Medicaid Policy
Medicaid Policy
Previous Policy (373-2 renumbered to 573-2 as of November 1, 2017)
Determine the protected share of resources for the community spouse when the institutionalized individual applies for Medicaid and meets all eligibility requirements.
If the spousal assessed share (573-1) is:
Between $0.00 and the minimum spousal asset share, the community spouse's protected share is the minimum spousal asset share. (See Table II-A for amounts)
Between the minimum spousal asset share and the maximum spousal asset share, the community spouse's protected share is the spousal assessed share determined in 573-1.
Over the maximum spousal asset share, the community spouse's protected share is the maximum spousal asset share. See Table II-A.
The protected share of resources for the community spouse may be increased through a fair hearing if it is necessary to raise the spouse's income to the minimum monthly maintenance needs allowance for a spouse (Table II-A), or a higher monthly income amount that has been set by a fair hearing or court order. The "income first" rule applies to the hearing decision. This means the Hearings Officer must consider all income available to the community spouse, including the full spousal income allowance from the institutional spouse's income first before allocating more resources to the community spouse to raise the spouse's income. The Hearings Officer decides if the protected share can be increased.
If a fair hearing decision increases the spouse's protected share of resources, subtract the increased allowance from the total value of assets at application to determine the countable assets you use to determine eligibility for the spouse in the institution.
If a long-term care Medicaid member has not been and will not be covered by any category of Medicaid for more than 30 days, determine a new protected share of resources when the individual reapplies for long-term Medicaid. If a member is receiving Medicaid for ancillary services during a penalty period, do not determine a new protected share when the penalty period ends.
If the maximum and minimum protected resource amounts have changed when the individual reapplies, the protected share may be different than it was before.
Do not complete a new assessment of assets. Use the original one.
Determine the current countable resources, and a new protected share based on the assessed share subject to the current minimum and maximum allowances in effect.
The member receives a new protected period to use or transfer assets (573-6).
Use the amount determined under a previous fair hearing decision if it is higher.