DATE: NOVEMBER 26, 2001
Manual: Aged, Blind, and Disabled Medicaid
Change No: 09-02
To: County Directors of Social Services
Effective: January 1, 2002
Section 1924 (g) of the Social Security Act contains provisions for the protection of income and resources when an institutionalized individual has a community spouse (CUSP). Each January 1st, there is an increase in the maximum community spouse income allowance and the minimum and maximum community spouse resource allowance. This increase is a result of an increase in the Consumer Price Index (CPI) and is based on the difference between the September 1988 CPI and the September 2001 CPI.
The Centers for Medicare and Medicaid Services (CMS) has determined that the CPI increase from September 1988 to September 2001 is 48.8 percent. This percentage was used to determine the new spousal impoverishment amounts.
There is no change in the minimum community spouse income allowance, dependent allowance, or the allowance for excess shelter expenses. These amounts change in July of each year.
The protection of income applies when the a/r is institutionalized and has a CUSP. In order for the CUSP to be eligible for income protection, the a/r must be budgeted long-term care. The protection of income begins the first month of long term care budgeting.
The community spouse resource allowance (CSRA) applies when the a/r is institutionalized and has a CUSP. In order for the CUSP to be eligible for resource protection, the a/r may be budgeted PLA or long-term care. The protection of resources begins the first month of the continuous period of institutionalization (CPI).
The new spousal protection amounts are as follows:
This change in policy is effective January 1, 2002.
Apply the new CSRA amounts to any months in the certification period beginning January 2002 or later.
Recalculate the amount of the countable resources of the institutionalized spouse (ISP) effective January 1, 2002, by applying the new CSRA amounts. This may reduce the countable resources of the ISP effective January 1, 2002.
(1) If the CSRA is less than $17,856, increase the allowance to the new amount and recalculate the countable resources of the ISP.
Example: The CSRA determined prior to 1-1-02 was $17,400. The couple’s countable resources on 12-31-01 totaled $19,610. This left $2,210 in countable resources for the ISP ($19,610 - $17,400 = $2,210). Effective 1-01-02, increase the CSRA to $17,856. This reduces the countable resources of the ISP to $1,754 ($19,610 - $17,856 = $1,754). Assistance may be authorized effective 1-1-02 provided all other eligibility factors are met.
(2) If one-half of the couple’s countable resources at the beginning of the CPI is greater than the previous maximum CSRA, increase the CSRA to the new maximum amount for any months in the certification period beginning January 2002 or later. Recalculate the countable resources of the ISP based on the increased CSRA.
Example: The couple’s countable resources at institutionalization totaled $183,214. One-half of this amount was $91,607. However, the maximum CSRA of $87,000 was protected for the CUSP. The couple’s countable resources on 12-31-01 totaled $170,000. This left $83,000 in countable resources for the ISP ($170,000 - $87,000 = $83,000). Effective 1-1-02, increase the CSRA to$89,280. This reduces the countable resources of the ISP to $80,720 ($170,000– $89,280 =$80,720).
Hospital inappropriate level of care, ventilator dependent care, and swing bed rates have increased. Table A has been updated to reflect the new rates. Apply these rates to services incurred on or after January 1, 2002.
The new Medicare rates apply to eligible medical services incurred on or after January 1, 2002. Table B is updated to reflect the new rates.
Insert attached MA-2231, pages 7-10, effective 1-1-02
B. Remove MA-2270, pages 15-16
Insert attached MA-2270, pages 15-16, effective 1-1-02
C. Remove MA-2270, Table i and Table ii
Insert attached MA-2270 Table i and Table ii, effective 1-1-02
If you have any questions, please contact your Medicaid Program Representative.
Nina M. Yeager
(This material was researched and written by Vanessa Broadhurst, Policy Consultant, Medicaid Eligibility Unit).
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.