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Effective: December 1, 2006 |
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23.40.30ar1 - LTC Community Spouse Allocation (Archive) |
Archived: April 1, 2008 |
LTC and Elderly Waiver (EW) clients using a LTC income calculation may deduct a portion of their monthly income and allocate it for the needs of their community spouse. The allocation is the amount of income that the LTC spouse may give to the community spouse.
l This is an optional allocation. The use of this allocation will reduce the LTC spenddown or waiver obligation for the LTC spouse.
l This deduction is also allowed on the QMB and SLMB income calculation for EW and LTC clients.
l Do not allow this allocation when the spouse is not considered a community spouse due to receipt of EW services or residence in an LTCF.
l For information on allocations to the other family members, see LTC Family Allocations.
Beginning the Community Spouse Allocation.
Ending the Community Spouse Allocation.
Determining the Community Spouse Allocation Amount.
Allocation Causing Financial Hardship.
Community Spouse MHCP Eligibility.
Beginning the Community Spouse Allocation
Begin the Community Spouse Allocation deduction the month the LTC spouse enters the facility or receives services through EW.
End the Community Spouse Allocation:
l The month following the end of using the LTC income calculation for the LTC spouse’s eligibility.
l If the spouse becomes ineligible for an allocation because of a change in circumstances, end the allocation as noted for each of the following situations:
n The spouse enters an LTCF or begins receiving EW services. End the allocation starting the first full month in which the spouse is no longer eligible for the allocation.
Example:
Brian resides in an LTCF. His wife Dorothy resides in the community and receives an allocation from Brian’s income. Dorothy enters an LTCF on January 10.
Action:
End the allocation for February (the first full month of LTC residence).
n The community spouse dies. End the allocation for the month after the month of death.
n The couple divorces. End the allocation for the month after the divorce becomes final.
Determining the Community Spouse Allocation Amount
Follow these steps to determine the amount to deduct for the Community Spouse Allocation:
1. Determine the community spouse’s total gross earned and unearned monthly income.
n Include in the total monthly income:
m Otherwise excluded under MA policy such as Supplemental Security Income (SSI), Minnesota Supplemental Aid (MSA) and all other excluded income.
m Interest earned on income-producing assets.
m If the Veteran’s Administration (VA) grants an apportionment of the LTC spouse’s VA benefits for the community spouse, the apportionment may be considered income to the community spouse.
m If the community spouse is self-employed count the adjusted gross income of the self-employment.
Note: Allow self-employment business expenses as a deduction from the total business gross income to arrive at the adjusted gross income.
m When the community spouse receives income less often than monthly, add together all the irregular income received during a calendar year and divide by 12 to determine the monthly amount of income.
Note: This is only used for the community spouse allocation and not for irregular income received by the LTC spouse. The LTC spouse’s income calculation budgets the income in the month received.
n Allow deductions from the income that the community spouse has no control over, such as FICA and garnished court-ordered child support payments.
n Do not allow work expenses or other taxes as deductions.
n Do not allow MA disregards and deductions from gross income.
2. Total the community spouse’s shelter expenses.
n Do not include costs for upkeep and repair as shelter expenses.
n Community spouse residing in an assisted living facility:
People residing in assisted living facilities often pay one amount to cover the costs of rent, utilities services and meals. In these situations ask the community spouse to request a breakdown of expenses from the facility in order to accurately determine the community spouse allocation amount. Allow a utility allowance if the community spouse is charged for phone service.
n Community spouse living in a group residential housing (GRH) facility.
GRH facilities have both a room rate and a board rate. Use the room rate as the shelter expense. Allow a utility allowance if the community spouse is charged for phone service.
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.
3. Subtract the basic shelter allowance from the community spouse’s total shelter expenses (Step 2) to determine the excess shelter allowance.
4. Add the minimum monthly income allowance to the excess shelter allowance (Step 3) to determine the estimated monthly income allowance for the community spouse.
5. Compare the estimated monthly income allowance (Step 4) to the maximum monthly income allowance. If the estimated monthly income allowance (Step 4) is:
n Less than the maximum monthly income allowance, use the estimated monthly income allowance (Step 4 amount) in Step 6.
n Is equal to or greater than the maximum monthly income allowance, use the maximum monthly income allowance in Step 6.
6. Subtract the community spouse’s total gross income (Step 1) from the monthly income allowance (Step 5) to determine the community spouse allocation amount.
This amount is allowed as a deduction on the LTC spouse’s income calculation.
n Do not allow an allocation deduction from VA Aid and Attendance benefits received by the LTC spouse. Allow the deduction from other types of income.
n If there is a court-order for an income allocation, which is higher than the community spouse allocation, allow the higher court-ordered amount as the deduction.
Verify the following for the community spouse at the LTC spouse application or when a change is reported at renewal or at another time:
l Income.
l Shelter expenses.
l Utility expenses.
Do not allow a community spouse allocation if the verifications are not provided.
There may be cases when the LTC spouse does not have enough income to allow the full community spouse allocation. In these cases deduct as much of the allocation as income will allow.
There may be circumstances in which the allocation amount is not enough to cover the community spouse’s costs. If the allocation amount is not enough and is causing a financial hardship, due to exceptional or unusual circumstances, allow an increased community spouse allocation amount for a temporary time period to allow the community spouse time to resolve the situation.
If the community spouse is unable to resolve the situation or they refuse to resolve it an increase allocation cannot be provided.
Example:
Kelsey’s husband Connor is in a LTCF. Connor is able to provide her with the total amount of her community spouse allocation, but it is not enough to cover the rent on their condo. Kelsey contacts the worker and indicates she needs a higher allocation to pay the remaining four months left on the lease. She plans to move to a smaller apartment, with lower rent, at the end of the lease.
Action:
Because the situation will be resolved by moving to the smaller apartment, Increase the community spouse allocation amount to allow Kelsey to meet her rental costs for the next four months.
Community Spouse MHCP Eligibility
The community spouse allocation must be counted as unearned income when determining the community spouse’s eligibility for the Minnesota Health Care Programs (MHCP).
Note: County workers must alert the MinnesotaCare (MCRE) worker of the allocation, so that it may be included in the MCRE income calculation.
The community spouse allocation may increase the spouse’s spenddown or premium amount, or create ineligibility due to the increase in income. The community spouse may choose to either:
l Continue the allocation and pay the higher premium or meet the higher spenddown amount.
l Reduce or end the allocation. This will increase the amount of the LTC spouse’s LTC spenddown.