Policy History for 5.10.4 Assets

Release 06-04

5.10.4 Assets

5.10.4.1 Asset Assessment

5.10.4.2 Calculate the CSA

5.10.4.3 Asset Test

5.10.4.4 Undue Hardship

5.10.4.5 Asset Transfer

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:

1. 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.

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.

2. 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).
    

3. Any/all assets designated for burial purposes are exempt.  Any unreasonable 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).  
    

4. Household goods and personal items, regardless of their value.
    

5. All assets not counted in determining EBD MA eligibility.
    

6. IRA’s of an ineligible community spouse (See 4.5.7.21).
    

5.10.4.1 Asset Assessment

The ESA must make an assessment of the total countable assets of the couple at the:

1. Beginning of the person’s first continuous period of institutionalization of 30 days or more, or
    

2. 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.  If s/he has remarried since the first date of institutionalization or waivers request, apply the policy from the date s/he got married to his/her current spouse.

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).

5.10.4.2 Calculate the CSA

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.

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.

5.10.4.3 Asset Test

When the institutionalized person applies for MA, compare the total countable assets of the couple to $2,000 plus the greater of:

1. CSAS, or
    

2. 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.

5.10.4.4 Undue Hardship

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.

5.10.4.5 Asset Transfer

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.

5.10.4.5.1 Asset Transfer Period

The institutionalized spouse must transfer the assets to the community spouse by the next regularly scheduled review (12 months).  If his/her assets are above $2,000 on the date of the next scheduled review, s/he will be determined ineligible.  S/he will remain ineligible until his/her assets no longer exceed the $2000 Medicaid asset limit.   

5.10.4.5.1.1  Leaves Institution or becomes ineligible during the 12 month transfer period.

If the institutionalized spouse during the 12 month transfer period:

1. Leaves the institution for 30 days or more and becomes institutionalized again,
   
   or
    

2. Becomes ineligible for Medicaid and then becomes eligible for Medicaid once again.
   
    

the time allowed to transfer assets does not start over again.

 

5.10.4.5.2  Institutionalized Spouse is Eligible after the 12 month transfer period

5.10.4.5.2.1   Leaves Institution for 30 or more days then Re-institutionalized

If the institutionalized spouse remains in the institution and MA eligible after the expiration of the 12 month transfer period, but then leaves the institution for 30 days or more, and subsequently becomes institutionalized once again for 30 days or more, s/he would be subject to all spousal impoverishment rules upon becoming re-institutionalized.

Including:

• An asset assessment (5.10.4.1) would be required for the purpose of determining the community spouse asset share,
  
  and
   

• The couple would have to once again pass a joint asset test,
  
  and
   

• The institutionalized spouse would get another 12 month period to transfer all of his/her assets in excess of $2000 to their community spouse.

5.10.4.5.2.2  Loses Medicaid eligibility but remains institutionalized

If the institutionalized spouse:
 

1. Remains in the institution and MA eligible after the 12 month transfer period,
    

2. But subsequently becomes ineligible and remains institutionalized,

Spousal impoverishment asset rules would not be applicable if s/he should reapply.    

If the institutionalized person reapplies for Medicaid,
 

• Her/his asset limit would be $2000.

• The spouse's assets would not be counted.  
   

If eligible, s/he would still be allowed to allocate some of her/his income to the community spouse.

This page last updated in Release Number : 06-02

Release Date: 06/29/06

Effective Date: 06/29/06