Revision 09-4; Effective December 1, 2009

Spousal impoverishment policy does not change the determination of what constitutes income or the methodology and standards for determining and evaluating income. See Chapter E, General Income. For spousal impoverishment, do not consider Section E-7000, Deeming Income, or Section E-8000, Support and Maintenance.

 

J-2110 Income Eligibility Test for the Institutional Spouse

Revision 09-4; Effective December 1, 2009

For the income eligibility test, separate treatment of income is required. During any month in which an institutionalized spouse is in an institutional setting, no income of the community spouse is used to determine the eligibility of the institutionalized spouse. When totaling countable income for the institutional spouse, consider the following.

If payment of income is made:

• solely in the name of the institutionalized spouse or the community spouse, the income shall be considered available only to that respective spouse;
• in the names of the institutionalized spouse and the community spouse, one-half of the income shall be considered available to each of them; and
• in the names of the institutionalized spouse or the community spouse, or both, and to another person or persons, the income shall be considered available to each spouse in proportion to the spouse’s interest (or, if payment is made with respect to both spouses and no such interest is specified, one-half of the joint interest shall be considered available to each spouse).

An institutionalized spouse can rebut the treatment of the income based on the assumed ownership interest by establishing a preponderance of evidence that the ownership interests in income are different.

 

J-2111 Treatment of Interest from a Joint Account

Revision 09-4; Effective December 1, 2009

For treatment of jointly owned accounts with liquid assets such as a joint bank account, follow Appendix XXV, Accessibility to Income and Resources in Joint Bank Accounts, in determining how to treat the interest. Also refer to the policy for treatment of interest in the following items:

• Section E-3331, Interest and Dividends;
• Section E-5000, Variable Income; and
• Section E-9000, Infrequent or Irregular Income.

 

J-2112 Treatment of Income from a Trust

Revision 09-4; Effective December 1, 2009

If income from a trust is countable, the income is considered available to each spouse as provided in the trust. If the trust does not specifically address how the income is to be distributed and payment of income is made:

• solely to the institutionalized spouse or the community spouse, the income shall be considered available only to that respective spouse;
• to both the institutionalized spouse and the community spouse, one-half of the income shall be considered available to each of them; and
• to the institutionalized spouse or the community spouse, or both, and to another person or persons, the income shall be considered available to each spouse in proportion to the spouse’s interest (or, if payment is made with respect to both spouses and no such interest is specified, one-half of the joint interest shall be considered available to each spouse).

 

J-2113 Other Treatment of Income

Revision 09-4; Effective December 1, 2009

When income is received, but there is no instrument establishing ownership, one-half of the income shall be considered to be available to the institutionalized spouse and one-half to the community spouse.

An institutionalized spouse can rebut the treatment of the income based on the assumed ownership interest by establishing a preponderance of evidence that the ownership interests in income are different.

Revision 10-2; Effective June 1, 2010

For the resource eligibility test, combined treatment of resources is required by federal regulations. In determining the resources of an institutionalized spouse, regardless of any state laws relating to community property or the division of marital resources, all the resources held by either the institutionalized spouse, community spouse or both shall be considered to be available to the institutionalized spouse.

When totaling countable resources for the institutional spouse consider the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest.

Use Chapter F, Resources, for treatment of resources to determine countable value. Apply exclusions, as appropriate, keeping in mind the federal requirement to use the combined resources regardless of any state laws relating to community property or the division of marital resources.

For the assessment and the initial eligibility period, follow these exceptions to the resource exclusions in Chapter F and do not consider in the countable value the following resources:

• one automobile; and
• a home, if:
  • the community spouse or dependent family member continues to live in the home while the person is in the institutional setting;
  • the community spouse lives in another state on out-of-state property, whether or not the institutionalized spouse has ownership interest; or
  • the community spouse had been living in the out-of-state property as a home but is not residing there during the assessment and initial eligibility period and the community spouse signs a statement of intent to return to the home.
• household goods and personal effects (see Section F-4222, Household Goods and Personal Effects).

Determine countable resources based on resources of the couple beginning with the first month for which eligibility is being tested (including prior months). Follow standard resource requirements to verify the resources as of 12:01 a.m. on the first day of the month.

Countable resources can be reduced by the amount of funds encumbered before 12:01 a.m. on the first day of the month by any checks written before that time that have not yet been processed by the financial institution. For further information about encumbered funds, see Section F-1311, Encumbered Funds, and Section F-1312, Nursing Facility Refunds.

At application, resource eligibility will be determined from the countable resource. See Section J-5000, Spousal Initial Application.

 

J-2210 Out-of-State Home and Spousal Impoverishment

Revision 09-4; Effective December 1, 2009

With the following exceptions, a person who applies for and receives Medicaid benefits in Texas is not allowed to exclude a home in another state. Otherwise, if the person considers his home in another state to be his principal place of residence, he is not a Texas resident, and he must apply for assistance in his home state.

• If the community spouse lives in another state in a house that the institutional spouse claims is not his homestead, to determine the protected resource amount and initial eligibility, exclude the out-of-state property as a part of resources totally excluded regardless of value. If the institutional spouse still has an ownership interest in the property at the first annual redetermination, HHSC considers the value of the property a countable resource that is real property. This situation does not affect residency requirements. As long as the institutionalized spouse intends to remain in the state where he is institutionalized, he is considered a resident.
• If the community spouse lives in another state in a house that is the institutional spouse’s homestead, the home is excluded in the resource assessment and throughout the initial eligibility period of 12 months. If the institutional spouse still has an ownership interest in the property at the first annual redetermination, the home is a countable resource. If the community spouse is not living in the out-of-state home, the community spouse must sign a statement of intent to return for the home to be excluded for the resource assessment and initial eligibility period of 12 months.

See Section F-3000, Home, and Section F-3500, Out-of-State Home Property.