A request to add a spouse to an existing MA spend down or non-spend down case can be received through the mail or by phone, it does not have to be in writing. The request to add the spouse to an existing case can be received as part of the annual review, or any time the claimant reports a spouse in the home. Requests may also be received to change the status of a spouse already in the home from included to active. An annual review is not necessary to change the status of a spouse already in the home from included to active.
Since eligibility for MA spend down and non-spend down for a married couple, who are living together, is determined on a couple basis, both must be entered on the same case in the IMU5 system. Refer to 0805.015.05.05 Couple Cases in the IMU5 System. When one spouse is eligible and the other is not, the system requires the non-eligible spouse to be entered as an included person (level of care “Z” in field 13G) in IMU5 on the eligible spouse’s case. If the included spouse later requests MA coverage use the following procedure:
- Record the date of the request for coverage of the spouse. The date of request is used as the application date when determining the earliest possible Medicaid (Title XIX) eligibility begin date.
- Determine the spouse’s eligibility for MA, and record the basis for the determination.
- When the spouse is approved or rejected send the appropriate notice, IM-33, to the casehead.
- Change the included spouse to an active (loc “T”) person on the case.
NOTE: It is not necessary to re-verify income of a spouse currently included on the case.
When the spouse being added was not previously included on the case (for example: a previously excluded spouse, refer to 0805.015.05 Persons Whose Income and Needs are Considered or a new spouse) use the following procedure:
- Record the date of the request to add the spouse.
- IAPP the individual on the active MA case.
- Determine eligibility for MA, and record the basis for the determination.
- Complete a couple budget to reflect the spouse and their income.
- Enter an IMU5 transaction to reflect the new budget and the status of the spouse.
- When the spouse is approved or rejected send the appropriate notice, IM-33 to the casehead.
When a spouse is added as an active person on a MA spend down case, the system will enter Medicaid coverage on the MSPI screen for all dates the casehead had coverage back to the added spouse’s Title XIX begin date.
EXAMPLE: Mrs. Jones has had an active spend down case since December 2002. Her 66 year-old non-citizen husband has been shown on the case only as an included person as he did not want to apply or divulge his alien status. In July 2003 Mr. Jones requests coverage back to April 1, 2003. It is verified that Mr. Jones was admitted to the United States as a lawful permanent resident on February 1, 1998. Since has five year period of ineligibility for Medicaid expired before the beginning of his prior quarter, enter April 1, 2003 as his Title XIX begin date as on Mrs. Jones case with a loc “T”, reason code “S”. Income and resources do not need to be re-verified, as Mr. Jones was already included. Mrs. Jones has spend down coverage by bills for 4/10/03 – 4/30/03 and 6/2/03 – 6/30/03 and by pay-in effective 7/1/03. The day after Mr. Jones is changed to a loc “T”, the system will add the same coverage for him on MSPI.