707 Community Spouse Resource Budgeting

Policy

Community Spouse rules protect a certain amount of the couple's resources for the spouse living in the community.

This protected amount of the couple’s resources is the Community Spouse Resource Deduction (CSRD).

NOTE          The customer must meet the requirements in MA508 to qualify for the CSRD.

Under Community Spouse Initial rules, the CSRD is deducted from the couple’s combined counted resources for up to 12 consecutive months when determining resource eligibility.  The 12-month period:

·        Begins the 1st month eligibility is determined using community spouse rules and ends after the next 11 months.

·        May include months when the individual is not eligible or gets acute care only. See Ineligible Month in Initial Period for an example.

This 12-month Initial Period gives the couple time to transfer sole ownership of counted resources to the Community Spouse.  The resources left in the customer’s name must not be more than the $2,000 resource limit when the initial rules period ends to meet the resource limit when post-initial rules are applied.

The Initial Period may be shorter than 12 consecutive months when:

·        The customer transfers all counted resources over $2,000 to the community spouse before the end of the Initial Period.

·        The couple’s counted resources increase during the Initial Period and the customer no longer qualifies using initial rules.  The couple is given the option to switch to post-initial rules early and has10 days to transfer remaining resources over $2,000 to the Community Spouse.   See Ending the Initial Period Early – Resources Increased for an example.

·        Eligibility stops before the end of the 12-month period.

1)    When are Initial Rules applied?

When the customer has a community spouse and is not currently on ALTCS, see the table below to determine which rules to use:

2)    CSRD Standards

The following standards are used to determine the Community Spouse Resource (CSRD). These Federal standards generally change every year on January 1st.

3)    Community Spouse Resource Assessment (CSRA)

A resource assessment is often needed to determine the value of the couple’s resources for the month the customer’s first continuous period of institutionalization (FCPI) began. This is called the Community Spouse Resource Assessment (CSRA).  The CSRA amount is then used to calculate the Community Spouse Resource Deduction (CSRD). 

Exception:

A CSRA is not needed when the customer is resource eligible in the month of application using the minimum CSRD in section 2 above.  The minimum CSRD amount is used for the Initial Period.

When a CSRA is needed, the steps in the table below are followed:

NOTE          A customer can have a CSRA done without applying for ALTCS.  For example, a couple thinking about moving to Arizona, may request a CSRA to see if they might qualify before they move.

4)    How to calculate the CSRD

The table below describes how to calculate the CSRD:

See Community Spouse Resource Deduction for examples.

NOTE          Resource policy varies from state to state. A resource assessment or determination from another state cannot be used to qualify in Arizona. 

5)    Using the CSRD for Later Applications

Once determined, a customer’s (CSRD) is used for all later applications when initial rules are applied, unless the customer was given the Minimum or Maximum CSRD.

The Minimum and Maximum CSRD amounts can increase from year to year.  If the customer qualified for the Minimum or Maximum CSRD originally and applies again later, the Minimum or Maximum CSRD in effect for the month of the later application is used.

6)    Undue Hardship Exception

When a customer's resources are over the limit using Community Spouse rules, the customer may still qualify for ALTCS when denying the customer would cause an undue hardship and all of the following are met:

·        Except for resources, the customer meets all of the ALTCS requirements;

·        The customer is unable to get medically necessary care without ALTCS benefits;

·        The property is legally unavailable without the signature of the community spouse, and the community spouse has refused to make the property available to the customer; and

·        There has been a break in marital ties.

7)    Post-Initial Rules

Post-initial rules are used to determine resource eligibility when the initial rules period has ended.  Under post-initial rules resource eligibility resources are counted as follows:

·        The CSRD is not used;

·        None of the community spouse's resources are considered available to the customer;

·        The customer's ALTCS is not affected by community spouse transferring his or her sole property;

NOTE          The transfers may affect the community spouse if he or she applies for ALTCS in the future.

·        Only the customer's resources are totaled and compared to the resource limit.

8)    How to Calculate Community Spouse Resource Eligibility

How resource eligibility is determined for a customer with a Community Spouse depends on whether Initial Rules or Post-Initial Rules are being used.

Community Spouse Resource Calculation – Initial Rules

Determine the customer’s resource eligibility using initial rules as follows:

See Initial Rules Calculation for an example.

Community Spouse Resource Calculation – Post-Initial Rules

Determine the customer’s resource eligibility using Post-initial rules as follows:

See Post-Initial Rules Calculation for an example.

Definitions

Proof

The proof needed for Community Spouse resource budgeting depends on the specific policy.

1)    Application Period Resource value

Proof of the value of all resources currently owned by the customer and community spouse.

If the customer has a copy of a resource assessment completed in another other state, this document is acceptable proof of the resources the customer owned at the time the assessment was done.  However, more proof may be needed if a different FCPI is determined or the value of a resource if it is determined differently based on Arizona policy.  A copy of the resource assessment completed in the other state and all related documentation must be provided.  Otherwise, for proof of resource values, see the proof section for that resource type in MA705.

2)    FCPI Month Resource value

When the customer does not qualify using the Minimum CSRD, he or she must also provide proof of the value of resources the couple owned during the month the FCPI began. A copy of a resource assessment completed in another state may be used as proof of the resources the couple owned in the month assessed.  

However, more proof may be needed when a different FCPI month is determined or the value of a resource type is determined differently based on Arizona policy.   For proof of specific resource values, see the proof section for that resource type in MA705.

3)    Post-Initial period resource value

During the post-initial period, the customer must provide the following proof:

·        The value of only the resources remaining in his or her name.

·        Proof that the excess resources were transferred and to whom.

4)    FCPI determination

The customer must provide the following proof to establish the FCPI:

·        Medical institution admission and discharge dates;

·        Proof of formal paid HCBS received and when.  This includes proof that the person providing the services was licensed or certified and that the services were paid.

·        Proof of an FCPI month based on intent to receive long-term care services is the first eligible PAS determination made for an ALTCS application, CSRA request or Private Request PAS.

5)    Undue Hardship

Some proof needed for undue hardship claims is collected during the application process.  This includes proof the customer meets all other ALTCS requirements and the customer’s ability to get necessary services without ALTCS.

Proof needed for the other two undue hardship conditions includes the following:

·        Proof that a resource is legally unavailable without the spouse’s signature and that the spouse refuses to make the resource available.  This may include:

o       Court documents,

o       Titles or deeds,

o       Spouse’s signed statement (for refusal to make the resource available),

o       Contracts or other documents that support the customer’s claim.

·        Proof of a break in marital ties includes:

o       A dissolution or annulment petition that has been filed with the court; or

o       A copy of a court approved Legal Separation Agreement.

Legal Authorities