MEMORANDUM

DISCUSSION:

Effective immediately, the definition of institutionalized spouse who qualifies for a Division of Assets is changed to remove the requirement that the individual must reside in a MO HealthNet certified bed. This is to comply with the Missouri Court of Appeals Western District December 2006 decision in the Gee vs. Department of Social Services, Family Support Division case.

Individuals residing in Intermediate Care Facility (ICF) and Skilled Nursing Facility beds that are not MO HealthNet certified beds are now eligible for Division of Assets.  The disregard of spousal share continues to apply only to eligibility for HCB and vendor coverage.  Do not disregard the spousal share when determining eligibility for Supplemental Nursing Care (SNC), MO HealthNet for Aged, Blind, and Disabled (MHABD) Spenddown or Non Spenddown, or Ticket to Work Health Assurance (TWHA) programs.

Definition of Institutionalized Spouse

In the Gee case, the Court 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.  Therefore, the definition of institutionalized spouse used to determine when a couple qualifies for a Division of Assets is changed. The participant no longer has to meet the requirement of residing in a MO HealthNet certified bed to be eligible to receive a Division of Assets.  Effective immediately for the purposes of Division of Assets an institutionalized spouse is 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.  To be considered institutionalized, the individual MUST reside in:

• an Intermediate Care Facility (ICF);
• a Skilled Nursing Facility;
• a medical hospital;
• a mental hospital; or
• a mental health (ICF-MR) facility.

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

Nursing facility licensure information is available by viewing the Missouri Department of Health and Senior Services (DHSS) Internet link: www.dhss.mo.gov/showmelongtermcare/ “Locate a Long Term Care Facility”.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Process requests for Division of Assets when an individual meets the definition for an institutionalized spouse contained in this memorandum.
• Do not apply a disregard of assets or spousal share to determine eligibility for Supplemental Nursing Care, MHABD Spenddown or Non Spenddown, or TWHA.
• Apply a disregard of assets or spousal share to determine eligibility for MO HealthNet vendor coverage or HCB.