Department of Human Services: Chapter 2: Exhibit VII-3

2.4.3:

Assistance Unit Requirements

If the community spouse is eligible for MA as SR, each spouse is considered to be financially responsible for the other for the month of their physical separation. During this one-month period, both spouses are included in the same assistance unit.

2.5: MA Income Eligibility Determination

In addition to the allowances listed, individuals institutionalized prior to October 1, 1989 who have a community spouse also receive an allowance for maintenance of the spouse and children (see Section 2.6: LTC Income Allowances below).

2.6: LTC Income Allowances

If the community spouse is eligible for MA as an SR, apply the income deductions (see Chapter 6: Income Disregards and Deductions in Part VI) to the income of the community spouse before adding his/her net income to the income of the institutionalized spouse. The LTC SSR should then apply the LTC Income Allowances to their combined income.

In addition to those listed, the LTC Income Allowances also include an allowance for maintenance of the spouse and children.

When an individual entering or residing in a LTC facility has a community spouse and/or dependent children who are not included in his/her assistance unit, an amount may be deducted from the total countable income of the institutionalized spouse for maintenance of the community spouse and any dependent children. This allowance is only allowed for institutionalized spouses who were residing with the community spouse at the time of admission to the LTC facility.

Before the allowance can be deducted, the financial eligibility for MA of the community spouse and any dependent children must first be established and verified (see Part VI: Financial Eligibility Requirements). If the community-assistance unit's total countable assets are within the appropriate medically needy asset limitation and net MA income is less than the appropriate MNIL, deduct an allowance from the institutionalized spouse's income for maintenance of the community-assistance unit. The allowance is the difference between the net MA income of the community-assistance unit and the MNIL that corresponds to the size of the community-assistance unit.

Example

Mrs. Carey is 45 years old and is institutionalized. Her husband lives in the community with their two children, Sam (14) and Alissa (16). The total countable assets of Mr. Carey, Sam, and Alissa is less than the medically needy asset limitation. Their net MA income equals $450. The MNIL for a group of three equals $652.92. Consequently, Mrs. Carey is eligible for an allowance of $202.92 ($652.92 - $450.00) to be deducted from her income.

If the institutionalized spouse is eligible for this allowance, then the community-assistance unit has effectively established financial eligibility for MA by meeting the financial eligibility requirements. However, the community-assistance unit cannot be certified for MA unless an application is submitted and the community-assistance unit meets all of the non-financial eligibility requirements (see Part IV: Non-Financial Eligibility).

For the LTC assistance unit in which both the community spouse and the LTC spouse are SR, this allowance is not applicable until the month following the month of physical separation (i.e., when the community spouse and the institutionalized spouse are no longer considered to be members of the same assistance unit).

2.7: Projected Income

Projected Income The allowance for maintenance of the spouse and children also may be projected for a prospective period not to exceed six months.

2.15: Determining Total Countable Income for PPA Calculation

If the community spouse is eligible for MA as an SR, each spouse is considered to be financially responsible for the other for the month of their physical separation. In addition, apply the income deductions (see Chapter 6: Income Disregards and Deductions in Part VI) to the income of the community spouse before adding his/her net income to the income of the institutionalized spouse. The LTC SSR should then apply the LTC income allowances to their combined income.