DATE: NOVEMBER 21, 2003
Manual: Aged, Blind, and Disabled Medicaid
Change No: 11- 04
To: County Directors of Social Services
Effective: January 1, 2004
Section 1924 (g) of the Social Security Act contains provisions for the protection of income and resources when an institutionalized spouse (ISP) has a community spouse (CUSP). Each January 1st, there is an increase in the maximum community spouse income allowance (CSIA) and the minimum and maximum community spouse resource allowance (CSRA). This increase is a result of an increase in the Consumer Price Index and is based on the difference between the September 1988 Consumer Price Index and the September 2003 Consumer Price Index.
The Centers for Medicare and Medicaid Services (CMS) has determined that the Consumer Price Index increase from September 1988 to September 2003 is 54.6 percent. This percentage was used to determine the new spousal impoverishment amounts.
There is no change in the minimum CSIA, dependent family member allowance, or the allowance for excess shelter expenses. These amounts change in July of each year.
The protection of income applies when the applicant/recipient (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 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).
This change in policy is effective January 1, 2004.
Apply the new CSRA amounts to any month in the certification period beginning January 2004 or later.
Recalculate the amount of the countable resources of the institutionalized spouse (ISP) effective January 1, 2004, by applying the new CSRA amounts. This may reduce the countable resources of the ISP effective January 1, 2004.
Example: The CSRA determined prior to 1-1-04 was $17,900. The couple’s countable resources on 12-31-03 totaled $20,110. This left $2,210 in countable resources for the ISP ($20,110 - $17,900 = $2,210). Effective 1-01-04, increase the CSRA to $18,552. This reduces the countable resources of the ISP to $1,558 ($20,110 - $18,552 = $1,558). Assistance may be authorized for the ISP effective January 1, 2004, provided all other eligibility factors are met.
Example: The couple’s countable resources at institutionalization totaled $183,214. One-half of this amount is $91,607. However, the maximum CSRA of $90,660 was protected for the CUSP. The couple’s countable resources on 12-31-03 totaled $170,000. This left $79,340 in countable resources for the ISP ($170,000 - $90,660 = $79,340). Effective 1/1/04, increase the CSRA to $92,760. This reduces the countable resources of the ISP to $77,240 ($170,000– $92,760 = $77,240) beginning 1/01/04.
Hospital inappropriate level of care, ventilator dependent care, and swing bed rates have not changed.
The new Medicare rates apply to eligible medical services incurred on or after January 1, 2004. MA-2270, Table B, is updated to reflect the new rates.
Insert: MA-2231, Community Spouse Resource Protection,
pages 7- 10, effective 1-1-04.
Insert: MA-2260, Financial Eligibility Regulations – PLA,
Pages 14-15 (Income Table), effective 1-1-04.
Insert: MA-2360, Medicaid Deductible, pages 11-12, 15-16, 19-20,
If you have any questions, please contact your Medicaid Program Representative.
(This material was researched and written by Susan Ryan, Medicaid Policy Consultant, Medicaid Eligibility Unit).
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.