J-1300, Spousal Definitions

Revision 15-3; Effective September 1, 2015

Community spouse — A person who is not living in a setting that provides medical care/services and who is married to:

  • an institutionalized person, or
  • a person who has been determined eligible for a Home and Community-Based Services waiver program.

Note: The community spouse of an institutionalized person may receive services under a Home and Community-Based Services waiver program, which will not affect the spousal diversion.

Dependent family member — Either spouses' minor or dependent children, dependent parents or dependent siblings (including half brothers, half sisters and siblings gained through adoption) who were:

  • living in an institutionalized recipient's home before the recipient's institutionalization; or
  • living with a recipient of a Home and Community-Based Services waiver program; and
  • who are unable to support themselves outside the recipient's home because of medical, social or other reasons.

First continuous period of institutionalization — A spouse who is likely to reside in one or more of the following medical care facilities for a continuous period of institutionalization:

  • Hospital, including a VA hospital
  • Nursing facility, whether private-pay or Medicaid
  • ICF/IID
  • IMD
  • Rehabilitation facility

Institutional setting — In this chapter only, a living arrangement in which a person applying for or receiving Medicaid:

  • lives in a Medicaid-certified long-term care facility,
  • receives services under a Home and Community-Based Services waiver program, or
  • receives services under the Program of All-Inclusive Care for the Elderly (PACE).

Institutionalized spouse — A person who is married to a spouse residing in the community and who:

  • receives care in an institutional setting, and
  • has met or is likely to meet the continuous period of institutionalization for at least 30 consecutive days.

or

  • is eligible for a Home and Community-Based Services waiver program, and
  • is likely to need such services for at least 30 consecutive days.

Spousal protected resource amount (SPRA) — The portion of a couple's combined countable resources that is reserved for the community spouse and deducted from the couple's combined countable resources in determining eligibility.