Medicaid and the Minimum Monthly Maintenance Needs Allowance
The Minimum Monthly Maintenance Needs Allowance (or MMMNA) is a Medicaid concept that becomes important between legally married couples where one spouse desires Medicaid and requires institutional care (skilled nursing facility / nursing home); and the other spouse is relatively healthy (referred to as the “Community Spouse”) and does not desire Medicaid.
In this situation, there are laws in place that are designed to prevent the well / community spouse from being forced into poverty due to the very restrictive asset and income Medicaid qualification standards.
Typically, the Medicaid / institutionalized spouse’s monthly income goes to the facility handing his/her long-term care needs, less a "personal needs allowance" ($130.00 / month as of January 2022). The Medicaid recipient’s contribution (i.e. co-pay) is known as “cost of care” or "patient responsibility."
But, a portion (or all) of a Medicaid recipient’s income can be diverted to the community spouse (thereby reducing their cost of care) if the community spouse does receive enough income to cover certain living expenses. This is referred to as the "monthly maintenance needs allowance."
However, Medicaid has a "you can't have your cake and eat it to" exception: those engaging in the "spousal refusal" or "just say no" Medicaid strategy cannot take advantage of the MMMNA!
But, we elder law attorneys can get creative. As an example, we might suggest engaging family-law attorneys for the purposes of entering a marital income settlement without dissolution (i.e. get a judge to order that the sick spouse's income be diverted to the well spouse). This is only if the minimum monthly maintenance needs allowance provides insufficient income to the well spouse.
How to Calculate the Monthly Maintenance Needs Allowance in Florida
In Florida there is a Minimum and Maximum Monthly Maintenance Needs Allowance. In 2022, the MMMNA is $2,178.00/month. The Maximum Monthly Maintenance Needs Allowance is $3,260.00 (these numbers change periodically and will be updated on the linked page with important Medicaid numbers for Florida).
The community spouse can always get the MMMNA. So, as an easy example, if the community spouse only earns $1,178.00/month and the Medicaid spouse earns $1,000.00/month, the Medicaid spouse’s cost of care will be zero, because all of their income will be diverted to the well spouse to meet the MMMNA standards.
In order to divert more than the Minimum Monthly Maintenance Needs Allowance, without going to court, the Medicaid caseworker will look at a few additional items:
Medicaid Shelter Standard
Currently the excess shelter standard is: $654.00 (as of 2022, again, this number is subject to change). If the community spouse’s shelter expenses (e.g. mortgage + real estate taxes or rent payments + homeowners insurance) do not exceed the shelter standard, the MMMNA will be sufficient. But if the community spouse’s actual shelter expenses exceed the excess shelter standard, then the Monthly Maintenance Needs Allowance income diversion can be increased from the Minimum Monthly Maintenance Needs Allowance up to the Maximum Monthly Maintenance Needs Allowance.
Medicaid Standard Utility Allowance
The average utility cost in the State of Florida is: $361.00/month (as of 2020) which is automatically added to the cost of living calculation to determine whether the Minimum Monthly Maintenance Needs Allowance can be exceeded.
As a 2020 example, if the community spouse has: (a) a mortgage payment and real estate taxes of $1,200 + (b) homeowners insurance of $300. You would then add to that the (c) Standard Utility Allowance… So, $1,200 + $300 + 361 = $1,861 per month of total monthly shelter + utility expenses.
You would then deduct the Medicaid Shelter Standard of $634, which gets you an excess shelter expense of: $1,227 per month ($1,861 - $634). Since the Minimum Monthly Maintenance Needs Allowance in Florida is: $2,114.00 (as of 2020) , the community spouse is entitled to a dollar-for-dollar raise in her excess shelter expense (not to exceed the Maximum Monthly Maintenance Needs Allowance).
We would then add: $2,114.00 + $1,227.00 = $3,341.00 as the "excess shelter expenses."
Since, $3,341.00 exceeds the Medicaid Maximum Monthly Needs Allowance, the community spouse only gets up to $3,217.00 (because that is the maximum) to maintain his/her lifestyle.
Sample Monthly Maintenance Needs Allowance Calculation
Lets assume that the Medicaid-recipient spouse earns $3,500.00 per month (requiring a qualified income trust or Miller trust) and the Community Spouse earns $1,000.00 per month. Also assume the above cost of living numbers. Even though the excess shelter expenses add up to $3,341.00, the community spouse will only be able to divert enough of the Medicaid spouse's income so that the Community Spouse earns up to the Maximum Monthly Maintenance Needs Allowance.
In this case, we would be able to divert $2,161.00 from the Medicaid Spouse to the Community Spouse ($2,161 + $1,000 of CS's current income = $3,161.00, the Maximum Monthly Maintenance Needs Allowance).
So the Medicaid spouse's cost of care would roughly be: $1,339.00 per month (less a $130.00 personal needs allowance). Medicaid will pick up the difference.
For any other questions regarding how the Medicaid application works, or how to protect the assets of the Medicaid recipient (and their community spouse), set up an Elder Law Attorney consultation today.
Another blog post discusses a potential Medicaid planning strategy to use when the MMMNA isn't enough for the community spouse.
Florida Medicaid Lawyer Resources
The minimum monthly maintenance needs allowance excess shelter cost calculation can be found in ESS Policy Manual Section 2640.0119.04.
Actual Text of: 2640.0119.04 discussing the Minimum Monthly Maintenance Needs Allowance.