*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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 |
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23.15.10.05 - Community Spouse Income Allocation |
Archived: June 1, 2016 (Previous Versions) |
An LTC spouse can allocate his or her income to a Community Spouse if the community spouse’s income is insufficient to meet his or her monthly maintenance needs.
Calculating the Community Spouse Income Allocation.
When to Deduct the Community Spouse Income Allocation.
Community Spouse Requests MHCP Coverage.
The agency cannot determine if it can deduct a community spouse income allocation in the LTC income calculation unless the client, or the client’s authorized representative, provides verification of the community spouse’s income and shelter expenses. Do not allow a deduction for a community spouse income allocation if the client or authorized representative does not provide verification of the community spouse’s income and shelter expenses.
The client, or the client’s authorized representative, must provide verification of the community spouse’s income and shelter expenses at the time of the request for MA payment of LTC services and at each renewal.
If the agency deducts a community spouse income allocation in the LTC income calculation, inform the client or authorized representative that he or she must report changes in the income or shelter expenses of the community spouse. Do not require the client, or the client’s authorized representative, to report income and expenses monthly.
Recalculate the community spouse income allocation when the client or authorized representative notifies the agency of a change in the income or expenses of the community spouse and the agency has verified the change.
Follow the steps outlined in this section to determine the amount of income needed by the community spouse in order to meet his or her monthly maintenance needs. This amount is the maximum amount that an agency can deduct in the LTC spouse’s income calculation as a community spouse income allocation.
1. Total the community spouse’s verified gross earned and unearned monthly income. This includes income received by the community spouse (for example, Social Security income or employment income) as well as income earned from assets owned by the community spouse.
n Count all gross income, except excluded income.
n Determine a monthly amount if income is not received monthly. Total the annual income and divide by 12.
n Do not allow any MA disregards or deductions.
n Do not count Veteran’s Administration Aid and Attendance benefits unless an amount has been apportioned specifically for the community spouse.
2. Determine the community spouse’s total verified monthly shelter expenses.
Shelter expenses include:
n rent.
n mortgage payments, including principal and interest.
n real estate taxes.
n homeowner’s or renter’s insurance.
n required maintenance charges for a cooperative or condominium.
Shelter expenses do not include charges for services received by a person who resides in a residential living arrangement or a Housing with Services Establishment. Require an itemized statement of monthly charges to identify the amount the community spouse must pay for rent or any other shelter expense.
Base the amount of a shelter expense on the amount that the community spouse must pay in order to maintain the shelter. Allow the full amount of the shelter expense for a community spouse, regardless of whether the couple lives together.
Example:
Hanson is a community spouse. He resides with his wife in their home. His wife is on EW. They are joint owners of the property and their mortgage payment is $1,200.65 a month.
Action:
Hanson’s monthly shelter expense for the mortgage payment is the full amount of the mortgage, $1,200.65.
Example:
Mabel is a community spouse. Her husband resides in an LTCF. Mabel lives with her sister in an apartment, and together they pay $800 a month in rent. Both Mabel and her sister are on the lease. Mabel’s share of the rent is $400 a month.
Action:
Mabel’s monthly shelter expense for rent is $400.
3. Determine if the community spouse has any excess shelter expenses. The amount determined in Step 2 that is greater than the basic shelter allowance is the community spouse’s excess shelter expenses.
4. Add the minimum monthly income allowance to the community spouse's excess shelter expenses, if any.
5. Compare the amount calculated in Step 4 to the maximum monthly income allowance. The community spouse’s monthly maintenance needs is the lesser amount. It is an amount, up to the maximum monthly income allowance, of the minimum monthly income allowance plus any excess shelter expenses.
6. Compare the community spouse’s gross monthly income (from Step 1) to the community spouse’s monthly maintenance need (amount from Step 5).
n If the community spouse’s gross monthly income is greater than or equal to the community spouse’s monthly maintenance needs, the community spouse does not qualify for an income allocation since the community spouse can meet his or her monthly maintenance needs through his or her income.
n If the community spouse’s gross monthly income is less than the community spouse’s monthly maintenance needs, the community spouse qualifies for an income allocation. The maximum amount that an agency can deduct in the LTC spouse’s income calculation is the difference between the community spouse’s gross monthly income and the community spouse’s monthly maintenance needs.
When to Deduct the Community Spouse Income Allocation
Deduct the community spouse income allocation when there is a community spouse at any time in the month.
Example:
Gracie is married to William. Gracie was determined eligible for MA payment of LTC services and the agency used an LTC income calculation to determine the amount of her income she must contribute toward the cost of her care. At the time Gracie requested MA payment of LTC services, William resided in an LTCF. As a result, William was not a community spouse and did not qualify for a community spouse income allocation. On November 29, William returns home and becomes a community spouse. Gracie’s worker determines William is eligible for a community spouse income allocation from Gracie’s income because his income is insufficient to meet his monthly maintenance needs.
Action:
Allow a deduction for a community spouse income allocation starting in November.
Deduct the amount of income needed by the community spouse to meet his or her monthly maintenance needs as a community spouse allocation in the LTC income calculation unless:
l there is a court order for spousal support for an amount that is greater than the maximum amount of the community spouse income allocation. Deduct the court ordered amount.
This only applies to a court order in effect while a couple is still married. This may occur in a legal separation. Do not deduct a court order for spousal maintenance in a divorce action since there is not a community spouse if the enrollee is divorced.
Example:
Earl is on EW. He is married to Mary, a community spouse. Mary filed for legal separation from Earl and the court ordered Earl to give her all of his pension money. This amount is greater than the amount needed to meet the community spouse’s monthly maintenance needs.
Action:
Deduct the amount indicated in the court order as the community spouse income allocation in Earl’s LTC income calculation.
Example:
Molly resides in an LTCF. She received final divorce papers from her spouse, Tom. The court awarded spousal maintenance of all of Molly’s income to Tom.
Action:
Do not deduct a community spouse income allocation in Molly’s LTC income calculation. There is no longer a community spouse because the couple is divorced.
l the LTC spouse does not have enough income for the deduction. Deduct the amount of income remaining, if any, after the other allowable LTC income deductions that must occur prior to the community spouse income allocation.
Example:
Vera resides in an LTCF and has a community spouse, Jim. Jim needs $750 in income in order to meet his monthly maintenance needs. However, after deducting the other allowable deductions in Vera’s LTC income calculation, she only has $552 available for a community spouse income allocation.
Action:
Deduct $552 as a community spouse income allocation in Vera’s LTC income calculation.
l exceptional or unusual circumstances temporarily warrant a greater amount.
There may be circumstances in which the community spouse allocation can be temporarily increased due a financial hardship caused by an exceptional or unusual circumstance. The community spouse must take the necessary steps to resolve the situation.
Example:
Connor resides in an LTCF and is married to Kelsey, a community spouse. Connor is receiving MA payment of LTC services and the agency uses an LTC income calculation to determine the amount Connor must contribute toward the cost of his care. Kelsey’s actual shelter expenses exceed the maximum monthly income allowance amount by $200. Kelsey is obligated to pay four more months on her lease before she can move into a more affordable living arrangement. She does not have enough income or assets available to pay the additional $200 she needs to pay for her shelter expenses. Kelsey contacts Connor's worker and indicates she has given notice on the condominium and will be moving to a more affordable apartment when her lease is up.
Action:
Temporarily increase the community spouse allocation by $200 a month for four months to cover Kelsey’s shelter expenses. Recalculate the community spouse allocation when Kelsey moves to the new apartment taking into account her new verified shelter expenses.
l the LTC spouse does not make the income available to the community spouse. The LTC spouse can choose not to make an income allocation to the community spouse.
Example:
Leonard is married to Gretchen, a community spouse. Leonard is eligible for MA payment of LTC services, and the agency uses an LTC income calculation to determine the amount of his income he must contribute toward the cost of his care. Leonard does not want to make a community spouse income allocation.
Action:
Do not allow a deduction for a community spouse income allocation in Leonard’s LTC income calculation.
l the community spouse chooses to accept a reduced income allocation or chooses not to accept any income allocation.
Example:
Heather is married to Rex, a community spouse. Heather is eligible for MA payment of LTC services, and the agency uses an LTC income calculation to determine the amount of her income she must contribute toward the cost of her care. Rex is applying for MA and does not want to receive the income allocation since the agency will count it as unearned income when determining his eligibility. Rex chooses not to accept any income allocation.
Action:
Do not allow a deduction for a community spouse income allocation in Heather’s LTC income calculation.
Count the community spouse income allocation as unearned income for the community spouse when determining eligibility for any Minnesota Health Care Program.