REVISION

On page 3 of IM-#117, we stated, "If both members of the couple are determined by DA to require both an NF level of care and HCB waiver services, the couple is not eligible for an assessment of assets or Title XIX using HCB waiver criteria."

It is correct that such a couple may not receive an assessment and division of assets, because both members of the couple meet the definition of institutionalized.  If the couple meets the regular resource standard ($2,000), however, the HCB waiver income criteria ($750) may be applied in determining Medicaid eligibility for each member of the couple.

EXAMPLE

Both Mr. and Mrs. Hickby are authorized by DA for HCB waiver services.  They do not qualify for division of assets, but their combined resources are $1,500, which is less than the resource maximum.  Mr. Hickby's gross income of $654.80 allows him to qualify for Medicaid under the HCB waiver criteria, and Mrs. Hickby's gross income of $559.80 allows her to qualify for Medicaid under the HCB waiver criteria.

CLARIFICATION

Following are common questions we have received regarding HCB waiver criteria Medicaid eligibility and responses.

17. In a couple case, if the non-HCB waiver spouse remains a spenddown, do we allow the medical expenses of the HCB individual to meet spenddown?

1. No.  Only the expenses of the non-HCB waiver spouse can be used to meet spenddown.

17. Must clients accept HCB waiver services, or do they have a choice?  For example, the non-HCB spouse may have a much larger spenddown when budgeted separately from the HCB individual.

1. Clients do not have to accept HCB waiver services.  If they do not wish to receive the services, they must notify DA to end their authorization.  While a client is authorized for HCB waiver services, Medicaid eligibility must be determined under HCB waiver criteria.

17. If a spenddown client has declined QMB due to its effect on the amount of spenddown, and now is eligible under HCB waiver criteria, should we automatically put them on QMB?

1. There should be no adverse effect to this action; thus, approve for QMB at the same time the case is transferred to HCB.  It is not necessary to have the claimant sign an IM-1, although an application for QMB should be entered through IAPP.

17. On an ongoing basis (for cases not on the HCB listings), can we use the IM-2D and waive the face-to-face interview for HCB applicants referred by the DA?

1. Yes, you may adopt this simpler application process for HCB applicants referred by DA.  If the client has not been referred by DA, you may not use the IM-2D or waive the face-to-face interview.

17. In couple cases, do we count the income of the HCB individual's spouse toward the $750 limit?  Although IM-#117 (1992) indicated the answer is no, the fact sheet confused us by saying to count the "HCB spouse's" income.

1. Count only the income of the HCB individual toward the $750 limit.  Do not count income of the spouse of the HCB individual.

When we developed the HCB fact sheet, it was to help the home care industry understand HCB waiver eligibility criteria.  We equated the term "HCB Spouse" with "Institutionalized Spouse", as it is used for division of assets.  This terminology was familiar to the industry, because one of it's main interests was to implement spousal impoverishment rules for HCB recipients.

In the HCB policy memorandum, however, we used the term "HCB Individual" to mean a single individual or an "Institutionalized Spouse".  Our use of two different terms with the same meaning was confusing, for which we apologize.

As we stated in IM-#117 (1992), it is very important to quickly convert Social Services 
Block Grant cases to HCB Medicaid.  A review of the listing of cases requiring action by 
DFS shows that most of these conversions have been completed.  Thank you for your 
prompt action in converting these cases.

We also appreciate you cooperation with Division of Aging staff, and you prompt action in dealing with cases they refer to you.

• Review this memorandum with all appropriate staff.