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Wisconsin Department of Health and Family Services |
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Wisconsin Department of Health and Family Services |
5.9.2.2 Spousal Impoverishment
All waiver clients being discharged from a nursing home, and persons in non-institutional living arrangements must complete an application form unless they are already receiving full-benefit MA (7.1.2).
All waiver clients receive assessment and case planning services from a case manager. The case manager is responsible for determining a level of care and completing a service plan for each client. In some counties this function is performed at the Resource Center.
The service plan packet contains documentation verifying the person's eligibility for waivers. For Group A clients, case managers submit CARES Client Assistance for Re-employment & Economic Support eligibility and budget screens. ( ECSC and ECED ), or the MA Waiver Eligibility and Cost Sharing Worksheet (DDE-919). For Group B and C clients, the CARES eligibility and budget screens ( ECSC and ECED ) are submitted. DDE-919 serves as a backup to CARES.
Spousal impoverishment policy applies to waiver participants with a community spouse, with the exception of Medicaid Purchase Plan ( MAPP The Medicaid Purchase Plan (MAPP) offers people with disabilities who are working or interested in working the opportunity to obtain health care coverage through the Wisconsin Medicaid Program. ) waiver participants (5.10.2.3 and 5.12.3.6).
Minors (3.5.1.4) are not eligible for waiver services unless they have been determined disabled (3.6.1). Consider only the disabled child’s assets and income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. unless the parents make an actual cash contribution to the child. If they do, include that amount as part of the child’s unearned income (5.9.7).
Persons who apply for waivers other than PACE and WPP may receive tentative waiver approval from the Division of Disability and Elder Services ( DDES ) while their MA eligibility is being determined.
The tentative approval process begins when the case manager refers the waiver applicant to the ESA with accompanying information about the type of waiver, waiver begin date, medical/remedial expenses, and MA card coverable expenses. Enter the case into CARES and send the case manager the CARES screen prints showing the eligibility determination, cost share amount, family member allowance, and spenddown amount.
If it is a spousal impoverishment case, also send along the CARES screen prints or manual worksheets which show the spousal and family member income allocations. Complete a manual Spousal Impoverishment Income Allocation Worksheet (WKST 07 8.2.1) for any spousal impoverishment case that is Group C eligible. Send a copy of this worksheet or a modified copy of ECSC to the case manager. Send a manual notice to the client with the corrected cost share amount, if the cost share calculated on WKST 07 differs from the amount calculated in CARES.
The case manager then submits the screen prints and the service plan packet to DDES for tentative approval. Until the case manager informs you the case has been tentatively approved, keep it in pending status in CARES. After tentative approval is received, confirm the case on CARES. This will certify the person for MA.
This page last updated in Release Number: 02-03
Release Date: 07/01/02
Effective Date: 07/01/02
