Ariz. Admin. Code § R9-28-410 - Community Spouse
A. The
methodology in this Section applies to an institutionalized person who has a
community spouse.
B. If the
institutionalized person's most current period of continuous
institutionalization began on or after September 30, 1989, the Administration
shall use the methodology for the treatment of resources under
42
U.S.C. 1396r-5(c).
1. The following resource criteria shall be
used in addition to the criteria specified in
R9-28-407 to be eligible:
a. Resources owned by a
couple at the beginning of the first continuous period of institutionalization
from and after September 30, 1989, shall be computed from the first day of
institutionalization. The total value of resources owned by the
institutionalized spouse and the community spouse, and a spousal share equal to
one-half of the total value, are computed under
42 U.S.C.
1396 r - 5(c)(1).
b. The Community Spouse Resource Deduction
(CSRD) is calculated under
42 U.S.C.
1396 r - 5(f)(2).
c. The CSRD is subtracted from the total
resources of the couple to determine the amount of the couple's resources
considered available to the institutionalized spouse at the time of application
under
42 U.S.C.
1396 r - 5(c)(2).
i. Resources in excess of the CSRD must be
equal to or less than the standard for a person specified in
R9-28-407.
ii. The CSRD is allowed as a deduction for 12
consecutive months beginning with the first month in which the
institutionalized spouse is eligible for ALTCS benefits. Beginning with the
13th month, the separate property of the institutionalized spouse must be
within the resource standard for a person specified in
R9-28-407.
iii. If a person who was previously eligible
for ALTCS as an institutionalized person with a community spouse reapplies for
ALTCS after a break in institutionalization of more than 30 days, the CSRD will
be allowed as a deduction from resources for a 12-month period in addition to
the period in subsection (c)(ii).
2. Resources are excluded as specified in
R9-28-407, except that one vehicle is totally excluded regardless of its value,
and any additional vehicles are included using equity value.
3. The Director may grant eligibility if the
Administration determines that a denial of eligibility would create an undue
hardship for the institutionalized spouse.
C. This Section applies to the income
eligibility and post-eligibility treatment of income beginning September 30,
1989, regardless of when the first period of institutionalization began.
1. Income payments are attributed to the
institutionalized person and the community spouse under
42 U.S.C.
1396 r - 5(b)(2).
2. Income is excluded as specified in
R9-28-408.
3. The institutionalized spouse's income
eligibility is determined by combining the income of the institutionalized
person and the community spouse and dividing by two. If the institutionalized
person is not eligible using this method, the income eligibility shall be based
on the income received in the person's name.
4. The following allowances described in
42
U.S.C. 1396r-5(d)(1) and (2)
are allowed as deductions from the institutionalized spouse's income in
determining share-of-cost:
a. A
personal-needs allowance specified in
R9-28-408(E)(5);
b. A community spouse monthly income
allowance, but only to the extent that the institutionalized spouse's income is
made available to or for the benefit of the community spouse;
c. A family allowance for each family member
equal to one-third of the amount remaining after deducting the countable income
of the household member from a Minimum Monthly Maintenance Needs Allowance
(MMMNA);
d. An amount for medical
or remedial services as specified in
R9-28-408;
and
e. An amount for Medicare and
other health insurance premiums, deductibles, or coinsurance not subject to
third-party reimbursement.
D. Transfers.
1. The institutionalized spouse may transfer
to any of the following an amount of resources equal to the CSRD without
affecting eligibility under
42
U.S.C. 1396r-5(f). The
institutionalized spouse may transfer resources to:
a. The community spouse; or
b. Someone other than the community spouse if
the resources are for the sole benefit of the community spouse.
2. The institutionalized spouse is
allowed a period of 12 consecutive months, beginning with the first month of
eligibility, to transfer resources in excess of the resource standard in
R9-28-407 to the persons listed in subsection (D)(1).
3. All other transfers by the
institutionalized person or transfers by the community spouse are treated under
the provisions in
R9-28-409.
E. Specific hearing rights as
described under 9 A.A.C. 34 apply to a person whose eligibility is determined
under this Section.
1. The institutionalized
spouse or the community spouse is entitled to a fair hearing if dissatisfied
with the determination of any of the following:
a. The community spouse monthly income
allowance,
b. The amount of monthly
income allocated to the community spouse,
c. The computation of the spousal share of
resources,
d. The attribution of
resources, or
e. The
CSRD.
2. The hearing
officer may increase the amount of the MMMNA if either the community spouse or
institutionalized spouse establishes that the community spouse needs income
above the established MMMNA due to exceptional circumstances.
3. The hearing officer may increase the
amount of the CSRD to allow the community spouse to retain enough resources to
generate income to meet the MMMNA. The hearing officer may allow the community
spouse to retain an amount of resources necessary to purchase a single premium
life annuity that would furnish monthly income sufficient to bring the
community spouse's total monthly income up to the MMMNA.
Notes
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