House Passes Bill With Medicaid Home Care Eligibility Provision

Members of the U.S. House voted 371-46 Tuesday to pass H.R. 3253, a bill that would extend the Medicaid long-term care benefits eligibility “spousal impoverishment” rules.

The provision could affect financial professionals with clients married to people who are using Medicaid to pay for home care services or adult day care services.

The Spousal Impoverishment Rules

Federal law normally limits use of Medicaid benefits to low-income people with limited assets.

The eligibility rules tend to be looser for people who are using Medicaid to pay for nursing home care or for other long-term care services, and especially for the spouses of people who are using Medicaid long-term care benefits.

One policymaker goal has been to keep a man or woman from becoming desperately poor simply because a husband or wife is using Medicaid long-term care benefits.

The current rules let the healthier spouse keep extra assets when the sicker spouse is using Medicaid to pay for home care or adult day care services.

Congress has been keeping the anti-spousal impoverishment rules for home and community-based care in place through a series of short-term extensions. The current authorization for those rules is set to expire Sept. 30, 2019.

H.R. 3253 would push the expiration date to March 31, 2024.

The Debate

Some long-term care planners and policy specialists oppose many of the federal and state rules that ease Medicaid eligibility requirements for people who are using Medicaid to pay for long-term care services.

Opponents of “Medicaid LTC planning” contend that Medicaid planning strategies shift scarce government health care funding to middle-income families, or even upper-income families, from poor families; reduce the incentive for middle-income and upper-income families to use their own resources to prepare for long-term care expenses; and may crowd out private long-term care insurance and savings arrangements.

The Vote

House leaders put H.R. 3253 on their “suspension calendar,” or list of bills with broad, bipartisan support that can be considered without all of the requirements applied to more controversial bills.

H.R. 3253 was more hotly contested than many bills considered using the suspension calendar process.

All Democrats who participated in the vote voted for the bill, but 46 of the 188 Republicans who participated voted against the bill.

Rep. Greg Walden, R-Ore., the highest-ranking Republican on the House Energy and Commerce Committee, rose during House floor debate to speak in favor of both the bill and the anti-spousal impoverishment provision.

“This bill actually helps keep spouses of elderly patients from impoverishment and out of costly nursing home settings,” Walden said during the debate, which was streamed live on the web. “For spouses of patients receiving home or community-based care, the bill will protect them from impractical reductions in their income or resources.”

The list of Republicans who voted against the bill includes Justin Amash, of Michigan; Jim Jordan, of Ohio; and Mark Meadows, of North Carolina. Opponents did not talk about their thoughts on the bill on the House floor.

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