2004 Memorandums
IM-21      03/03/04
MANUAL REVISION #3:  1030.035.15.03,   1030.035.36
Once an institutionalized spouse is determined Medicaid eligible the subsequent institutionalization of the community spouse has no effect on the original institutionalized spouse’s eligibility, unless the community spouse applies for Medicaid. This policy is based on a Missouri Court of Appeals decision, Maples v. Department of Social Services .  When a community spouse enters a Medicaid certified Nursing Facility bed, do not deactivate the assessment of assets nor count the community spouse’s resources as available to the institutionalized spouse if:
  • the institutionalized spouse has been determined vendor eligible; AND
  • the community spouse does not apply for Medicaid.
If the community spouse becomes institutionalized and applies for Medicaid, spousal impoverishment rules no longer apply.  Eligibility for both spouses will be determined as a regular couple case. 

This revision does not change the definition of a community spouse. Continue to follow the current instructions on assessing assets, establishing the spousal share, permitting transfer of assets to the community spouse, and determining eligibility should the community spouse apply for assistance. 

Under the previous policy, staff deactivated the assessment case if the community spouse became institutionalized. Staff then counted all resources to include those owned solely by community spouse and covered by the spousal share. If resources exceeded the $2000 married couple maximum, the institutionalized spouse’s continued vendor eligibility ended.

If a community spouse enters a nursing facility and does not apply for Medicaid, the community spouse may continue to receive an allotment.

  • Review this memorandum with appropriate staff.
  • Use revised policy when a community spouse enters an institution.