8140 Treatment of Resources and Income - The general guidelines of 5200 and 6100 are applicable to persons in institutional arrangements. The following additional rules must also be considered.
8141 Initial Resource Test - When a one spouse enters a medical institution (whether or not the facility is Medicaid approved) on or after September 30, 1989 for at least 30 consecutive days and the temporary stay policy of 8113 is not applied, the total value of the resources owned by the couple which exceed the community spouse resource allowances as determined in accordance with 8144.1 below shall be considered available to the institutionalized spouse in determining eligibility (including prior eligibility) regardless of which spouse owns the resources and regardless of whether the spouses intend to divide resources under the spousal impoverishment provisions. This provision is also applicable regardless of any previously established prenuptial or postnuptial agreement or court-ordered divisions of martial property. The combined resources of the couple must be considered despite such agreement.
If the value exceeding the community spouse resource allowance is less than or equal to the allowable 1 person resource level described in 5130, the person in the institution is eligible. In the month following the first month of eligibility, only those resources owned by the institutionalized spouse shall be considered for determining continuing eligibility on his or her case. This may result in ineligibility for the following months unless the couple intend to transfer assets under the spousal impoverishment provisions.
If the value exceeding the community spouse resource allowance is more than the allowable 1 person resource level, the person shall not be eligible until such time that the excess falls below the 1 person resource standard. At that point, the person becomes eligible for the month the excess is reduced. For the following months, only the resources owned by the institutionalized spouse shall be considered on his or her case. This may result in ineligibility for those months as indicated above.
The institutionalized spouse shall not be rendered ineligible because of the initial resource test if the agency initiates legal action in court against the community spouse for failure to make those resources in excess of the resources allowable available to the institutionalized spouse. The institutionalized spouse shall also not be rendered ineligible because of this initial resource test if denial of eligibility would result in an undue hardship. This could include instances in which the community spouse is refusing to make resources he or she owns available to the institutionalized spouse and the above-mentioned support proceeding has not been initiated or where the couple has a substantial outstanding debt which must be met through those resources currently available to them. If undue hardship is claimed, it must be referred to KDHE-DHCF Policy for a decision.
8142 Other Resource Provisions
1. The combined resources of two spouses shall be considered only for the month the institutional arrangement begins in the following situations:
a. One spouse enters a medical institutional (whether or not the facility is Medicaid approved) prior to September 30, 1989 for other than a temporary stay as defined in 8113;
b. Both spouses enter a medical or non-medical institutional living arrangement (whether or not the facility is Medicaid approved) for other than a temporary stay as defined in 8113; or
c. One spouse enters a nonmedical institution. If the community spouse is also an applicant or recipient of any medical program, (including HCBS), the community spouse resource allowance is considered available to the community spouse to determine eligibility of the community spouse, beginning in the month the arrangement begins.
d. This includes those assets in which the community spouse has no current ownership interest. If the couple’s total combined resources are less than the minimum community spouse resource allowance, the total combined resources less the one person resource standard (currently $2,000) is considered available to the community spouse.
e. In the month following the first month of eligibility of the LTC spouse, only those assets in which the applicant or recipient has ownership interest in shall be considered in the determination of eligibility for each individual spouse. Those assets which intend to be transferred to the community spouse per the M-2 are attributable to the community spouse when determining his or her eligibility. The pro rata share of jointly owned resources shall be considered.
NOTE: If only a one spouse entered a medical institution or HCBS arrangement prior to September 30, 1989 but returns to an independent living arrangement for at least 30 consecutive days, the provisions of 8141 above shall apply if he or she returns to the institutional arrangement on or after September 30, 1989.
2. The combined resources of two spouses shall be considered only for the month the institutional arrangement begins in the following situations:
3. There is no resource test for a child or young adult under the age of 21 who enters an institutional living arrangement (whether or not the facility is Medicaid approved). A resource test is applicable the month after the month the individual turns 21 years old.
Parents of children under the age of 18 in state institutions may retain a legal obligation for payment of costs above those covered by the medical program. Parental obligation will be established by institutional personnel.
4. Individuals applying for medical assistance to cover the cost of institutional care have the option of making a voluntary contribution of excess resources towards the patient liability in order to become resource eligible. This provision allows applicants otherwise ineligible for coverage due to excess resources to qualify by counting the amount of excess resources as income in determining the patient liability. See 5200 (14) and 8172.4.
This provision also applies to institutional care recipients with excess resources. In addition, otherwise unspent exempt income which over time results in excess resources may also be voluntarily contributed by an institutional care recipient towards the share of cost in an on-going basis to maintain resource eligibility.