Medical Assistance for Long-Term Care Services
At the time of a request for Medical Assistance for Long-Term Care Services (MA-LTC), the LTC spouse who has a community spouse must report and verify their assets. An asset evaluation is used to calculate which assets are protected for the community spouse. The assets that the community spouse is allowed to keep is called the Community Spouse Asset Allowance (CSAA).
There are many factors that a couple must consider when deciding which of the couple's assets are included in the CSAA, including tax implications as well as personal factors such as the desire to retain ownership of a particular asset. The decision on how to divide the couple’s assets is up to the couple. The couple can contact a tax accountant, an attorney or someone who specializes in estate planning for questions unrelated to Medical Assistance (MA) policy.
The CSAA includes the couple’s total countable assets as determined by the asset evaluation. The couple must provide proof of the value of all of their assets, regardless of whether the asset is excluded or unavailable.
The total value of the couple's countable assets are compared to the maximum CSAA. The community spouse may keep up to the maximum asset allowance in effect on the date of the request. The maximum CSAA is updated annually.
The remaining assets that do not make up the CSAA are evaluated in an asset eligibility determination for the LTC spouse, to determine whether the LTC spouse meets the MA asset limit. If the couple's assets exceed the CSAA and the MA asset limit, the LTC spouse may have to reduce assets before MA can be approved.
An asset evaluation is not used to determine asset eligibility if an enrollee receiving MA-LTC marries a person who meets the definition of a community spouse after eligibility for MA-LTC is approved.
A new asset evaluation is required if a person has a break in LTC services of one calendar month or more and the county or tribal agency receives a new request for MA-LTC.
When an asset evaluation is required and the LTC spouse does not know the whereabouts of the community spouse, they must make a reasonable effort to locate the community spouse.
If reasonable efforts to locate the community spouse do not succeed, eligibility for MA-LTC for the LTC spouse is still possible. The LTC spouse must report assets on the application based on the information they know about the community spouse's assets. The signature of the community spouse on the Account Validation Service (AVS) authorization (DHS-7823) is not required to complete the CSAA.
The LTC spouse, the LTC spouse's authorized representative, if applicable, and the community spouse must be notified of the CSAA. Any of these individuals may appeal the results.
The CSAA is increased beyond the maximum CSAA in the following situations:
A court, due to a legal separation, orders an amount of the couple’s assets for the community spouse that is greater than the CSAA.
The community spouse qualifies for additional income-producing assets to meet the community spouse’s monthly maintenance needs.
A community spouse may keep additional income-producing assets above the CSAA, if he or she cannot meet his or her monthly maintenance needs with the income allocated from the LTC spouse combined with his or her own income.
The couple must meet the following requirements for the community spouse to keep additional income-producing assets above the CSAA:
The community spouse’s income, combined with any income allocation from the LTC spouse, is less than the calculated monthly maintenance needs.
The CSAA must already include as many income-producing assets as possible.
The LTC spouse must make available, and the community spouse must accept, the community spouse income allocation. The couple cannot refuse to make or accept a community spouse income allocation as a way to reduce the community spouse’s income in order to qualify for additional income-producing assets.
The purchase of an income-producing asset for the benefit of the community spouse, under this provision, must occur before MA-LTC may be approved.
The amount of assets above the CSAA is limited to an amount necessary to produce the additional income needed to meet the community spouse's monthly maintenance needs.
Assets already producing an income cannot be used to purchase another income-producing asset, unless the asset purchased produces more income.
Assets considered available to the community spouse through the CSAA must be put in the community spouse’s name no later than the LTC spouse’s next annual renewal. At the LTC spouse’s next annual renewal, all assets still in the name of the LTC spouse are evaluated in order to determine asset eligibility.
Income from an asset in the LTC spouse’s name is counted in the LTC income calculation even if it is income produced by an asset that is considered part of the CSAA. Therefore, it is in the best interests of the couple to transfer any income-producing asset in the name of the LTC spouse to the community spouse as soon as possible.
Ownership of assets that are in the community spouse's name but are not included in the CSAA and do not have to be reduced must be transferred to the LTC spouse. Transfer of ownership must be verified before MA-LTC eligibility may be approved.
The community spouse must make assets owned jointly or individually in excess of the CSAA available to the LTC spouse. If the community spouse does not make those assets available, the LTC spouse may still be found eligible for MA-LTC if the LTC spouse cannot use those assets without the consent of the community spouse, and if any of the following occurs:
the LTC spouse assigns the right to support from the community spouse to the Minnesota Department of Human Services (DHS)(this is done by signing the Minnesota Health Care Programs Application for Long-Term Care Services (DHS-3531));
the LTC spouse is unable to assign the right to support due to a physical or mental impairment; or
the denial of eligibility would cause an imminent threat to the LTC spouse's health and well-being.
A person whose request for a hardship waiver is denied can appeal the denial. When MA-LTC is approved under this provision, the county or tribal agency makes a referral to the county attorney’s office to determine if a cause of action exists against the community spouse.
Once MA-LTC has been approved, any additional assets acquired by the community spouse are not available to the LTC spouse, as long as there is no break in MA-LTC eligibility for one calendar month or more and the county or tribal agency receives a new request for MA-LTC.
Minnesota Statutes, section 256B.059
Minnesota Statutes, section 256B.0913, subdivision 12