IM-#168, December 11, 2020, IM-#163, November 26, 2019, IM-#68, December 10, 2018, IM-#161, December 21, 2017, IM-#01, January 04, 2017, IM-#5 January 15, 2015, IM-#115 December 13, 2013, IM-#112 December 28, 2012, IM-#102 December 3, 2008, IM-#116 December 7, 2007, IM-#145 December 1, 2005, IM-#127 December 2, 2004
In determining the resources of an institutionalized spouse at the time of application for vendor benefits, all non-exempt assets held by either the institutionalized spouse or the community spouse, or both, are considered available to the institutionalized spouse only to the extent that the assets exceed the spousal share, provided the institutionalized spouse intends to transfer the excess assets to the community spouse. Refer to the policy covering Required Transfer of Assets (Spouse Vendor Case) for spouse vendor cases.
To determine the initial vendor eligibility of the institutionalized spouse:
- Verify the equity value of all the non-exempt assets owned by the institutionalized and community spouse for the month in which the first continuous period of institutionalization began. (Verify the continuous period.)
- Determine the spousal share.
NOTE: If the assessment was completed prior to the vendor application, the total non-exempt asset at institutionalization and the spousal share would already have been determined.
- Verify the equity value of all non-exempt assets owned by the institutionalized and community spouse for the month in which the application was made.
- Deduct the amount of the spousal share from the total non-exempt assets in the month of application.
If the remainder is at or below the resource maximum for a single person the institutionalized spouse is initially eligible for vendor benefits based on resource availability subject to the Required Transfer of Assets (Spouse Vendor Case) policy.
NOTE: The current Minimum and Maximum Spousal Share can be found on Appendix B.
EXAMPLE #1: On October 7 Mr. Taylor applied for MHABD vendor for his spouse and requested an assessment of assets. Mrs. Taylor was admitted to a MO HealthNet certified NF bed on February 6 and is likely to remain 30 days. The couple’s total non-exempt assets consist of one $5,000 savings account. The spousal share is $26,076. ($5,000 / 2 = $2,500, but the minimum spousal share is $26,076). For the initial MO HealthNet vendor eligibility determination, Mrs. Taylor has no resources to consider. ($5,000 – $26,076< 0.)
EXAMPLE #2: Mrs. Lawrence (institutionalized spouse) was admitted to a MO HealthNet certified NF bed on September 15 and is likely to remain 30 days. Mr. Lawrence (community spouse) requests an assessment of assets on September 16. The total non-exempt assets amount to $300,000. Mr. Lawrence’s spousal share is $130,380. ($300,000 / 2 = $150,000; however, the maximum spousal share is $130,380). Mrs. Lawrence resides in a MO HealthNet certified bed in the facility and therefore may qualify for MO HealthNet vendor benefits. When Mrs. Lawrence applies for vendor benefits, whether at the time she becomes institutionalized or later, $130,380 will be deducted from the verified non-exempt assets at the time of the application. If the remainder of those assets is at or below the resource maximum for a single person, Mrs. Lawrence will be initially eligible for vendor benefits based on the resource eligibility factor.
After initial vendor eligibility for the institutionalized spouse is determined, the assets of the community spouse are NOT considered available to the institutionalized spouse during any continuous period of institutionalization. This provision is subject to the policy governing Required Transfer of Assets (Spouse Vendor Case).
Consider only the assets in the name of the institutionalized spouse when determining continued eligibility for vendor benefits. The institutionalized spouse’s assets are CONSIDERED AVAILABLE to the community spouse if that spouse applies for IM assistance. Should the community spouse apply for IM assistance, consider the application as a couple case.
NOTE: Division of Assets affects only vendor or HCB cases. A Division of Assets does not affect eligibility determinations for Supplemental Nursing Care (SNC), MHABD Spenddown, MHABD Non Spenddown, or TWHA. SNC and non vendor programs do not allow for a disregard of spousal share in determining eligibility even though an individual residing in a non MO HealthNet certified bed in an Intermediate Care Facility or a Skilled Nursing Facility may qualify for a Division of Assets.