ENFORCEMENT OF SUPPORT OBLIGATION

CS 870P Medicaid-eligible Noncustodial Parent in Nursing Home

06/87 Revised 01/05/16 Training Completed 08/26/08 Last Reviewed 11/04/24

In order to receive Medicaid, a noncustodial parent (NCP) who is in a nursing home is generally required to pay all but a small amount of his/her income toward the cost of care in the nursing home. The portion of the NCP’s income that s/he must pay to maintain Medicaid eligibility is called “family income” and is paid directly to the nursing home. The NCP is allowed to keep a small portion of his/her income for personal needs ($45.00 - $90.00 per month), and the amount necessary for spousal maintenance and insurance coverage is generally transferred to the spouse at home. The Office of Recovery Services (ORS) is not involved in the collection of family income and cannot enforce upon it since the NCP owes this amount to the nursing home for the cost of care. Similarly, the income required for personal needs, insurance, and spousal maintenance is not subject to child support collection or enforcement.

The only time it may be appropriate to pursue collection from the income and/or assets of an NCP who is a Medicaid recipient in a nursing home is when there is proof s/he has fraudulently transferred or hidden income and/or assets in excess of the spousal share limits to become eligible for Medicaid and/or to avoid paying child support. Consult with your management chain (Manager, Associate Regional Director (ARD), Regional Director (RD), and CSS Director) before proceeding with income withholding or any enforcement action.

If all of the NCP’s income with the exception of the portion allowed for personal needs and insurance offsets Medicaid costs and there is no proof that the NCP has fraudulently transferred or hidden income and/or assets, ORS/Child Support Services (CSS) will not pursue enforcement. If, at any point, the amount of family income exceeds actual Medicaid charges, the nursing home must send the difference to the Bureau of Medical Collections (BMC).

Review cases of NCPs in nursing homes for possible closure if Medicaid eligibility is expected to continue and discharge from nursing home care is unlikely. For additional information on case closure, refer to CS 061P Case Closure Overview.