*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: January 1, 2011 |
|
19.45.05 - Community Spouse Asset Allowance |
Archived: June 1, 2016 (Previous Versions) |
A worker uses an asset assessment to determine the amount of assets set aside for the community spouse that the worker does not apply to the LTC spouse’s Medical Assistance (MA) asset limit when determining eligibility for MA payment of LTC services. The amount of assets that the community spouse may retain is the Community Spouse Asset Allowance. A worker attributes all assets of the couple that do not make up the Community Spouse Asset Allowance to the LTC spouse.
Asset Verification Requirements.
Which Assets are Evaluated in an Asset Assessment?
Determining the Community Spouse Asset Allowance.
When to Redetermine the Community Spouse Asset Allowance.
Asset Verification Requirements
Verify the value of all of the couple’s assets on the asset assessment effective date.
Follow standard Minnesota Health Care Programs policy for obtaining verifications.
The types of assets evaluated in an asset assessment are the same types of assets evaluated in Minnesota Health Care Programs eligibility determinations.
A worker either counts or excludes an asset. The availability of an asset is not a factor in this determination. Count all non-excluded assets even if they are unavailable.
Example:
Muhammad reports he owned a life estate interest in non-homestead real property on his asset assessment effective date. The property has an equity value of $200,000 and Muhammad’s life estate interest, based on his age on the asset assessment effective date, was .58914. There are no other life estate owners, so his life estate interest was worth $117,828 ($200,000 X .58914).
Action:
Count the life estate interest, $117,828, when determining the Community Spouse Asset Allowance.
Example:
Casper reports he was a seller on a contract for deed on his asset assessment effective date. The outstanding principal balance on his asset assessment effective date was $52,159.96. Casper, per the terms of the contract for deed, cannot sell the contract.
Action:
Count the outstanding principal balance, $52,159.96, when determining the Community Spouse Asset Allowance.
If either the LTC spouse or the community spouse had an interest in a trust on the asset assessment effective date, determine the amount of the trust corpus that the LTC spouse or the community spouse could access on that date. Review the trust document and follow the policy listed in the trust section of the HCPM to determine the amount of the trust corpus the LTC spouse or community spouse had access to.
n Do not count the amount of the trust corpus that the couple could not access.
n Do not count Special Needs or pooled trusts that meet the criteria to be excluded.
n If the LTC spouse or the community spouse could access an amount of the trust corpus, require an accounting of the trust corpus on the asset assessment effective date to determine the value to use in the asset assessment.
n Non-excluded, client-funded irrevocable trusts created on or after July 1, 2005 are revocable by operation of state law for trust beneficiaries requesting or receiving MA payment of LTC services. When processing a requested asset assessment, consider these trusts to be revocable. Base the estimated Community Spouse Asset Allowance on the amount of the trust corpus accessible to the LTC spouse if he or she were to apply for MA payment of LTC services.
Determining the Community Spouse Asset Allowance
Follow these steps to determine the Community Spouse Asset Allowance. Base this calculation on the assets owned by the couple on the LTC spouse’s asset assessment effective date. Use Method B methodology when calculating the Community Spouse Asset Allowance. This is true even if the LTC spouse’s basis of eligibility requires a different methodology to calculate asset eligibility for MA.
1. Identify excluded assets.
Exclude certain assets owned by a couple for purposes of determining the Community Spouse Asset Allowance. Follow the standard guidelines for excluded assets for Method B with the following exception: exclude one vehicle (regardless of which spouse owns the vehicle) for the couple. Exclude the vehicle with the lowest equity value.
Evaluate whether the asset met the criteria to be excluded based on the couple’s situation on the asset assessment effective date.
Example:
Romeo and his spouse owned a savings account with a value of $12,000 on his asset assessment effective date. The funds in the account were from a lump sum payment of RSDI that Romeo received within nine months of his asset assessment effective date.
Action:
Exclude the savings account as an asset in determining the Community Spouse Asset Allowance.
2. Calculate the total counted value of all non-excluded assets owned by the couple on the asset assessment effective date.
Follow standard Method B policy based on the type of asset to determine the counted amount of an asset. If applicable, round the counted value of each asset up or down to the nearest cent.
Add together the counted value of all non-excluded assets to determine the total counted value, regardless of availability, for all of the couple’s non-excluded assets.
3. Determine one-half of the total counted value of all non-excluded assets owned by the couple.
Divide the total counted value of all non-excluded assets owned by the couple (the amount determined in Step 2) by two. Round the amount down to the nearest cent.
Example:
The total counted value of all non-excluded assets is $10,800.45. One-half of the total counted value is $5,400.225.
Action:
Round the amount down to the nearest cent. One-half of the total counted value is $5,400.22.
4. Compare one-half of the total counted value of all non-excluded assets owned by the couple to the minimum/maximum Community Spouse Asset Allowances.
When the Community Spouse Asset Allowance is being determined based on a requested asset assessment, use the minimum/maximum amounts in effect for the year in which the agency processes the requested asset assessment.
When the Community Spouse Asset Allowance is being determined based on a request for MA payment of LTC services, use the minimum/maximum in effect for the month the LTC spouse requests MA payment of LTC services to begin.
n If one-half of the total counted value of all non-excluded assets is less than or equal to the minimum Community Spouse Asset Allowance, the Community Spouse Asset Allowance is the minimum amount.
n If one-half of the total counted value of all non-excluded assets is greater than the minimum but less than the maximum Community Spouse Asset Allowance, the Community Spouse Asset Allowance is one-half of the total counted value of all non-excluded assets owned by the couple.
n If one-half of the total counted value of all non-excluded assets is greater than or equal to the maximum Community Spouse Asset Allowance, the Community Spouse Asset Allowance is the maximum Community Spouse Asset Allowance.
Notify both the client, including the client’s authorized representative if applicable, and the community spouse of the results of the asset assessment. Complete the appropriate results form and mail a copy to each party. Retain a copy of the form in the case file.
l Send the Asset Assessment Results (DHS-3340A) form when a Community Spouse Asset Allowance is determined based on a request for MA payment of LTC services.
l Send the Requested Asset Assessment Results (DHS-3340B) when an estimated Community Spouse Asset Allowance is determined based on a requested asset assessment.
Redetermine the Community Spouse Asset Allowance and notify the client and community spouse of the new results if one of the following conditions occurs:
l The agency discovers the couple owned additional assets on the asset assessment effective date which were not included in the assessment.
l The agency based the Community Spouse Asset Allowance on a requested asset assessment. The Community Spouse Asset Allowance may change at the time the LTC spouse requests MA payment of LTC services since the minimum/maximum Community Spouse Asset Allowance figures can change each year. Base the Community Spouse Asset Allowance on the minimum/maximum amounts in effect at the time the LTC spouse requests MA payment of LTC services.
l The asset assessment date is not valid. If the individual does not attain a Continuous Period of Institutionalization, the asset assessment effective date is not valid for future requests for MA payment of LTC services. If the individual requests MA payment of LTC services in the future, a new asset assessment effective date is established which can change the Community Spouse Asset Allowance.
Example:
Shirley is married to a community spouse. She requested MA payment of LTC services last year because she entered an LTCF for an anticipated stay of more than 30 consecutive days. She had never previously resided in an LTCF or had an LTCC. Her worker anticipated her asset assessment effective date to be the date she entered the LTCF and was likely to remain institutionalized. However, Shirley did not actually reside in an LTCF for 30 consecutive days. A year later Shirley requests MA payment of LTC services again because she reentered an LTCF for an anticipated stay of more than 30 consecutive days.
Action:
A new asset assessment effective date is established. Redetermine the Community Spouse Asset Allowance based on assets Shirley and her spouse owned on her new asset assessment effective date.
When is the Amount of Assets Available to the Community Spouse Greater than the Calculated Community Spouse Asset Allowance?
The Community Spouse Asset Allowance indicates the amount of assets set aside for the community spouse that a worker does not apply to the LTC spouse’s Medical Assistance (MA) asset limit when determining eligibility for MA payment of LTC services. The amount of assets set aside for the community spouse can increase in the following situations:
l A court, due to a legal separation, orders an amount of the couple’s assets for the community spouse that is greater than the Community Spouse Asset Allowance. Determine asset eligibility for the LTC spouse based on the court order.
Note: A worker must still complete an asset assessment to determine which amount is greater.
l The community spouse qualifies for additional assets to meet the community spouse’s monthly maintenance needs.