Resources and income are evaluated for married couples when one spouse is institutionalized and one spouse continues to live in the community (referred to as the “community spouse”) when applying for the Institutional Care Program (ICP), Institutional Hospice, HCBS Waiver (Cystic Fibrosis, iBudget SMMC LTC only) or PACE Programs.
Resources at Application:
All resources of the couple must be counted together to determine the eligibility of the institutionalized individual. After deducting $120,900.00 from their combined resources for the community spouse resource allowance, the institutional spouse’s remaining resources must not exceed $2,000.00 to qualify ($5,000.00 if the institutional spouse’s monthly income is $885.00 or less).
Resources after Approval:
Resources over the individual limit ($2,000.00 or $5,000.00) acquired after Medicaid is authorized must be transferred to the community spouse within twelve months after approval to maintain eligibility.
Income at Application:
Only the total gross monthly income received by the institutionalized spouse is considered in determining eligibility.
Allocation to the Community Spouse:
To calculate the amount of the institutional spouse’s income, a special budget is used to determine the monthly patient responsibility amount once the personal needs allowance has been deducted. An additional amount of the institutional spouse’s income may be allocated to the community spouse. This is called the community spouse needs allowance.
Determining the Community Spouse Needs Allowance:
The community spouse needs allowance is computed as follows: $2,030.00 (minimum monthly maintenance needs allowance) + excess shelter costs* – community spouse’s monthly gross income = community spouse income allowance**
*Excess Shelter Cost is the amount by which the community spouse’s shelter costs exceed $609.00 per month. Shelter costs may include rent or mortgage payment, homeowner’s insurance, condominium maintenance fees, and a monthly utility allowance of $338.00 based on the Food Assistance Program standard utility allowance.
** Total community spouse income allowance cannot exceed $3,023.00.
If there is a court order for support that is greater than the above allowance, the court ordered amount will be used as the community spouse allowance.
Under certain conditions, a dependent allowance may also be deduced from the institutionalized individual’s income.