Clarifying Information
Under Section 1924 of the Social Security Act, married people who receive coverage under an 1115 waiver demonstration project are considered to be an institutionalized spouse for the purposes of applying spousal impoverishment protections. Spousal impoverishment protections do therefore apply to both MAC and TSOA clients if the spouse of the MAC/TSOA applicant doesn't reside in an institution.
For married TSOA applicants: the spousal impoverishment protections community (SIPC) spouse is allowed to have resources of $55,547 (effective 7/1/17) before any resources are counted towards the applicant’s $53,100 limit. The $53,100 standard does not change, however the state spousal resource standard ($55,547) may adjust every odd year in July.
Combined resources must be at or below the state resource standard for a married couple plus $53,100 ($108,647 as 7/1/2017) for initial eligibility. Once eligibility is determined, the spouse receiving services has one year to transfer resources in their name over $53,100 to his or her spouse.
For TSOA income determinations, the name on check rule applies in that only the income of the TSOA applicant is counted, and not that of the community spouse. For TSOA, the community income rule (add both spouses income together and divide by two) isn’t permitted.
For married MAC applicants: for the most part MAC applicants will already be eligible for CN or ABP Medicaid. However, in the following circumstances a second review of the person’s income and resources is required:
- A married MAC applicant is not eligible for SSI-related CN Medicaid (for example, the person is active on S95 medically needy coverage, or pending spenddown on S99 due to the deemed income of their spouse.
- SSI-related Medicaid is denied due to the couple being over the $3000 resource limit.
If the MAC applicant’s separate income is below the SSI-related CNIL and the couples joint resources are below the combined standard of $2000 for the applicant plus $55,547 for the community spouse, the applicant is eligible for SSI-related CN coverage (S02) as a spousal impoverishment protections institutional (SIPI) spouse.
A person who is approved for SSI-related CN coverage as a SIPI spouse receives a 12 month certification regardless of whether they receive ongoing MAC services throughout the certification period.
Note: For working clients who are potentially eligible for HWD, the same spousal impoverishment income protections apply.
Under current statute the spousal impoverishment protections are time-limited for MAC applicants and will end on December 31, 2018. This does not affect spousal impoverishment protections for TSOA applicants.
Worker Responsibilities
Use an ACES workaround to approve S02 or S08 coverage for SIPI MAC recipients, by coding the community spouse as a nonmember in the assistance unit. Code all resources over the $2000 resource limit on the spouse’s resource screens. Manually generate a notice to notify the applicant of the requirement to transfer all resources in excess of $2000 to their spouse prior to the first eligibility review.
Text to include with the letter: “We will review your case in (last day of review month). The amount of resources in your name must be $2,000 or less by the end of the review month. You can transfer any resources over $2,000 to your spouse. We will need proof of these transfers. See WAC 182-513-1660 for more information.”