When Both Spouses Need Care – Part 1

In some of my past blog posts, I have often presented scenarios in which one spouse needs long term care but the other one does not.  When we do long term care planning before any care is needed, we typically recommend placing assets in a trust to help insure they will be available not only for the first spouse to need care but also the second.  Without this type of planning, it is possible that providing care for that first spouse could exhaust most or all of their savings, leaving nothing for the second spouse.

In cases where clients reach us too late to do this type of preplanning, we are still often able to utilize strategies to maximize what the healthy spouse can keep before applying for Medicaid.  In other words, we want to get to Medicaid as quickly as possible to preserve as much as possible for the healthy spouse.  This is necessary since we don’t know how long that spouse will live (more often than not the healthy spouse is the wife who is younger than the husband and women live longer than men) or how much care they will need.

But, what if both spouses already need long term care?  We have had a number of recent cases in our office in which both spouses are in nursing homes or the family is about to place both in a facility.  At a cost of $15,000 per month per person, even $200,000 or $300,000 of assets won’t take very long to spend down before applying for Medicaid for both spouses at the same time.

In the case of double Medicaid applications, combined assets must be under $3000 at the close of business on the last day of the month directly preceding the first month of Medicaid eligibility.  One would think that simply spending these assets down and then applying for both spouses is the only answer.  In many cases, however, I can make a compelling case that you don’t want to do that.  Instead, it is often better to file one application at a time, getting to eligibility for the first applicant spouse as quickly as possible.

Next week I’ll tell you why.