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
- 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.
- 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.