Revision 09-4; Effective December 1, 2009

HHSC assesses the couple's combined countable resources as of 12:01 a.m. on the first day of the month in which the first continuous period in an institutional setting began. When determining the first day of the month in an institutional setting for the SPRA, HHSC may count days the person spent in a hospital if the person is admitted directly from the hospital to an institutional setting. After the continuous period begins, hospital stays and therapeutic home visits are not considered as breaks in the 30-consecutive-day period. See Section G-6210, 30 Consecutive Days and the Special Income Limit.

Note: When determining the first day of month of institutionalization for the SPRA, institutionalization can be based on hospitalization if the individual is admitted directly to the nursing facility from the hospital stay.

J-4310 Determining the Assessment Date for a Home and Community-Based Services Waiver

Revision 09-4; Effective December 1, 2009

The SPRA is assessed as of 12:01 a.m. on the first day of the month that the application was received for the financial Medicaid eligibility component. See Chapter O, Waiver Programs, Demonstration Projects and All-Inclusive Care.

  • If the waiver application is certified, the SPRA assessment date does not change unless it was based on incomplete or inaccurate information.
  • If the waiver application is not certified and the individual reapplies, the SPRA assessment date is 12:01 a.m. on the first day of the month of the re-application month.

J-4311 Examples of the Assessment Date

Revision 09-4; Effective December 1, 2009

If spousal impoverishment is applicable and:
an institutionalized Medicaid recipient requests a program transfer to a waiver,use the established SPRA.This is considered an institutional SPRA.
a community applicant applies for a waiver,assess resources as of 12:01 a.m. on the first day of the month of the MEPD application.This is considered a waiver SPRA if the waiver application is certified.
an institutionalized applicant applies for Medicaid and then a waiver before being certified,assess resources as of 12:01 a.m. on the first day of the month of institutionalization.

Institutionalization can be based on hospitalization if the individual is admitted directly to the facility from the hospital stay.
This is considered an institutional SPRA.
Note: When determining the 30-day stay requirement, consider both the days in a medical facility and the days in the waiver setting.
a community applicant applies for a waiver and then enters a medical facility before being certified,assess resources as of 12:01 a.m. on the first day of the month of institutionalization from a medical facility regardless if the applicant remains in the medical facility or returns to community waiver services before certification.This is considered an institutional SPRA. Note: When determining the 30-day stay requirement, consider both the days in a medical facility and the days in the waiver setting.

Note: When determining the first day of month of institutionalization for the SPRA, institutionalization can be based on hospitalization if the individual is admitted directly to the nursing facility from the hospital stay.