Medicaid Treatment of Unmarried Couples in Long-Term Relationships

Medicaid generally treats each partner of an unwed couple as if they were single, even if the couple lives together. This means the finances of one partner does not impact the long-term care Medicaid eligibility of the other partner. In other words, when one partner applies for Medicaid, it is only their income and assets that are calculated towards Medicaid’s income and asset limits. The income and assets of the non-applicant partner are disregarded.

Depending on the finances of each partner, there could be some advantages for an unmarried couple to wed. If one spouse of a married couple is applying for Nursing Home Medicaid or home and community based services (HCBS) via a Medicaid Waiver, the income of a non-applicant spouse is not counted towards the income eligibility of their applicant spouse. Furthermore, while there is an income limit for the applicant spouse, if the non-applicant spouse does not have sufficient income to support themself, the applicant spouse may be able to transfer a portion of their monthly income to their non-applicant spouse as a Monthly Maintenance Needs Allowance (MMNA). See state-specific income limits.

Medicaid, however, considers the assets of a married couple to be jointly owned. Therefore, the assets of both spouses (regardless of if only one spouse is an applicant) is counted towards Medicaid’s asset limit. When only one spouse of a married couples applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, the applicant spouse is generally only permitted $2,000, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA). Therefore, if the non-applicant spouse has little assets, and the applicant spouse has a fair amount, the CSRA could be beneficial to the non-applicant spouse. See state-specific asset limits.

Another important point of relevance for long-term care Medicaid applicants is Medicaid’s Look-Back Period. This is a period of 60 months immediately preceding Medicaid application during which the Medicaid agency scrutinizes all asset transfers, looking for assets that have been gifted (including selling an asset for under fair market value). If assets have been “gifted”, this is a violation of the Look-Back Period, and the applicant is penalized with a period of Medicaid ineligibility. Married couples, however, can freely transfer assets between themselves without violating Medicaid’s Look-Back Rule and risking a Penalty Period. Unmarried couples, however, cannot.

Note that for Regular Medicaid, which relevant to seniors, is often called Aged, Blind and Disabled Medicaid, the income and assets of a married couple are calculated differently. The income and assets of both spouses, even if only one spouse is an applicant, is used to calculate financial eligibility. Furthermore, there is no Look-Back Period.