J-6400, SPRA Expansion before Sept. 1, 2004

Revision 12-4; Effective December 1, 2012

If the first continuous period of institutionalization was before Sept. 1, 2004, follow a resource-first methodology, which allows the $1 diversion procedure to calculate the expanded SPRA. The expanded SPRA looks at only the community spouse's income, plus an income diversion from the spouse in the nursing home, and only $1 diversion is required from the spouse in the nursing home when using the resource-first methodology. (Use Appendix XXVII, Worksheet for Expanded SPRA on Appeal.)

In nursing facility and waiver cases with a community spouse, the applicant/recipient can appeal to increase the SPRA to produce additional income for the spouse. The eligibility specialist or hearing officer may increase the SPRA to a level adequate to produce income up to but not to exceed the monthly maintenance needs allowance.

The couple can protect additional resources. The resources can be equal to the dollar amount that must be deposited in a one-year certificate of deposit (CD), at current interest rates, to produce interest income equal to the difference between the monthly maintenance needs allowance (in effect at the time of the filing of the appeal) and other countable income not generated by either spouse's countable resources. The couple is not required to invest in the CD as a condition of eligibility.

To determine the amount of the increased SPRA, the eligibility specialist or hearing officer determines the current interest rate of a one-year 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.)

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.)

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

J-6410 Sharing Required Information

Revision 09-4; Effective December 1, 2009

If institutionalization was before Sept. 1, 2004, the eligibility specialist must know how much income the institutionalized spouse wishes to divert to the community spouse to determine the value of additional resources to be protected.

Hearing officers or eligibility specialists should inform the couple or the couple's authorized representative (AR) that the lower the income diversion amount, the higher the expanded SPRA, and that the institutionalized spouse must agree to divert at least $1 for the SPRA to be expanded.

The hearing officer or eligibility specialist should further inform the couple or the couple's AR that once the SPRA is expanded, an additional amount may be diverted to the community spouse whose total income (including income from the expanded SPRA) is less than the MMMNA. The new spousal diversion amount (after the SPRA is expanded) may be recalculated by either the hearing officer or the eligibility specialist.

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

• the total actual income from resources to which the institutionalized spouse has sole title; plus
• one-half of actual income from resources to which 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 to which the community spouse has sole title, plus one-half of actual income from resources to which 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).

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