December 1973 Eligibility Requirements Manual

1030.035.05 DEFINITIONS

With regard to Division of Assets, the following definitions apply:

Community Spouse – The spouse of an institutionalized individual.  Included in this definition is the concept of ‘spouse with whom the participant is living’.  Apply the Division of Assets policy only if the community spouse was married to and living with the institutionalized spouse at the time of the institutionalization.  This includes cases where there is involuntary separation because one member of the couple is out of the home to receive medical or nursing home care.

Institutionalized Spouse – An individual who enters a nursing facility or medical institution; AND is expected to be in the medical institution or nursing facility for at least 30 days; AND is married to a spouse who is not confined to a nursing facility or medical institution.

HCB Waiver Services participants also meet the definition of institutionalized spouse.

Medical institution– A medical hospital or a mental hospital.

Nursing Facility – A nursing facility licensed by the Missouri Department of Health and Senior Services (DHSS) as an Intermediate Care Facility (ICF) or Skilled Nursing Facility.  Licensure information is available by viewing the DHSS Internet link: www.dhss.mo.gov/showmelongtermcare/ “Locate a Long Term Care Facility”.  For the purposes of Division of Assets, Nursing Facility also includes a mental health (ICF-MR) facility.

Continuous Period of Institutionalization – A period in a medical institution and/or nursing facility that is likely to be at least 30 consecutive days.  Transfers between beds either within or between facilities or medical institutions does not break the continuous period of institutionalization.

The Missouri Court of Appeals Western District in its December 2006 opinion reversed the Family Support Division’s decision to deactivate Gee’s Division of Assets on the basis that she did not meet the definition of an institutionalized spouse because she was not in a Medicaid certified bed. Thereafter, the definition of institutionalized spouse is changed to comply with the Court’s decision in the Gee case.  The definition now includes individuals residing in an Intermediate Care Facility (ICF) or Skilled Nursing Facility.  Prior to the Gee decision, the individual was required to reside in a Medicaid certified bed to qualify for a Division of Assets.