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Wisconsin Department of Health and Family Services |
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Wisconsin Department of Health and Family Services |
Count the combined assets of the institutionalized person and his/her community spouse. (Note: Disregard prenuptial agreements. They have no effect on spousal impoverishment determinations.) Add together all countable, available (4.5.1) assets the couple owns.
Do not count the following assets:
Homestead property. If the institutionalized person and the community spouse each owns home property and meets the criteria in 4.5.8.1.3, exempt the institutionalized person’s home, but not the community spouse's home.
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Example: One spouse is in a nursing home, the other lives in the community. They have lived apart for 10 years. The institutionalized person owns a home and intends to return. The community spouse owns a different home. The home that each spouse owns is the principal residence of that spouse. The institutionalized person's home is an exempt asset. The community spouse's home is not exempt. |
If they both own homes and the institutionalized person’s home is not exempt, count the institutionalized person’s home, but exempt the spouse’s home. Both homes cannot be exempt simultaneously.
One vehicle, regardless of value or purpose. If
the AG has more than one vehicle, disregard one vehicle totally, regardless
of value or purpose. Then,
for the remaining vehicles, follow the EBD rules for vehicles (4.5.7.9).
Any/all assets designated for burial purposes
are exempt. The amount should be supported by documentation of the burial
related costs or contract. For example, ask the client to document that
they have arranged to purchase a $100,000 casket or that a funeral home
will provide them with a $75,000 funeral along with an itemized listing
of the funeral goods and services that will be provided.
Do not allow applicants and recipients to simply state that they are
setting aside an unreasonable amount of cash (e.g., $1,000,000) as their
burial fund for unspecified funeral expenses. If they can document the
funeral expense that they expect to incur, it can be totally exempt regardless
of its cost.
This differs from EBD burial policies for non-institutionalized persons
and institutionalized persons without a community spouse (4.5.5).
Household goods and personal items, regardless
of their value.
All assets not counted in determining EBD MA eligibility.
IRA’s of an ineligible community spouse (See 4.5.7.21).
The ESA must make an assessment of the total countable assets of the couple at the:
Beginning of the person’s first continuous period
of institutionalization of 30 days or more, or
Date of the first request for community waivers, whichever is earlier.
Complete an asset assessment using the HCF 10095 “Medicaid Asset Assessment” when someone applies, even if s/he had one done in the past, to get the most current asset share.
If the client was not married on the first date of institutionalization or waivers request, apply the policy from the point s/he is married.
You must also do an asset assessment at any other time the institutionalized person or his/her spouse requests it.
Tell the person for whom you are making the assessment what documentation is required. S/he must document ownership interest in and the value of any available assets the couple had at the time of his/her first period of continuous institutionalization. Use the same documentation procedures used when an application is filed (1.2).
The community spouse asset share ( CSAS ) is the amount of countable assets greater than $2,000 that the community spouse, the institutionalized person, or both, can possess at the time the institutionalized person applies for MA.
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IF the total countable assets of the couple are: |
THEN the CSAS is: |
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$190,200, or more |
$95,100.00 |
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Less than $ $190,200 but greater than $100,000 |
½ of the total countable assets of the couple |
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$100,000 or less |
$50,000 |
CARES Client Assistance for Re-employment & Economic Support will send each member of the couple a letter that states the couple’s total countable assets, the CSAS, how much the institutionalized spouse must transfer to the community spouse, the date by which the transfer must be made, and the institutionalized person’s asset limit.
When the institutionalized person applies for MA, compare the total countable assets of the couple to $2,000 plus the greater of:
CSAS, or
An amount ordered by a court, or fair hearing.
If assets at the time of application are equal to or less than this amount, the institutionalized person is eligible. If they are more, s/he is not eligible.
The institutionalized person will not be denied MA if the ESA determines that the ineligibility caused by excess assets creates undue hardship for him/her. Undue hardship means an immediate, serious impairment to the institutionalized person's health.
After the institutionalized person is found eligible, s/he may transfer assets to the community spouse. The maximum amount s/he can transfer is the CSAS (or a greater amount ordered by a court or a fair hearing). If the community spouse already has some assets, the institutionalized person can transfer assets which when added to the community spouse's assets equal the CSAS (or an amount ordered by a court or a fair hearing).
S/he isn't allowed to transfer assets for less than fair market value to anyone other than the community spouse.
S/he must transfer the assets by the next regularly scheduled review. If his/her assets are above $2,000 on the date of the next scheduled re-view, s/he will be determined ineligible.
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Example: Phil is a community waivers participant. He inherits $100,000. He will remain asset eligible as long as he transfers it to his wife. She can do anything she wants with the money except give it away. See 4.7.4. |
If s/he leaves the institution for 30 days or more and then becomes institutionalized again as an applicant or recipient, the time allowed to transfer the assets does not start over.
S/he is held to the requirement to transfer assets within 1 year of the date of s/he was first determined eligible for institutional MA.
There is no recovery by MA for MA services already provided if, at the time of the next scheduled review, the institutionalized person is found ineligible because of assets s/he should have transferred.
This page last updated in Release Number : 05-01
Release Date: 01/11/05
Effective Date: 01/01/05
