J-6200, Spousal Expansion Sept. 1, 2004, or After

Revision 13-4; Effective December 1, 2013

If the first continuous period of institutionalization was Sept. 1, 2004, or after, follow an income-first methodology in spousal impoverishment Medicaid eligibility evaluations. When using the income-first methodology, the institutionalized spouse must divert all non-resource income minus the institutionalized spouse's personal needs allowance to the community spouse.

If a resource is excluded, the income from such a resource is countable income in the expansion budgeting for the individual and community spouse. For example, an annuity is an excluded resource; thus, the income produced from that annuity is countable income in the spousal budgeting.

To determine the amount of the increased SPRA, the eligibility specialist or hearing officer determines the current interest rate of a one-year certificate of deposit (CD), as published in the local paper or provided by a local bank that offers one-year CDs. The eligibility specialist or hearing officer then determines the amount of resources required to produce income, at the specified interest rate, that would increase the spouse's income to the monthly maintenance needs allowance.

Determine the protected amount of resources by using the formula specified in the following steps. This formula is to be used to determine the maximum amount of resources to be protected regardless of the actual income a resource may or may not be producing at the time of the original SPRA or at the time of the appeal hearing. (Use Appendix XXVII, Worksheet for Expanded SPRA on Appeal.)

Note: The expanded SPRA may not exceed the value of the couple's combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

Example

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

The expanded SPRA is the lesser of:

• $250,300, or
• the value of the couple's total combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

When determining the post-eligibility co-payment and the amount available for spousal diversion, the eligibility specialist uses the actual dollar amount produced if the actual amount is in excess of the amount a one-year CD would produce. However, if the actual amount a resource produces is less than the amount a one-year CD would produce, the eligibility specialist uses the amount a one-year CD would produce. (Use Appendix XXVIII, Worksheet for Spouse's Income [Post-Expanded SPRA Appeals].)

The institutionalized spouse's income placed into a qualified income trust (QIT) is considered income in the calculation of the expanded SPRA.

The expanded SPRA cannot exceed the total countable assets determined for the initial SPRA.

Use Appendix XXVII.

Note: Form H1275, Request for Expanded Spousal Protected Resource Assessment, must be signed by the applicant/authorized representative.

J-6210 Sharing Required Information

Revision 24-1; Effective March 1, 2024

After the expanded SPRA appeal, income attributed to the institutionalized spouse for both eligibility and co-payment purposes is the sum of:

• the total actual income from resources where the institutionalized spouse has sole title; and
• one-half of actual income from resources where the institutionalized spouse and the community spouse have joint title.

After the expanded SPRA appeal, income attributed to the community spouse for purposes of determining the spousal diversion is the higher of:

• the total actual income from all resources where the community spouse has sole title, plus one-half of actual income from resources where the institutionalized spouse and community spouse have joint title; or
• imputed income from all resources included in the expanded SPRA whether or not the community spouse has title to those resources.

Only consider the imputed income during the initial eligibility period. After the initial eligibility period, actual income generated by a resource is countable to the spouse who holds title. If the spouses have joint title, one-half of the actual income is countable to each spouse.

Examples:

Jon Janis enters the nursing facility on Jan. 2, 2024. He applies for Medicaid on Jan.15, 2024. Before entering the facility, he lived with his wife, Josie. She still resides in their home. Their total countable combined resources equal $500,000.

Form H1275, Request for Expanded Protected Resource Assessment, is signed and Mr. Janis diverts all of his non-resource monthly income. Mr. Janis has monthly income of $2,800. Mrs. Janis has monthly income of $1,029.50. Both incomes are non-resource produced income. Income first method is used and $2,800 – $75 PNA = $2,725 + Mrs. Janis' income $1,029.50 = $3,754.50 < $3,853.50 MMMNA; this amount is determined to be available for the spouse. Enter this amount into Step 2 of Appendix XXVII. New SPRA is calculated. CD interest rate is 4.5%.

Step 1:
 

Step 2:

Step 3:

Step 4:

Step 5:

• The expanded SPRA is less than the original SPRA of $154,140.
• Use the original SPRA to determine eligibility when the expanded SPRA is less than the original SPRA.

Bob Barrister enters the nursing facility on Jan.10, 2024. He applies for Medicaid on Feb.15, 2024. Before entering the facility, he lived with his wife, Betty. She still lives in their home. Their total countable combined resources equal $500,000.

• Mr. Barrister has monthly income of $2,800. Mrs. Barrister has monthly income of $1,200. Both incomes are non-resource produced income. Since the first continuous period of institutionalization was on or after Sept. 1, 2004, use the income first method to determine the expanded SPRA.
• Calculation: Mr. Barrister's income $2,800 – $75 PNA = $2,725 + Mrs. Barrister's income $1,200 = $3,925 > $3,853.50 MMMNA.
• The calculation of the person's net non-resource produced income and the spouse's non-resource produced income resulted in an amount greater than the MMMNA.
• Do not expand the SPRA.