Medicaid’s Snapshot Date for Long Term Care (in a Nursing Home or at Home)

Last updated: October 20, 2020

 

Definition: Medicaid Snapshot Date

The Medicaid snapshot date is the date on which Medicaid takes a financial “snapshot” of a married couple’s assets. (The “snapshot” can be thought of as taking a photo). To be clear, the snapshot date is only relevant for married couples in which only one spouse is an applicant for Medicaid (be that for nursing home care or in-home and community-based services). Remember, Medicaid has financial limitations (income and assets) in order for one to be eligible for long-term care. Furthermore, Medicaid considers all assets of a married couple to be jointly owned.

The “snapshot” is used to calculate the amount of countable assets the non-applicant spouse, also called a community spouse, can retain. This is called a Community Spouse Resource Allowance, is abbreviated as CSRA, and is a spousal impoverishment protection. The CSRA is intended to prevent non-applicant spouses from living in poverty so their applicant spouses can meet Medicaid’s asset criteria. The Medicaid snapshot date is also used to determine if an applicant spouse is asset eligible for Medicaid, and if not, how much must be “spent down” to become eligible.

 

When is the Snapshot Date / How is it Determined?

According to federal regulations, for Medicaid nursing home applicants, the date of the snapshot is the first day on which the applicant was continuously institutionalized. Further defined, it must be the first time the individual was institutionalized for a minimum of 30 days without returning home. “Institutionalized” could mean an applicant was in the hospital, a nursing home, or spent part of the time in the hospital and the remainder of the time in a nursing home.

Note that the date used for the snapshot may vary slightly based on the state in which one resides. For instance, a state may use the actual date that the applicant was institutionalized or may use the first day of the month in which the applicant was admitted. To avoid confusion, the snapshot date occurs prior to one applying for long term care Medicaid. If an individual has had more than one nursing home stay that qualifies as a snapshot date, the first period of “continuous institutionalization” will be used as the snapshot date.

 Because the snapshot date is prior to application, it is critical that families know whether or not they are Medicaid-eligible prior to applying. An eligibility pre-screen is available here.  

For long term care in which a Medicaid recipient receives benefits and services in his / her home and /or community, the “snapshot” date is generally the date of one’s Medicaid application or the date of the functional needs assessment to determine functional eligibility. A nursing home level of care, or at the very least, assistance with activities of daily living, is required for long-term home and community based services.

Note that some states may take a second snapshot at the time a Medicaid application is submitted. This second Medicaid snapshot is because the amount of one’s assets can change between the date that one is first institutionalized and the date of Medicaid application.

 

Examples of Medicaid Snapshot Date

Example 1:
Charles had a stroke on February 7th, 2020 and was admitted to the hospital, and upon hospital discharge, immediately moved into a nursing home. His condition unfortunately has not improved and his wife, Emelia, is not equipped to provide care for him at home. As the months have gone by, Emelia realizes that Charles will need to apply for nursing home Medicaid in order to pay for his continued care. In August of 2020, a Medicaid application is submitted. The snapshot date will be February 7th, 2020.

Example 2:
Richard lives at home with his wife, Anna, but has difficulty completely some of his daily living activities, such as bathing, dressing, and eating, without assistance. Anna provides help as she can, but it is too much for her to handle on her own. On January 12th, 2020, an application is submitted for long-term home and community based services via a Medicaid waiver. The snapshot date will be January 12th, 2020.

 

How is the Snapshot Taken?

The Medicaid snapshot, which may also be referred to as a resource assessment, is usually done with a specific form (i.e., asset declaration form) and financial documentation. The form must be completed to reflect the value of the assets owned by the applicant spouse and the non-applicant spouse on the snapshot date. Documentation proving ownership and the value of the assets on the snapshot date must also generally be submitted with the asset declaration form.

 

Calculating the CSRA from the Snapshot

Once the snapshot is taken and the total amount of the couple’s countable assets calculated, the value of the couple’s assets protected for the non-applicant spouse is calculated as a resource allowance and it is determined if the applicant is asset eligible.

In order for a Medicaid applicant to be eligible for long term care, he / she must have limited assets, generally no more than $2,000, as well as meet other eligibility criteria. However, for the purpose of calculating the CSRA, only assets are relevant. (To see asset limits and other eligibility requirements by state, click here). When an applicant is married and only one spouse is applying for long term care Medicaid, as is the situation with the Medicaid snapshot, the non-applicant spouse is entitled to a larger portion of the couple’s assets. To be clear, this spousal asset allowance is above and beyond the $2,000 in assets the non-applicant spouse is able to retain. At the time of this writing, in most states, a non-applicant spouse is entitled to a maximum CSRA of $128,640. (State specific CSRAs can be found here).

Please note that not all assets are counted towards Medicaid’s asset limit. For instance, one’s primary home, household furnishings, personal belongings, and vehicle are generally exempt from the limit. Some examples of countable assets include checking and savings accounts, stocks and bonds, and real estate other than one’s primary home, such as a vacation home, etc. Furthermore, some, but not all states, count retirement funds, such as IRAs and 401Ks. (Learn more).

When calculating the amount of the CSRA, it is important to mention and differentiate between 50% and 100% states. (To see if a state is a 50% or a 100% state, click here). In a 100% state, a non-applicant spouse can keep 100% of the couple’s assets up to the maximum CSRA. In 100% states, the snapshot date is not relevant. Instead of utilizing a snapshot date, the couple’s total amount of assets are considered on the date a Medicaid application is submitted. In 50% states, there is a minimum CSRA in addition to the maximum CSRA. At the time of this writing, the minimum CSRA in most states is $25,728, and as mentioned previously, the maximum CSRA is generally $128,640. (To see state specific minimum and maximum CSRAs, click here).

In 50% states, the couple’s total countable assets are added up and divided into two. To clarify, half of the assets are considered to belong to the non-applicant spouse and the other half to the applicant spouse. However, if the non-applicant’s half of the assets are less than the state’s minimum CSRA, he / she can be allotted some of the applicant spouse’s portion to bring his / her share of assets up to the minimum CSRA. If the non-applicant spouse’s share of assets falls between the minimum and maximum CSRA, then that is his / her CSRA, and if the non-applicant spouse’s half of the assets are in excess of the maximum CSRA, he / she can only keep as much as the maximum CSRA.

As a few quick examples, let’s take a look at a state with a minimum CSRA of $25,728, a maximum CSRA of $128,640, and an applicant asset limit of $2,000. Please note that any “excess” assets must be “spent down” before the applicant can become asset eligible, and hence, qualify for long term care Medicaid. https://www.medicaidplanningassistance.org/medicaid-spend-down/

1) A couple has $40,000 in countable assets, which means $20,000 belongs to the non-applicant spouse and $20,000 belongs to the applicant spouse. Because the non-applicant’s share is less than the minimum CSRA, he / she is entitled to a portion of the applicant spouse’s assets, bringing his / her CSRA to $25,728. The applicant spouse can retain $2,000 in assets. This means they must spend down $12,272 in assets before the applicant is asset eligible.

2) A couple has $70,000 in countable assets, $35,000 of which belongs to the non-applicant spouse and the other $35,000 to the applicant spouse. Because $35,000 is between the minimum CSRA of $25,728 and the maximum CSRA of $128,620, the non-applicant’s CSRA is $35,000. The applicant spouse can keep $2,000, and the remaining $33,000 must be spent down for the applicant spouse to become asset eligible.

3) A couple has $300,000 in countable assets, which means $150,000 is said to belong to the non-applicant spouse and the other $150,000 to the applicant spouse. The non-applicant spouse can keep up to the maximum CSRA of $128,640 and the applicant spouse can keep $2,000. This means $169,360 in assets will need to be spent down in order for the applicant spouse to meet Medicaid’s asset limit.

 

Important of Advance Planning

Medicaid’s snapshot date and the calculation of assets can be complicated. For this reason, it is highly recommended that one contact a Medicaid planner. These professionals can help to establish one’s snapshot date, calculate the value of the couple’s countable assets, determine the amount of assets the non-applicant spouse can keep, and assist in implementing Medicaid planning strategies to maximize the amount of assets a couple can retain. Ideally, one should contact a professional Medicaid planner well in advance of the need for long term care to implement planning techniques. This is because there are more options to maximize the amount of assets that can be preserved for the non-applicant spouse, as well as to protect assets from Medicaid’s estate recovery program. Find a Medicaid expert here.

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