(1) Determining income from
property.
a.
Nontrust
property. Where there is nontrust property, unless the document
providing income specifies differently, income paid in the name of one person
shall be available only to that person. If payment of income is in the name of
two persons, one-half is attributed to each. If payment is in the name of
several persons, including a Medicaid client, a client's spouse, or both, the
income shall be considered in proportion to the Medicaid client's or spouse's
interest. If payment is made jointly to both spouses and no interest is
specified, one-half of the couple's joint interest shall be considered
available for each spouse. If the client or the client's spouse can establish
different ownership by a preponderance of evidence, the income shall be divided
in proportion to the ownership.
b.
Trust property. Where there is trust property, the payment of
income shall be considered available as provided in the trust. In the absence
of specific provisions in the trust, the income shall be considered as stated
above for nontrust property.
(2) Division of income between married people
for SSI-related coverage groups.
a.
Institutionalized spouse and community spouse. If there is a
community spouse, only the institutionalized person's income shall be
considered in determining eligibility for the institutionalized
spouse.
b.
Spouses
institutionalized and living together. Partners in a marriage who are
residing in the same room in a medical institution shall be treated as a couple
until the first day of the seventh calendar month that they continuously reside
in the facility. The couple may continue to be considered as a couple for
medical assistance effective the first day of the seventh calendar month of
continuous residency if one partner would be ineligible for medical assistance
or receive reduced benefits by considering them separate individuals or if they
choose to be considered together. When spouses are treated as a couple, the
combined income of the couple shall not exceed twice the amount of the income
limit established in subrule 75.1(7). Persons treated together as a couple for
income must be treated together for resources and persons treated individually
for income must be treated individually for resources.
Spouses residing in the same room in a medical institution
may be treated as individuals effective the first day of the seventh calendar
month. The income of each spouse shall not exceed the income limit established
in subrule 75.1(7).
c.
Spouses institutionalized and living apart. Partners in a
marriage who are both institutionalized, although not residing in the same room
of the institution, shall be treated as individuals effective the month after
the month the partners cease living together. Their income shall be treated
separately for eligibility. If they live in the same facility after six months
of continuous residence, they may be considered as a couple for medical
assistance effective the first day of the seventh calendar month of continuous
residency if one partner would be ineligible for medical assistance or receive
reduced benefits by considering them separate individuals or if they choose to
be considered together.
In the month of entry into a medical institution, income
shall not exceed the amount of the income limit established in subrule
75.1(7).
(3)
Attribution of resources to institutionalized spouse and community spouse. The
department shall determine the attribution of a couple's resources to the
institutionalized spouse and to the community spouse when the institutionalized
spouse is expected to remain in a medical institution at least 30 consecutive
days on or after September 30, 1989, at the beginning of the first continuous
period of institutionalization.
a.
When determined. The department shall determine the
attribution of resources between spouses at the earlier of the following:
(1) When either spouse requests that the
department determine the attribution of resources at the beginning of the
person's continuous stay in a medical facility prior to an application for
Medicaid benefits. This request must be accompanied by Form 470-2577, Resources
Upon Entering a Medical Facility, and necessary documentation.
(2) When the institutionalized spouse or
someone acting on that person's behalf applies for Medicaid benefits. If the
application is not made in the month of entry, the applicant shall also
complete Form 470-2577 and provide necessary documentation.
b.
Information
required. The couple must provide the social security number of the
community spouse. The attribution process shall include a match of the Internal
Revenue Service data for both the institutionalized and community
spouses.
c.
Resources
considered. The resources attributed shall include resources owned by
both the community spouse and institutionalized spouse except for the following
resources:
(1) The home in which the spouse or
relatives as defined in 441-paragraph 41.22(3)"a" live
(including the land that appertains to the home).
(2) Household goods, personal effects, and
one automobile.
(3) The value of
any burial spaces held for the purpose of providing a place for the burial of
either spouse or any other member of the immediate family.
(4) Other property essential to the means of
self-support of either spouse as to warrant its exclusion under the SSI
program.
(5) Resources of a blind
or disabled person who has a plan for achieving self-support as determined by
division of vocational rehabilitation or the department of human
services.
(6) For natives of
Alaska, shares of stock held in a regional or a village corporation, during the
period of 20 years in which the stock is inalienable, as provided in Section
7(h) and Section 8(c) of the Alaska Native Claims Settlement Act.
(7) Assistance under the Disaster Relief Act
and Emergency Assistance Act or other assistance provided pursuant to federal
statute on account of a presidentially declared major disaster and interest
earned on these funds for the nine-month period beginning on the date these
funds are received or for a longer period where good cause is shown.
(8) Any amount of underpayment of SSI or
social security benefit due either spouse for one or more months prior to the
month of receipt. This exclusion shall be limited to the first six months
following receipt.
(9) A life
insurance policy(ies) whose total face value is $1500 or less per
spouse.
(10) An amount, not in
excess of $1500 for each spouse that is separately identifiable and has been
set aside to meet the burial and related expenses of that spouse. The amount of
$1500 shall be reduced by an amount equal to the total face value of all
insurance policies which are owned by the person or spouse and the total of any
amounts in an irrevocable trust or other irrevocable arrangement available to
meet the burial and related expenses of that spouse.
(11) Federal assistance paid for housing
occupied by the spouse.
(12)
Assistance from a fund established by a state to aid victims of crime for nine
months from receipt when the client demonstrates that the amount was paid as
compensation for expenses incurred or losses suffered as a result of a
crime.
(13) Relocation assistance
provided by a state or local government to a client comparable to assistance
provided under Title II of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970 which is subject to the treatment required by
Section 216 of the Act.
d.
Method of attribution.
The resources attributed to the institutionalized spouse shall be one-half of
the documented resources of both the institutionalized spouse and the community
spouse as of the first moment of the first day of the month of the spouse's
first entry to a medical facility. However, if one-half of the resources is
less than the minimum set by the federal spousal impoverishment provisions,
then the greater of $24,000 or the federally established minimum shall be
protected for the community spouse. Also, when one-half of the resources
attributed to the community spouse exceeds the maximum amount allowed as a
community spouse resource allowance under the federal spousal impoverishment
provisions, the amount over the maximum shall be attributed to the
institutionalized spouse. (The minimum and maximum limits are indexed annually
according to the consumer price index.) The federal spousal impoverishment
provisions are defined at Section 1924(f)(2)(A)(i) of the Social Security Act (
42
U.S.C. ยง
1396r-5(f)(2)(A)(i) ).
If the institutionalized spouse has transferred resources to
the community spouse under a court order for the support of the community
spouse, the amount transferred shall be the amount attributed to the community
spouse if it exceeds the specified limits above.
e.
Notice and appeal rights.
The department shall provide each spouse a notice of the attribution results.
The notice shall state that either spouse has a right to appeal the attribution
if the spouse believes:
(1) That the
attribution is incorrect, or
(2)
That the amount of income generated by the resources attributed to the
community spouse is inadequate to raise the community spouse's income to the
minimum monthly maintenance allowance.
If an attribution has not previously been appealed, either
spouse may appeal the attribution upon the denial of an application for
Medicaid benefits based on the attribution.
f.
Appeals. Hearings on
attribution decisions shall be governed by procedures in 441-Chapter 7. If the
hearing establishes that the community spouse's resource allowance is
inadequate to raise the community spouse's income to the minimum monthly
maintenance allowance, there shall be substituted an amount adequate to provide
the minimum monthly maintenance needs allowance.
(1) To establish that the resource allowance
is inadequate and receive a substituted allowance, the applicant must provide
verification of all the income of the community spouse. For an applicant who
became an institutionalized spouse on or after February 8, 2006, all income of
the institutionalized spouse that could be made available to the community
spouse pursuant to 75.16(2)"d" shall be treated as countable
income of the community spouse when the attribution decision was made on or
after February 8, 2006.
(2) The
amount of resources adequate to provide the community spouse minimum
maintenance needs allowance shall be based on the cost of a single premium
lifetime annuity with monthly payments equal to the difference between the
monthly maintenance needs allowance and other countable income not generated by
either spouse's countable resources.
(3) The resources necessary to provide the
minimum maintenance needs allowance shall be based on the maintenance needs
allowance as provided by these rules at the time of the filing of the
appeal.
(4) To receive the
substituted allowance, the applicant shall be required to obtain one estimate
of the cost of the annuity.
(5) The
estimated cost of an annuity shall be substituted for the amount of resources
attributed to the community spouse when the amount of resources previously
determined is less than the estimated cost of an annuity. If the amount of
resources previously attributed for the community spouse is greater than the
estimated cost of an annuity, there shall be no substitution for the cost of
the annuity, and the attribution will remain as previously
determined.
(6) The applicant shall
not be required to purchase this annuity as a condition of Medicaid
eligibility.
(7) If the appellant
provides a statement from an insurance company that it will not provide an
estimate due to the potential annuitant's age, the amount to be set aside shall
be determined using the following calculation: The difference between the
community spouse's gross monthly income not generated by countable resources
(times 12) and the minimum monthly maintenance needs allowance (times 12) shall
be multiplied by the annuity factor for the age of the community spouse in the
Table for an Annuity for Life published at the end of Iowa Code chapter 450.
This amount shall be substituted for the amount of resources attributed to the
community spouse pursuant to subparagraph 75.5(3)"f"
(5).
(4)
Consideration of resources of married people.
a. One spouse in a medical facility who
entered the facility on or after September 30, 1989.
(1) Initial month. When the institutionalized
spouse is expected to stay in a medical facility less than 30 consecutive days,
the resources of both spouses shall be considered in determining initial
Medicaid eligibility.
When the institutionalized spouse is expected to be in a
medical facility 30 consecutive days or more, only the resources not attributed
to the community spouse according to subrule 75.5(3) shall be considered in
determining initial eligibility for the institutionalized spouse.
The amount of resources counted for eligibility for the
institutionalized spouse shall be the difference between the couple's total
resources at the time of application and the amount attributed to the community
spouse under this rule.
(2)
Ongoing eligibility. After the month in which the institutionalized spouse is
determined eligible, no resources of the community spouse shall be deemed
available to the institutionalized spouse during the continuous period in which
the spouse is in an institution. Resources which are owned wholly or in part by
the institutionalized spouse and which are not transferred to the community
spouse shall be counted in determining ongoing eligibility. The resources of
the institutionalized spouse shall not count for ongoing eligibility to the
extent that the institutionalized spouse intends to transfer and does transfer
the resources to the community spouse within 90 days unless unable to effect
the transfer.
(3) Exception based
on estrangement. When it is established by a disinterested third-party source
that the institutionalized spouse is estranged from the community spouse,
Medicaid eligibility will not be denied on the basis of resources when the
applicant can demonstrate hardship.
The applicant can demonstrate hardship when the applicant is
unable to obtain information about the community spouse's resources after
exploring all legal means.
The applicant can also demonstrate hardship when resources
attributed from the community spouse cause the applicant to be ineligible, but
the applicant is unable to access these resources after exhausting legal
means.
(4) Exception based
on assignment of support rights. The institutionalized spouse shall not be
ineligible by attribution of resources that are not actually available when:
1. The institutionalized spouse has assigned
to the state any rights to support from the community spouse, or
2. The institutionalized spouse lacks the
ability to execute an assignment due to physical or mental impairment, but the
state has the right to bring a support proceeding against a community spouse
without an assignment.
b. One spouse in a medical institution prior
to September 30, 1989. When one spouse is in the medical institution prior to
September 30, 1989, only the resources of the institutionalized spouse shall
count for eligibility according to SSI policies the month after the month of
entry. In the month of entry, the resources of both spouses are countable
toward the couple resource limit.
c. Spouses institutionalized and living
together. The combined resources of both partners in a marriage who are
residing in the same room in a medical institution shall be subject to the
resource limit for a married couple until the first of the seventh calendar
month that they continuously reside in the facility. The couple may continue to
be considered as a couple for medical assistance effective with the seventh
month if one partner would be ineligible for medical assistance or would
receive reduced benefits by considering them separately or if they choose to be
considered together. Persons treated together as a couple for resources must be
treated together for income and persons treated individually for resources must
be treated individually for income. Effective the first of the seventh calendar
month of continuous residence, they may be treated as individuals, with the
resource limit for each spouse the limit for a single person.
d. Spouses institutionalized and living
apart. Partners in a marriage who are both institutionalized, although not
residing in the same room of the institution, shall be treated as individuals
effective the month after the month the partners cease living together. If they
live in the same facility after six months of continuous residence, they may be
considered as a couple for medical assistance effective the first day of the
seventh calendar month of continuous residency if one partner would be
ineligible for medical assistance or would receive reduced benefits by
considering them separately or if they choose to be considered together.
In the month of entry into a medical institution, all
resources of both spouses shall be combined and shall be subject to the
resource limit for a married couple.
(5) Consideration of resources for persons in
a medical institution who have purchased and used a qualified or approved
long-term care insurance policy pursuant to department of commerce, division of
insurance, rules in 191-Chapter 39 or 72.
a.
Eligibility. A person may be eligible for medical assistance
under this subrule if:
(1) The person is the
beneficiary of a qualified long-term care insurance policy or is enrolled in a
prepaid health care delivery plan that provides long-term care services
pursuant to 191-Chapter 39 or 72; and
(2) The person is eligible for medical
assistance under 75.1(6), 75.1(7), or 75.1(18) except for excess resources;
and
(3) The excess resources
causing ineligibility under the listed coverage groups do not exceed the "asset
adjustment" provided in this subrule.
b.
Definition. "Asset
adjustment" shall mean a $1 disregard of resources for each $1 that has been
paid out under the person's qualified or approved long-term care insurance
policy.
c.
Estate
recovery. An amount equal to the benefits paid out under a member's
qualified or approved long-term care insurance policy will be exempt from
recovery from the estate of the member or the member's spouse for payments made
by the medical assistance program on behalf of the member.
This rule is intended to implement Iowa Code sections
249A.3,
249A.4, and
249A.35
and chapter 514H.