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Separation refers to a change in relationship. There are two forms of separation:
· Physical separation; and
· Legal separation.
The effect of separation depends on:
When the spouses are... |
And the customer receives... |
Then... |
Physically separated and no longer living together |
SSI MAO Medicare Savings Program (MSP) |
Individual budgeting applies beginning the first full month the spouses do not live together. |
ALTCS (Non-Community Spouse) |
The separation does not affect the customer’s income budgeting but could affect Share of Cost (SOC). Family or spousal maintenance is redetermined. |
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ALTCS (Community Spouse) Freedom to Work (FTW) - ALTCS |
Community Spouse policy continues to apply unless the spouse moves to a medical facility and is no longer living in the community. |
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Breast and Cervical Cancer Treatment Program (BCCTP) |
The customer may now qualify for another MA program. When the customer qualifies for another AHCCCS Medical Assistance (MA) program, that eligibility is approved and BCCTP coverage is ended. |
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Adult Caretaker Relative Pregnant Woman Child KidsCare |
Changes to who lives in the home may impact who is included in the budget group. See MA602D |
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Legally separated |
Any program |
Legal separation alone does not affect income or resource budgeting. |
Term |
Definition |
Physical Separation |
Physical separation means the spouses are not living in the same residence. |
Legal Separation |
Legal separation involves a court order. The court order may: · Allocate parental rights; · Order the payment of child support or spousal support; and · Provide for the division of marital property and the distribution of assets. Legal separation often is a step toward divorce, but also is used by people who choose not to end their marriage. This may be done for religious reasons or in order to protect assets. |
The customer or representative’s statement of the separation and location of the spouse is accepted, unless it is questionable or the customer’s ALTCS eligibility is determined using Community Spouse policy.
When the customer’s ALTCS eligibility was determined using Community Spouse rules, the living arrangement of the Community Spouse must be verified to determine whether or not to continue using Community Spouse rules. See MA521.
This applies to all programs.
Changes must be reported as soon as the future event becomes known. Unanticipated changes must be reported within 10 calendar days of the date the change occurred.
Program |
Legal Authorities |
ALTCS |
42 USC 1396r-5 for Community Spouse 42 CFR 435.916 AAC R9-28-401, R9-28-410 and R9-28-411(A)(1)(h) |
SSI-MAO |
20 CFR 416.1132 and 1163 42 CFR 435.602 42 CFR 435.916 AAC R9-22-1501(H)(1)(e) AAC R9-22-1503 |
Medicare Savings Program (MSP) |
20 CFR 416.1132 and 1163 42 CFR 435.602 42 CFR 435.916 AAC R9-29-213 |
Freedom to Work (FTW) |
42 CFR 435.916 AAC R9-22-1901 |
Breast and Cervical Cancer Treatment Program (BCCTP) |
42 CFR 435.916 AAC R9-22-2008 |
MAGI |
42 CFR 435.603 42 CFR 435.916 AAC R9-22-1420(B) |