*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: May 1, 2013 |
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19.45 - Asset Assessments |
Archived: June 1, 2016 (Previous Versions) |
When is an Asset Assessment Required?
Whereabouts of the Community Spouse is Unknown.
The Asset Assessment (DHS-3340) Form.
Asset Assessment Effective Date.
Continuous Period of Institutionalization.
Anticipating a Continuous Period of Institutionalization.
Continuously Received LTC Services Prior to October 1, 1989.
Verification of Asset Assessment Effective Date.
Asset Assessment Effective Date between Spouses.
The asset assessment is an evaluation of assets owned by a married couple when there is a Long-Term Care Spouse. It is an evaluation of all assets owned individually or jointly by the couple on the first day of the LTC spouse’s first Continuous Period of Institutionalization. The married couple completes a form that asks them to list the assets they owned on a specific date. Completing the form is the first step in a process to identify assets attributable to a spouse who requests MA payment of long-term care services when the other spouse remains in the community.
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.
A worker uses an asset assessment to determine asset eligibility for an LTC spouse who requests MA payment of LTC services who resides in a Long-Term Care Facility (LTCF) or is requesting services through the Elderly Waiver (EW). Asset assessments are also used to determine eligibility in the Alternative Care (AC) program. It is not used to determine asset eligibility for other Minnesota Health Care Programs, such as Basic MA, home and community-based waivers for the disabled (CAC, CADI, DD or BI) or a Medicare Savings Program.
When is an Asset Assessment Required?
l Individuals requesting MA payment of LTC services:
Require an asset assessment when an individual requests MA payment of LTC services and all of the following conditions exist. An individual who meets these conditions is an LTC spouse.
n The individual is married. Separated spouses are still married; marriage only ends with divorce or the death of one spouse.
n The individual resides in an LTCF and has resided, or a physician anticipates an individual to reside, in an LTCF for at least 30 consecutive days; or
The individual is requesting services through the EW or AC programs and has received a long-term care consultation (LTCC) that demonstrated the individual requires an institutional level of care and the individual has received, or a lead agency case manager anticipates the individual to receive, EW or AC services for at least 30 consecutive days.
n The individual’s spouse resides in the community and does not receive services through the EW, CAC, CADI, BI, or DD waiver programs. This spouse is a community spouse. A community spouse can receive MA or services through the AC program.
Exception: Do not require an asset assessment when an individual on MA-EPD requests MA payment of LTC services through EW.
l MA enrollees receiving MA payment of LTC services who become an LTC spouse:
An individual may not be an LTC spouse at the time he or she initially requested MA payment of LTC services. As a result, a worker did not use an asset assessment to determine asset eligibility for MA payment of LTC services. However, a change may occur in which the individual becomes an LTC spouse. Require an asset assessment when an individual becomes an LTC spouse in order to determine asset eligibility for MA payment of LTC services. An MA enrollee receiving MA payment of LTC services can become an LTC spouse in the following situations:
n A physician certifies that an MA enrollee who was expected to reside in a LTCF for less than 30 days will need to remain in an LTCF for at least 30 consecutive days.
n The enrollee’s spouse becomes a community spouse.
n The enrollee is on the CADI, CAC, BI or DD waiver and enters an LTCF and has resided, or a physician anticipates the enrollee to reside, in an LTCF for at least 30 consecutive days.
n The enrollee is on the CADI, CAC, BI or DD waiver and requests services through EW or AC.
When an MA enrollee becomes an LTC spouse, request an asset assessment. Close eligibility for MA payment of LTC services in MMIS while waiting for the asset assessment process to be completed. Ten-day advance notice is required in situations where the worker initiates the closing; a notice is not required if the lead agency case manager has closed waiver eligibility and notified the enrollee.
Example:
Carl is an MA enrollee on the DD waiver. He resides with his wife Jean in the community. Jean is not on MA. On February 5, Jean informs Carl’s worker that Carl entered an LTCF on January 30. Carl’s worker receives a Physician Certification (DHS-1503) form that states a physician anticipates Carl to permanently reside in the LTCF. On February 15, Carl’s worker determines Carl is an LTC spouse and the worker will need an asset assessment to determine Carl’s asset eligibility for MA payment of LTC services.
Action:
Close eligibility for MA payment of LTC services effective March 1, the first month in which the agency can give 10-day advance notice. Notify the lead agency case manager that MA payment of LTC services has ended.
Exception: Do not use an asset assessment to determine asset eligibility if an enrollee receiving MA payment of LTC services marries a community spouse after the worker approves eligibility for MA payment of LTC services. An asset assessment is not required as long as the client continues to receive MA payment of LTC services. Require an asset assessment if a client has a Break in LTC Services, the agency receives a new request for MA payment of LTC services and the client is an LTC spouse at the time of the new request.
Example:
Eileen requests MA payment of LTC services through the EW program in January. She had an LTCC on January 5 that demonstrated she requires an institutional level of care and her lead agency case manager anticipates her to receive EW services for 30 consecutive days. At the time of her request she was not an LTC spouse because she was single. Because Eileen met all eligibility requirements, her worker approved her for MA payment of LTC services. In November, Eileen got married. Her husband does not reside in an LTCF or receive services through a waiver program.
Action:
Do not use an asset assessment to determine asset eligibility for Eileen as long as she continues to receive MA payment of LTC services. If Eileen has a break in LTC services and requests MA payment of LTC services in the future, an asset assessment may be required if she is an LTC spouse at the time of her request.
If an asset assessment is required and the client does not know the whereabouts of his or her community spouse, assist the client in making a reasonable effort to locate the community spouse. Have the client complete the asset assessment form based on known information. If reasonable efforts to locate the community spouse do not succeed, eligibility for MA payment of LTC services for the client is possible. Proceed as if the community spouse does not make assets available to the LTC Spouse.
The Asset Assessment (DHS-3340) Form
A couple uses the Asset Assessment (DHS-3340) form to report assets they owned on the LTC spouse’s asset assessment effective date. Do not require the couple to complete a new asset assessment form if the couple completed one previously and there is not a change in the asset assessment effective date. If the couple completed an asset assessment at another agency or in another state, request the original form as well as all supporting documentation from the other agency or state. Use the form to identify assets owned by the couple on the LTC spouse’s asset assessment effective date in order to calculate the Community Spouse Asset Allowance.
Note: The agency needs to receive a release form from the couple in order to request an asset assessment form and supporting documentation from another state. Request the couple complete the General Consent/Authorization for Release of Information (DHS-3549) and retain a copy of the completed release in the case file.
A couple may request that the county agency complete an asset assessment even if they are not applying for MA payment of LTC services when one spouse has or anticipates a continuous period of institutionalization. County agencies are required to complete the assessment. This will provide the couple with an estimated Community Spouse Asset Allowance which may help the couple decide when the LTC spouse should apply for MA.
Encourage couples to complete an asset assessment as close as possible to the asset assessment effective date since the information needed, and the verifications that are required, will be easier to obtain.
Nursing homes are required to advise new admissions and their families that asset assessments are available from county agencies upon request. To assist nursing homes with this responsibility, the Department of Human Services has developed a one-page brochure entitled Asset Assessment Fact Sheet (DHS-3340D) for nursing homes to give to married individuals and their families when one spouse enters a nursing home.
Asset Assessment Effective Date
The asset assessment requires an evaluation of all assets owned individually or jointly by a married couple on the LTC spouse’s asset assessment effective date. The asset assessment effective date is the first day of the LTC spouse’s first continuous period of institutionalization that has occurred on or after October 1, 1989.
A continuous period of institutionalization is:
l at least 30 consecutive days of either institutional care in an LTCF or receipt of services, based on a documented need, of nursing facility level of care that would qualify for payment by the EW or AC programs; or
l a combination of both a stay in an LTCF and receipt of services that would qualify for payment by the EW or AC programs that is at least 30 consecutive days.
The continuous period of institutionalization for LTCF stays is calculated by counting the date of entry and the date of discharge, if applicable, to determine whether a stay has lasted at least 30 consecutive days.
Note: An individual who is absent from an LTCF on a leave day is still considered to be residing in an LTCF.
A continuous period of institutionalization for receipt of home and community-based services is established when both of the following conditions are met.
l The individual received services that lasted at least 30 consecutive days that were paid or would qualify for payment by the EW or AC programs if the individual was otherwise eligible for either program, and receipt of the services prevented the individual from residing in an LTCF. A licensed provider qualified to provide home and community-based services must deliver the services.
l The individual received an LTCC within the past 60 days that demonstrated a need for an institutional level of care.
When a worker bases an individual’s first continuous period of institutionalization on receipt of home and community-based services, the asset assessment effective date is the date of the LTCC.
Anticipating a Continuous Period of Institutionalization
If the LTC spouse has not had a continuous period of institutionalization, a worker can anticipate one if the LTC spouse is likely to remain institutionalized. Under these circumstances, the asset assessment effective date would be either:
l the date the LTC spouse entered an LTCF when a physician anticipates the LTC spouse to reside in an LTCF for at least 30 consecutive days. An anticipated discharge date is indicated on the Physician Certification form (DHS-1503), or
l the date the LTC spouse received an LTCC within the past 60 days that demonstrates he or she requires an institutional level of care for the EW or AC program and a lead agency case manager anticipates the LTC spouse to receive those services for at least 30 consecutive days. The lead agency case manager communicates this to the agency via the Lead Agency Case Manager/Worker Communication Form (DHS-5181).
Note: Use the same LTCC date even if the client receives a new LTCC because of a delay in the eligibility determination for MA payment of LTC services.
Base an anticipated continuous period of institutionalization on the likelihood that the LTC spouse will remain institutionalized at the time eligibility for MA payment of LTC services is being determined.
l Do not delay an eligibility determination to determine if the LTC spouse actually resides in an LTCF or receives home and community-based services for at least 30 consecutive days
l Do not redetermine eligibility for past months if the person was likely to remain institutionalized at the time eligibility for MA payment of LTC services was determined but did not actually reside in an LTCF or receive home and community-based services for at least 30 consecutive days.
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.
Example:
Hank is married to a community spouse. Hank is applying for MA payment of LTC services because he entered a nursing home on May 18 for an anticipated stay of more than 30 days. He has never previously resided in an LTCF or had an LTCC. The county agency reviews his application on June 1.
Action:
Determine Hank’s asset assessment effective date to be May 18, the anticipated first day of his first continuous period of institutionalization. If Hank does not stay in the nursing home for 30 consecutive days, establish a new asset assessment effective date if he later requests MA payment of LTC services.
Example:
Daisy is married to a community spouse. Daisy requested MA payment of LTC services through the EW program on August 7 because she had an LTCC on August 5 that demonstrated she requires an institutional level of care and her lead agency case manager anticipates her to receive EW services for 30 consecutive days. Daisy has never resided in an LTCF or previously had an LTCC. The county agency reviews her application on August 12.
Action:
Determine Daisy’s asset assessment effective date to be August 5, the anticipated first day of her first continuous period of institutionalization. If she is not eligible for EW or AC or does not receive services that would qualify for EW or AC if she was on it, establish a new asset assessment effective date if she later requests MA payment of LTC services.
Automatically count the time spent in a medical hospital when determining a continuous period of institutionalization when the individual:
l is discharged directly from a medical hospital to another LTCF.
l received services that were paid or would qualify for payment by the EW or AC programs immediately upon release from the medical hospital.
Otherwise, count the time spent in a medical hospital when determining a continuous period of institutionalization when the person received skilled nursing care. Skilled nursing care in a medical hospital is typically care received in a swing bed.
Assist the person in obtaining clarification from the hospital as to whether or not the person received skilled nursing care while residing in the medical hospital.
If the LTC spouse entered an LTCF prior to October 1, 1989, and has been continuously receiving LTC services, asset assessment policy does not apply. Federal and state rules that were in effect prior to October 1, 1989, regarding spousal impoverishment apply. Please submit a HealthQuest for guidance if this situation arises.
The worker must verify the asset assessment effective date. Assist the individual in obtaining supporting documentation if the worker cannot verify the asset assessment effective date with sources already available, such as a Physician Certification (DHS-1503), a Lead Agency Case Manager/Worker Communication Form (DHS-5181) or eligibility information in MAXIS or MMIS.
If an asset assessment is required, determine the asset assessment effective date for the spouse requesting MA payment of LTC services. A married couple may have different asset assessment effective dates depending on which spouse is requesting MA payment of LTC services.
Example:
Edna and Frank are married. Edna entered an LTCF on June 15, 2009, for an expected stay of more than 30 days. She requested MA payment of LTC services at that time and met the requirements for an asset assessment. Her first continuous period of institutionalization began with an admission into the hospital on January 1, 2007, followed by a discharge directly into the LTCF. Base Edna’s asset eligibility for MA payment of LTC services on an asset assessment effective date of January 1, 2007.
Edna’s health improved and she returned home in December 2009. Frank received an LTCC on March 10, 2010, that demonstrated he requires an institutional level of care for EW and the case manager anticipates he will receive those services for at least 30 consecutive days. Frank has never resided in an LTCF or previously had an LTCC. Frank requests MA payment of LTC services on March 20. He meets the requirements for an asset assessment.
Action:
Frank’s asset assessment effective date is March 10, 2010, the anticipated first day of his first continuous period of institutionalization. Determine Frank’s asset eligibility for MA payment of LTC services based on the assets he and Edna owned on March 10.