County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Treatment of Property of Institutionalized Spouses and Their Community Spouses and LongTerm Care LTC Insurance Property Exemption Number Page 091301 1 of 2 Revision Date 05012019 Background This section explains the treatment of property for institutionalized spouses and their community spouses effective January 1 1990 as part of the Medicare Catastrophic Coverage Act and the property exemption for individuals with Statecertified LTC Insurance policies effective July 1 1994 In addition to the reformatting this section has been updated to include policy implemented by the Affordable Care Act ACA effective January 1 2014 Purpose This section explains the treatment of property for institutionalized spouses and their community spouses Policy A Definitions Institutionalized Spouse A person who has been admitted to a nursing facility or medical institution on or after 93089 and applies for MediCal on or after 1190 and is not a member of a CalWORKs Assistance Unit and is expected to remain in LTC for at least 30 days The ACA expanded the definition of institutionalized spouse to include Home and CommunityBased Services HCBS recipients and persons who have requested HCBS who generally reside at home or in the community MPG 051801 Community Spouse The spouse of an institutionalized individual who is not in longterm care and living in the home Community Spouse Resource Allowance CSRA The amount of countable property the community spouse is allowed to retain when the institutionalized spouse applies for medical benefits This may include the combined net market values of the nonexempt community and separate property belongings to either or both the institutionalized and community spouses CSRA is issued through ACWDL annually Note Refer to MPG 0907 for treatment of property transferred by an institutionalized individual for less than fair market value Procedures None Program Impacts None References MEPM Article 9 ACWDL 9001 1725 1819 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Treatment of Property of Institutionalized Spouses and Their Community Spouses and LongTerm Care LTC Insurance Property Exemption Number Page 091301 2 of 2 Sunset Date This policy will be reviewed for continuance by 05312022 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Maximum CSRA Allowable Number Page 091302 1 of 2 Revision Date 05012019 Background Effective January 1 1990 the community spouse is allowed to retain only the Community Spouse Resource Allowance CSRA This section has been reformatted no other changes have been made Purpose This section provides and overview of CSRA Policy A Maximum CSRA Any property considered to be part of the CSRA must be in the name of the community spouse The maximum CSRA is the greatest of the chart value or The amount granted through fair hearing Fair hearings may be requested by either spouse An amount established by a court order for the support of the community spouse and family members If a court order for support is sought by the community spouse and verification is provided an application may be pending for more than 45 or 60 days if necessary For a current listing of CSRA see Appendix II1A B Computation of the CSRA The couples net market value of the nonexempt community and separate property is combined and totaled as of the date of application for MediCal That total will be compared to the maximum CSRA If the total is less than or equal to the maximum CSRA then the CSRA shall be that amount If the total is more than the maximum CSRA then the CSRA shall be the maximum CSRA and the amount of excess shall be included in the property reserve of the institutionalized spouse After the CSRA has been determined new nonexempt property acquired by the community spouse and held in hisher name only is not to be considered available to the institutionalized spouse C Release From LongTerm Care LTC If an institutionalized spouse is released from a longterm care facility for at least 24hours and then reenters LTC a new CSRA shall be determined for the community spouse at the time of reentry Procedures D CSRA Example Mr and Mrs Harvest had 102580 when Mr Harvest had a stroke and was hospitalized Mr Harvest was transferred to a nursing facility on 101589 Of the 102580 52580 was Mrs Harvests inheritance from the death of her parents She has maintained this amount separately for 20 years Mrs Harvest is applying for MediCal for Mr Harvest on 3190 and Mr Harvest has spent 38000 Is Mr Harvest property eligible County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Maximum CSRA Allowable Number Page 091302 2 of 2 Answer Mr Harvest is eligible All property available on 3190 is combined 52580 Mrs Harvests inheritance 12000 Amount remaining after 38000 spent 64580 62580 Maximum CSRA for 1990 2000 Property limit for 1 0Excess Property Mr Harvest is eligible and has 90 days to remove his name from 10000 52580 is already in Mrs Harvests name Program Impacts None References MEPM Article 9 ACWDL 9001 Sunset Date This policy will be reviewed for continuance by 05312022 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Transfer Period Number Page 091303 1 of 2 Revision Date 05012019 Background When the couples property reaches the maximum CSRA plus 2000 property limit for one eligibility may be established for the institutionalized spouse A transfer period will be allowed from the date of the approval action being taken through the end of the month in which 90 days have elapsed This transfer period may be extended through the end of the month in which a court enters an order necessary to accomplish such transfers In addition to the reformatting this section has been updated to include policy implemented by the Affordable Care Act ACA Purpose This section provides and overview of the transfer period for property of an institutionalized spouse Policy A Transfer period Any property considered to be part of the CSRA must be in the name of the community spouse During the transfer period property included in the CSRA is not to be considered available to the institutionalized spouse When SI provisions for an institutionalized spouse are used in determining MediCal retroactively the CSRA transfer periods may extend several years Desk Aid 95 Request verifications only for the applicable application date which is the first month the SI provisions apply unless the countable property exceeds the CSRA plus 2000 If excess property inform the individual regarding spenddown and determine which month the property is under the CSRA plus 2000 and request verifications for that month On the approval NOA write the end date of the CSRA transfer period At the end of the transfer period the net market value of all property remaining in the name of the institutionalized spouse or both of the spouses is to be considered 100 available to the institutionalized spouse and included in the property reserve B Undue Hardship Eligibility cannot be denied if there is excess property and undue hardship Undue hardship exists when Except for such excess property the institutionalized spouse is otherwise eligible and HeShe is unable to obtain medical care without MediCal and The community spouses whereabouts are unknown or There has been a break in marital ties and the community spouse refuses to cooperate C Exceptions to Regular Medical Property Inclusions Jewelry regardless of its value is exempt The provision applies only to institutionalized and community spouses D Property Assessment A community spouse or institutionalized spouse or their representatives may request a property assessment even if the institutionalized spouse is not applying for MediCal Explain that if not County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Transfer Period Number Page 091303 2 of 2 applying for MediCal at the same time that the assessment is being completed that the amounts shown on the property assessment may change when they apply for MediCal The individuals are eligible for a property assessment only if one of the spouses Is institutionalized on or after September 30 1989 and The other spouse does not reside in a nursing facility or medical institution receiving a nursing level of care and The individual has verifications of the values of all real and personal property liquid and nonliquid assets at the time of the appointment Assessment Interview The assessment interview will be completed within 45 days from the date that the MediCal Property Assessment Application MC 176 PAA is signed and all of the following have been received The Property Assessment Statement of Facts MC 210 PA Relevant verifications The MediCal application if appropriate If verification is not provided by the assessment applicant use the information provided on the MC 210 PA and document on the Property WorksheetAssessment MC 176 PA that verification of value was not provided Explain the following a MediCal General Property Limitations for all MediCal applicants MC Information Notice 007 b How to reduce excess property Copies of the forms will be provided to each spouse andor their representatives Image the originals in the case and narrate in the case comments the date of the property assessment and the date of entry into LTC Procedures None Program Impacts None References MEPM Article 9 ACWDL 9001 9003 1819 504907 SDHS Clarification Sunset Date This policy will be reviewed for continuance by 05312022 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide LongTerm Care LTC Property Exemption Number Page 091304 1 of 2 Revision Date 05012019 Background Effective July 1 1994 individuals with Statecertified LTC insurance policies are eligible for an exemption of property equal to the amount of benefits paid under such a policy This section has been reformatted no other changes have been made Purpose This section provides and overview of LTC Property Exemptions Policy A Qualifications To qualify for Statecertified LTC insurance policies exemption the applicantbeneficiary will provide verification listing the amount of qualifying benefits that has been paid todate B Examples 1 An LTC individual applies for MediCal on 11696 The total value of his nonexempt property is 49900 The individual provides verification of 48000 paid for LTC services under his LTC insurance policy with Statecertified ABC Insurance Company 4990000 nonexempt property 4800000 qualified LTC property exemption 190000 net value toward property reserve This LTC applicants countable nonexempt property is within the property limit for one person 2 Generally an individual with an LTC insurance policy which provides coverage for a minimum of one year and a maximum of five years will not apply for MediCal until the policy benefits are exhausted However in some instances an individual may require acute hospitalization or some other services not covered by hisher insurance policy and will apply early In these cases the individual will receive an exemption equal to the benefits amount that has been paid to the date of application and they have to spenddown other excess property if any before eligibility may be established 3 When an LTC person is eligible for MediCal and is also covered by an LTC insurance policy an appropriate Other Health Coverage OHC code for the LTC insurance carrier has to be entered on the case record to assure that MediCal is not paying for services for which the insurance carrier is liable Refer to MPG 1501 for instructions on adding an OHC code Adding the OHC code is not required for a beneficiary who has an indemnity policy however the per diem payments to the beneficiary are considered income and included in the computation of shareofcost 4 If a beneficiary happens to acquire additional property after establishing eligibility for MediCal such as proceeds from the sale of hisher former residence lotto winnings inheritance etc County of San Diego Health and Human Services Agency HHSA MediCal Program Guide LongTerm Care LTC Property Exemption Number Page 091304 2 of 2 the amount of additional benefits paid under the Statecertified insurance policy should be verified to determine how much of the newly acquired nonexempt property can be exempted Procedures None Program Impacts None References MEPM Article 9 ACWDL 9426 9482 Sunset Date This policy will be reviewed for continuance by 05312022 Approval for Release Rick Wanne Director Eligibility Operations