Providing the client was married to the current spouse and the client was institutionalized for a period of 30 days or more the asset tests is based on the combined assets of the couple. The steps to calculate are as follows:
- Calculate the date of assessment. It's the begin date of the earliest 30 day consecutive stay.
- Calculate institutionalized individual's countable resources as on the date of assessment AND
- Total community spouse's countable resources as on the date of assessment AND
- Combine the countable resources for the institutionalized individual and the community spouse AND
- DIVIDE the total assets by 2 to give the Spousal Share AND
- Compare the Spousal Share to the Minimum Spousal Amount AND
- If the Spousal Share is less than the Minimum Spousal Amount
- The Spousal Share is the lesser of the total assets of the couple AND
- the Minimum Spousal Amount
- If the Spousal Share is greater than the Minimum Spousal Amount and less than the Maximum Spousal Amount
- The Spousal Share is the total derived from step 5 above
- If the Spousal Share is greater than the Maximum Spousal Amount
- The Spousal Share is the Maximum Spousal Amount
- Declare the Assessed Share of Assets (Spousal Share) for the Institutionalized Individual and Spouse.
- If the remainder is LESS than the asset limit the client is eligible OR
- If the institutionalized individual's countable resources EXCEEDs the asset limit the client may be eligible if they agree to transfer assets to the spouse within a time frame OR
- If the client's assets are NOT LESS than the asset limit, the client may receive Medicaid pending transfer of assets. The transfer to the community spouse can take place at any time but eligibility is not established until the resource share of the community spouse is equal to or below the spousal share after the transfer is made and the client's resources are at or below $2000. The client may receive Medicaid only if he agrees to bring his assets below the asset limit by transferring them to his spouse. The client must provide a statement expressing an agreement to transfer the appropriate amount of assets by the due date of the next review.
- If the remainder exceeds asset limit and the client does not agree to transfer assets, the client is ineligible UNLESS he proves Undue Hardship
Spousal impoverishment undue hardship may exist if:
- Counting the spouse's assets as available to the institutionalized client causes the client to exceed the asset limit AND
- The client's spouse refuses to make the assets available AND
- Without Medicaid coverage for institutional care, the client will not be able to get the medical care needed AND
- The client is at risk of death or permanent disability without institutional care.