts can fluctuate over time, assets may be spent.  That’s where the snapshot date becomes important.  We must determine the value of all countable assets as of the first day of the first month of continuous institutionalization.  That is the first day of the first month that the applicant enters a nursing home, intermediate care facility, or licensed special hospital.

 That’s critical to determine because if you use the wrong date, when the amount of assets was higher, then your CSRA number will be too high.  Let’s say I calculate the assets to be $200,000 at what I think is the correct snapshot date.  My spend down target is $100,000, or so I think.  But, if I used the wrong date, and my assets were valued at $180,000 on the correct snapshot date, then I must actually spend down to $90,000.  Next week I’ll explain how costly that mistake could prove to be.