Married Medicaid Rules

Each year, more than a million U.S. citizens receive health care benefits under the federally created Medicaid program. Medicaid provides health care benefits to low-income individuals and their families and to some individuals with medical bills that dramatically affect the availability of their regular income for day-to-day expenses. Each state administers its own Medicaid program and places strict guidelines on eligibility and other rules for participation. One factor used to determine eligibility is marital status. Married individuals are subject to some rules that do not apply to single individuals.

Income Rules

• One key criterion in determining Medicaid eligibility is income. The program requires married individuals to report their entire family income rather than their own income. In New York, for example, a single individual can earn $8,479 but a married couple can earn only $10,584. If a married couple qualifies for Medicaid, both spouses receive benefits. Individuals who are married but living separately do not need to include their spouses in the family income unless the spouse provides financial support for the household. If the spouse provides support, only the amount of that support is factored into the household income. In some cases, individuals who do not meet income guidelines still can qualify for Medicaid through an appeal. They must prove that they have long-term health care costs that leave little income for other living expenses.

Joint Assets

• Individuals who qualify for and receive Medicaid as single adults can lose those benefits if they become married and establish joint ownership of assets that were previously owned only by the other individual. This is because Medicaid rules in most states limit married couples' joint assets. In Wisconsin, Medicaid recipients are limited to $3,000 in joint assets before the couple becomes ineligible for Medicaid benefits, even if the couple meets income requirements. The rule also affects married elderly couples, who often need Medicaid help with long-term care costs. According to the Ohio Bar Association, the Ohio Department of Job and Family Services allows married couples exemptions for some assets. In accordance with federal Medicaid rules, homes and most automobiles are exempt and do not factor into assets. Some states also allow a portion of combined assets to be held by only one spouse. This can help the other spouse qualify for Medicaid benefits. Some states also have rules that allow one individual to continue to hold sole ownership of certain assets obtained before marriage, such as money that is not available to both spouses. In such cases, the money is only counted as an asset for the spouse that retains the sole ownership of the asset.

Gay Marriage

• Considerable debate has focused on whether Medicaid should be extended to gay couples. Gay marriage or civil unions are recognized in six of the 50 U.S. states, but a federal law has banned gay marriage and does not recognize the unions allowed in each of the states. On July 8, 2010, a federal judge ruled that the federal law banning gay marriage is unconstitutional because it interferes with states' ability to provide federal benefits for gay couples. In Massachusetts, the state argued that it should not be forced to deny gay couples the right to Medicaid benefits.