Bipartisan legislation that would permanently extend spousal impoverishment protections for Medicaid beneficiaries receiving long-term care is being resurrected in Congress.
The Protecting Married Seniors from Impoverishment Act, introduced by U.S. Sen. Bob Casey (D-PA), chairman of the Special Committee on Aging, in the Senate, and U.S. Reps. Fred Upton (R-MI) and Debbie Dingell (D-MI) in the House, seeks to permanently implement the spousal impoverishment protections introduced by Congress three decades ago. The act is designed to keep married couples from falling into poverty when one spouse requires institutional care, such as assisted living or skilled nursing.
LeadingAge and Lutheran Services in America are among the organizations supporting the legislation.
“LeadingAge’s support for federal law establishing protections against spousal impoverishment is longstanding,” LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living. The issue is part of the association’s Blueprint for a Better Aging Infrastructure.
“We believe that the U.S. does not have the infrastructure for aging services that we need — and the systems we do have are crumbling,” Sloan said. “That’s why we included the call to make home- and community-based services spousal impoverishment protections permanent as part of our blueprint recommendations for expanding access to long-term care at home and in our communities.”
Charlotte Haberaecker, president and CEO of Lutheran Services in America, noted that two-thirds of the health and human services organizations within its national network provide older adults with long-term services and supports.
“While the five-year extension of the spousal impoverishment provisions that was part of the Coronavirus Response and Relief Supplemental Appropriations Act in December was vitally important to sustaining protections for seniors, it is time to make permanent the assurance that if one spouse needs long-term institutional care, the other won’t fall into poverty,” Haberaecker told McKnight’s Senior Living.
The rules in the act shield the spouse remaining at home from having to completely deplete his or her financial resources. In 2010, the Affordable Care Act expanded these protections to include LTSS received in home- and community-based settings. Legislation passed in December extended the spousal impoverishment protections through Sept. 30, 2023.
“This bill would make the spousal impoverishment protections permanent so that married couples would no longer have to worry about falling into poverty because one spouse needs Medicaid long-term services and supports at home,” Casey said in a statement, adding it would also clarify the existing rules, allowing states to go beyond the federal minimum standards set in statute.
The 2021 rules would permit a community spouse resource allowance, enabling the community spouse to retain a modest amount of his or her assets at the time of application, to cover basic living and health expenses. Medicaid also would not be able to count the community spouse’s income when determining Medicaid eligibility for the institutionalized spouse. The community spouse also would be entitled to a minimum monthly maintenance needs allowance.
“Our seniors are some of our most vulnerable citizens, and we need to ensure they and their families have the financial protections they deserve to have the quality of life they deserve,” Upton said in a statement.
“Spousal impoverishment protections are critical in helping families stay together in their homes and communities without going broke,” Dingell said. “That’s why we must make them permanent.”
Justice in Aging noted that if Congress doesn’t act, the expanded spousal impoverishment protections will expire in 2023.
“This means that individuals who qualified under the expanded protection may lose access to Medicaid and to their HCBS and may be left with no choice but to move into institutional long-term care, away from their spouses,” according to a statement from the organization. “Letting the spousal impoverishment protection expire will hurt families and force more people out of their homes and their communities.”
The legislation previously was introduced in the House in 2018 and 2019. Original co-sponsors of the Senate bill included Sens. Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Tammy Duckworth (D-IL), Kristin Gillibrand (D-NY), Amy Klobuchar (D-MN), Catherine Cortez Masto (D-NV), Jeanne Shaheen (D-NH), Tina Smith (D-MN), Debbie Stabenow (D-MI) and Chris Van Hollen (D-MD).