ACL Policy Update: ICYMI – Extension of spousal impoverishment rules for HCBS

May 31, 2021
Vicki Gottlich, Director, Center for Policy and Evaluation, ACL

As we close Older Americans Month today, we wanted to call your attention to an important provision of the Consolidated Appropriations Act of 2021 that helps older people to live independently and participate in the community.

Under Medicaid financial eligibility requirements for nursing home care, states can disregard, or not include in their eligibility calculations, some income and assets of married individuals when one of the spouses needs long-term services and supports. The provisions, known as the spousal impoverishment rules, are designed to provide the spouse who does not enter the nursing home with a share of income and resources to prevent them from being impoverished.  In other words, the person going into the nursing home does not have to use all of the couple’s resources for their nursing home care, leaving their spouse with very little.

The Affordable Care Act (ACA) authorized the same spousal impoverishment rules to apply to people who are eligible for Medicaid home- and community-based services (HCBS). Thus, the ACA promoted community living by removing a financial incentive for a Medicaid beneficiary to receive services in a nursing home rather than their own home. The ACA provision, which originally was due to expire in 2018, has been extended several times. Most recently, the Consolidated Appropriations Act of 2021 extended the ACA’s mandate until September 30, 2023.

The Centers for Medicare & Medicaid Services (CMS) issued a Center Informational Bulletin (CIB) on May 4 to reminds states that they are required to apply the spousal impoverishment rules to married Medicaid applicants and beneficiaries of HCBS through that date. 


Last modified on 05/31/2021


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