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Effective: April 1, 2008 |
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19.45ar4 - Asset Assessments (Archive) |
Archived: December 1, 2008 |
An asset assessment is the first step in dividing marital assets between spouses when one spouse requires long-term care (LTC). The three steps are:
l Identifying all non-excluded assets owned by the couple at the beginning of the first continuous LTC/EW period. See Asset Assessment Determination.
l Determining the community spouse’s share of the assets, known as the community spouse asset allowance. See Determine the Community Spouse Asset Allowance under Asset Assessment Determination.
l Dividing the assets between the LTC spouse and the community spouse. This determination takes place when the LTC spouse actually requests and is found eligible for MA payment of long-term care services. The couple must divide ownership of the assets by the time of the LTC spouse’s first annual renewal. See Spousal Asset Determination.
Determining the Asset Assessment Effective Date.
When Is an Asset Assessment Required?
The following definitions will be used throughout this section of the manual. These definitions can also be found in the glossary.
Long-Term Care Facility (LTCF):
A nursing facility, intermediate care facility for persons with mental retardation or related conditions (ICF/MR), medical hospital, or an MA-covered bed in the Regional Treatment Center (RTC).
A person who lives in a medical or nursing facility or who receives EW services and is expected to remain in the facility or receive EW services for at least 30 consecutive days and who is married to a community spouse.
A person who does not reside in an LTCF or receive waiver services (including EW, CAC, CADI, DD or TBI) who is married to an LTC spouse. A community spouse may or may not receive MA.
Long-Term Care Consultation (LTCC):
A program to help people make decisions about long-term care and prevent inappropriate nursing home or boarding care placement. LTCC was formerly known as the Pre-Admission Screening Program (PAS). See Long-Term Care Consultation (LTCC) for more information on LTCC services and requirements.
Continuous LTC/EW Period (known federally as the ”r;Continuous Period of Institutionalization”):
A 30-consecutive-day period beginning on or after October 1, 1989, in which a person meets either of the following conditions:
l Resides in a long-term care facility.
l Receives a nursing facility level of care provided by home and community-based services that meets all of the following conditions:
n Was determined to be necessary by a long-term care consultation completed within the past 60 days.
n Is paid by or would qualify for payment by the EW program or the AC program if the person were otherwise eligible for either program.
n Is delivered by a licensed provider qualified to provide home and community-based services.
The asset assessment is an evaluation of all non-excluded assets owned individually or jointly by a married couple on the first day of a spouse’s first continuous LTC/EW period. The asset assessment determines the amount of assets considered available to each spouse when the LTC spouse requests MA payment of long-term care services. It helps the couple determine at what point the LTC spouse’s share of the assets may be within the MA asset limit.
Do not require couples to complete an asset assessment before requesting MA payment of long-term care services. However, because they must report and verify assets as of the first day of the LTC spouse’s first continuous LTC/EW period, it may be easier to complete an assessment close to that time.
Determining the Asset Assessment Effective Date
The effective date of the asset assessment, which is the date the ”r;snapshot” of non-excluded assets is taken, is the first day of the earliest continuous LTC/EW period for either spouse in one of the following situations:
l Admission to a long-term care facility.
l Receipt of home and community-based services that would be covered by the EW or AC program, or the LTCC date, whichever is later. Receipt of home and community-based services means that the person meets all of the following:
n Requires a nursing home level of care.
n Is at risk of nursing home placement.
n Is receiving specific services that would be paid for by EW or AC if the person was otherwise eligible for EW or AC. The services must be provided by a licensed person who is qualified to provide those services.
Note: If the services have not begun prior to the LTCC date, they must begin within the period of time covered by the LTCC.
The continuous LTC/EW period is calculated by counting the date of entry and the date of discharge to determine whether a stay has lasted at least 30 consecutive days.
Once established, the asset assessment effective date does not change from the first continuous LTC/EW period.
Example:
Josie, age 75, and Vinnie, age 70, are married. Josie enters a LTCF on June 10 for rehabilitation after knee surgery. She is discharged home on July 1. Josie then enters the same LTCF on September 1 for rehabilitation from surgery on the other knee. She is discharged home on October 15. Josie, who thinks she is having an unlucky year, enters a different LTCF on December 26 after falling and breaking her hip. She is discharged home on January 28. Josie does not plan to apply for MA any time soon because her private health insurance is covering her medical expenses.
Action:
The asset assessment date is September 1, which is the first day of her first 30 consecutive days of LTC/EW services. Josie can choose to complete the asset assessment prior to her MA application, or can wait until she applies for MA.
Although a new continuous LTC/EW period begins after a client re-enters an institution after having been discharged for at least 30 consecutive days, the date of the asset assessment is the first day of the first continuous LTC/EW period.
When Is an Asset Assessment Required?
Require an asset assessment for married couples at the time of request for MA payment of LTC services if an assessment was not previously completed in any state, or if a previously completed assessment is not available.
Use the same asset assessment at every request for MA payment of LTC services.
Provide the Asset Assessments for Medical Assistance form (DHS-3340) for the client to complete if one has not been completed prior to MA application.
Example:
Norman is admitted to a medical hospital on June 2. On July 7 he enters an LTCF directly from the hospital for convalescent care. He is discharged home on October 10. He does not apply for MA for any part of this period. On November 2 he is readmitted to the LTCF. His wife remains in the community. They apply for MA for Norman on September 15 of the next year.
Action:
The effective date of the asset assessment is June 2. The asset assessment will be based on all assets owned on that date. Norman and his wife must complete the asset assessment with the MA application in order to have eligibility determined.