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Medicaid Program - Spousal Impoverishment Provisions - South Carolina

Institutionalized individuals who have a spouse in the community are allowed to give a portion of their income to the community spouse and dependent family members living with the community spouse.

Special provisions are in place for how income and resources are considered for Medicaid eligibility for an individual who is in an institution (or receives Home and Community-Based Services) and has a spouse remaining in the community.

The countable resources of both the institutionalized spouse and the community spouse are used to determine eligibility. Countable resources are assets that an individual owns and can apply, either directly or by sale or conversion, to meet the basic needs of food, clothing and shelter. For purposes of the spousal impoverishment provisions, countable resources do not include the value of:

·          the home and contiguous land

·          household goods

·          one automobile

·          burial funds and spaces in accordance with SSI policy

·          certain non-home property

·          resources necessary to carry out a plan of self support for a blind or disabled person

·          resources received through a disaster assistance program

·          retroactive SSI/DI payments for 6 months

·          the cash value of insurance policies with a face value at or below $5,000

The community spouse’s share is subtracted from the couple’s total countable resources–the community spouse is allowed to retain up to $66,480 in countable resources. The remainder is the institutionalized spouse’s share of resources. If this amount is below $2000, and he or she is otherwise eligible, the institutionalized spouse is eligible for Medicaid. If this amount is equal to or above $2000, the institutionalized spouse is not eligible for Medicaid until his or her resources are below $2000.

Determining the specific amount of income to be allocated to the community spouse is a two-step process:

First, the institutionalized spouse must be determined eligible for Medicaid considering only his/her income–the institutionalized spouse must have gross monthly income below the Medicaid Cap in order to be eligible.

Second, the amount the institutionalized spouse must contribute toward the cost of his/her care must be established; this is called "monthly recurring income". Generally, the following deductions must be made from the institutionalized spouse’s gross income to determine the monthly recurring income. The deductions must be made in the following order:

·          personal needs allowance of $30

·          community spouse income allowance, not to exceed $2232 (the community spouse is allowed to keep enough of the institutionalized spouse’s income to bring his/her monthly income up to $2232, if the institutionalized spouse has income)

·          an allowance for other dependent family members

·          the cost of medical expenses not covered by Medicaid or other third party payers

The dollar amounts mentioned above were current as of 07/30/2005.

See also:

Medicaid Program - Financial Eligibility

Medicaid Program - Non-Financial Eligibility

Medicaid Program - SSI with Essential Spouse Recipients

Medicaid Program - Overview

Source

http://www.dhhs.state.sc.us/dhhsnew/insideDHHS/Bureaus/BureauofLongTermCareServices/GeneralInformation.asp

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