Revision 15-3; Effective September 1, 2015

 

J-6100 Policy and Procedure for SPRA Expansion

Revision 12-3; Effective September 1, 2012

 

The expanded SPRA allows assets protection above the maximum SPRA set by federal law. The formula provides that the applicant can protect enough assets based on interest earned to create available income up to the minimum monthly maintenance needs allowance.

The SPRA is expanded by either the MEPD specialist via the individual's request and signature on Form H1275, Request for Expanded Protected Resource Assessment, or by a hearing officer via the fair hearing process.

There are two methodologies to determine the expanded SPRA. The date of the first continuous period of institutionalization determines which methodology to use to determine the expanded SPRA. Determine if the first continuous period of institutionalization was:

  • before Sept. 1, 2004; or
  • Sept. 1, 2004, or after.

Calculate an expanded institutional SPRA based on the month of entry into a medical care facility, not the date of application.

 

J-6200 Spousal Expansion Sept. 1, 2004, or After

Revision 13-4; Effective December 1, 2013

 

If the first continuous period of institutionalization was Sept. 1, 2004, or after, follow an income-first methodology in spousal impoverishment Medicaid eligibility evaluations. When using the income-first methodology, the institutionalized spouse must divert all non-resource income minus the institutionalized spouse's personal needs allowance to the community spouse.

If a resource is excluded, the income from such a resource is countable income in the expansion budgeting for the individual and community spouse. For example, an annuity is an excluded resource; thus, the income produced from that annuity is countable income in the spousal budgeting.

To determine the amount of the increased SPRA, the eligibility specialist or hearing officer determines the current interest rate of a one-year certificate of deposit (CD), as published in the local paper or provided by a local bank that offers one-year CDs. The eligibility specialist or hearing officer then determines the amount of resources required to produce income, at the specified interest rate, that would increase the spouse's income to the monthly maintenance needs allowance.

Determine the protected amount of resources by using the formula specified in the following steps. This formula is to be used to determine the maximum amount of resources to be protected regardless of the actual income a resource may or may not be producing at the time of the original SPRA or at the time of the appeal hearing. (Use Appendix XXVII, Worksheet for Expanded SPRA on Appeal.)

Step Procedure

1

Subtract the community spouse's non-resource-producing income (including income diverted by the applicant/recipient, if any) from the monthly maintenance needs allowance (MMNA). The difference is additional monthly income needed by the community spouse.

2

Multiply additional monthly income needed by the community spouse from Step 1 by 12. The product equals annual income needed by the community spouse.

3

Multiply annual income needed by the community spouse from Step 2 by 100.

4

Divide the product from Step 3 by the interest rate for a one-year CD (do not use a percentage).

Note: The expanded SPRA may not exceed the value of the couple's combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

Example

Description Amount
Community spouse's own income = $608.50
Income diverted from applicant/recipient = + $750
Community spouse's total income = $1,358.50
CD interest rate = 6%

Step 1:

 

Amount Description
$2,610.00 MMNA in effect at the time of the filing of the appeal
– $1,358.50 community spouse's total income
$1,251.50 monthly income needed

Step 2:

 

Amount Description
$1,251.50 monthly income needed
× 12 months
$15,018 annual income needed

Step 3:

 

Amount Description
$15,018 annual income needed
× 100 multiplier
$1,501,800 product

Step 4:

 

Amount Description
$1,501,800 annual income needed
÷ 6 CD interest rate
$250,300 amount needed to increase SPRA to meet MMNA

 

Step 5:

The expanded SPRA is the lesser of:

  • $250,300, or
  • the value of the couple's total combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

When determining the post-eligibility co-payment and the amount available for spousal diversion, the eligibility specialist uses the actual dollar amount produced if the actual amount is in excess of the amount a one-year CD would produce. However, if the actual amount a resource produces is less than the amount a one-year CD would produce, the eligibility specialist uses the amount a one-year CD would produce. (Use Appendix XXVIII, Worksheet for Spouse's Income [Post-Expanded SPRA Appeals].)

The institutionalized spouse's income placed into a qualified income trust (QIT) is considered income in the calculation of the expanded SPRA.

The expanded SPRA cannot exceed the total countable assets determined for the initial SPRA.

Use Appendix XXVII.

Note: Form H1275, Request for Expanded Spousal Protected Resource Assessment, must be signed by the applicant/authorized representative.

 

J-6210 Sharing Required Information

Revision 09-4; Effective December 1, 2009

 

After the expanded SPRA appeal, income attributed to the institutionalized spouse (for both eligibility and co-payment purposes) is:

  • the total actual income from resources to which the institutionalized spouse has sole title; plus
  • one-half of actual income from resources to which the institutionalized spouse and the community spouse have joint title.

After the expanded SPRA appeal, income attributed to the community spouse (for purposes of determining the spousal diversion) is the higher of:

  • the total actual income from all resources to which the community spouse has sole title, plus one-half of actual income from resources to which the institutionalized spouse and community spouse have joint title; or
  • imputed income from all resources included in the expanded SPRA (whether or not the community spouse has title to those resources).

Consider the imputed income only during the initial eligibility period. After the initial eligibility period, actual income generated by a resource is countable to whichever spouse holds title. If the spouses have joint title, one-half of the actual income is countable to each spouse.

Examples:

  • Jon Janis enters the nursing facility on Jan. 2, 2009. He applies for Medicaid on Jan. 15, 2009. Before entering the facility, he lived with his wife, Josie. She still resides in their home. Their total countable combined resources is $500,000.
     

     

    Description Amount

    Total Countable Combined Resources

    $500,000 ÷ 2 = $250,000, thus use

    SPRA

    – $109,560

    Compare

    = $390,444 > $2,000 Not eligible

  • Form H1275, Request for Expanded Protected Resource Assessment, is signed and Mr. Janis diverts all of his non-resource monthly income. Mr. Janis has monthly income of $1,900. Mrs. Janis has monthly income of $800. Both incomes are non-resource produced income. Income first method is used and $1,900 – $60 PNA = $1,840 + Mrs. Janis' income $800 = $2,640 < $2,739 MMMNA; this amount is determined to be available for the spouse. Enter this amount into Step 2 of Appendix XXVII. New SPRA is calculated. CD interest rate is 4.5%.

    Step 1:
     

     

    Amount Description
    $2,739 MMNA in effect at the time of the filing of the appeal
    – $2,650 community spouse's total income
    $99 monthly income needed

    Step 2:

     

    Amount Description
    $99 monthly income needed
    × 12 months
    $1,188 annual income needed

    Step 3:

     

    Amount Description
    $1,188 annual income needed
    × 100 multiplier
    $118,800 annual income needed

    Step 4:

     

    Amount Description
    $118,800 annual income needed
    ÷ 4.5 CD interest rate
    $26,400 amount needed to increase SPRA to meet MMNA
     

    Step 5:

    The expanded SPRA is less than the original SPRA of $109,560.

  • When the expanded SPRA is less than the original SPRA, use the original SPRA to determine eligibility.
     

     

    Amount Description
    Total Countable Combined Resources $500,000
    Maximum SPRA – $109,560
    Compare = $390,440 > $2,000 Not eligible
  • Bob Barrister enters the nursing facility on Jan. 10, 2009. He applies for Medicaid on Feb. 15, 2009. Before entering the facility, he lived with his wife, Betty. She still resides in their home. Their total countable combined resources equal $500,000.
     

     

    Amount Description
    Total Countable Combined Resources $500,000 ÷ 2 = $250,000, thus use
    SPRA – $109,560
    Compare = $390,440 > $2,000 Not eligible
  • Mr. Barrister has monthly income of $1,900. Mrs. Barrister has monthly income of $1,200. Both incomes are non-resource produced income. Since the first continuous period of institutionalization was on or after Sept. 1, 2004, use the income first method for determining the expanded SPRA.
  • Calculation: Mr. Barrister's income $1,900 – $60 PNA = $1,840 + Mrs. Barrister's income $1,200 = $3,040 > $2,739 MMMNA.
  • The calculation of the person's net non-resource produced income and the spouse's non-resource produced income resulted in an amount greater than the MMMNA.
  • Do not expand the SPRA.

 

J-6300 Expanded SPRA for Home and Community-Based Services Waiver Programs

Revision 15-3; Effective September 1, 2015

 

In waiver cases with a community spouse, the waiver individual (i.e., the institutionalized spouse) can make a request or file an appeal to increase the SPRA to produce additional income for the community spouse.

Usually in a waiver situation, income-first expanded SPRA is only considered when the individual has a QIT. The expanded SPRA cannot exceed the combined resources as of the SPRA assessment date for a waiver.

An expanded SPRA in a waiver case is available only:

  • after the waiver individual (i.e., the institutionalized spouse) diverts all of the waiver individual's available income (i.e., the waiver individual's gross income minus the current special income limit — 300 percent cap for an individual) to the community ineligible spouse, and
  • the community ineligible spouse's resulting total income is less than the current minimum monthly maintenance needs allowance (MMMNA).

Do not develop the expanded SPRA for a waiver if, after diverting all of the waiver individual's available income (i.e., the waiver individual's gross income minus the current special income limit — 300 percent cap for an individual) to the community ineligible spouse, the community ineligible spouse's resulting total income is equal to or more than the current MMMNA.

Calculate the expanded SPRA for a waiver if, after diverting all of the waiver individual's available income (i.e., the waiver individual's gross income minus the current special income limit — 300 percent cap for an individual) to the community ineligible spouse, the community spouse's resulting total income is less than the current MMMNA.

See Appendix XXXI, Budget Reference Chart, for the current amounts.

Procedure for Increased SPRA Consideration

 

Step Procedure

1

The waiver individual (i.e., the institutionalized spouse) diverts all of the waiver individual's available income (i.e., the waiver individual's gross non-resource produced [NRP] income minus the current special income limit — 300 percent cap for an individual) to the community ineligible spouse.

Gross NRP income
− 300 percent cap for an individual
= Amount available for diversion

2

Add the community ineligible spouse's gross NRP income to the amount from step 1.

Spouse's gross NRP income
+ Amount available for diversion
= Spouse's resulting total income

3

If the community ineligible spouse's resulting total income is less than the current MMMNA, increase the SPRA.

If the community ineligible spouse's resulting total income is equal to or more than the current MMMNA, do not increase the SPRA.

 

J-6310 Expanded SPRA for Home and Community-Based Services Waiver Applicants in an Assisted Living Facility or Adult Foster Care

Revision 15-3; Effective September 1, 2015

 

If the person is living in an assisted living facility or adult foster care setting and is receiving waiver services from the STAR+PLUS Waiver (SPW) program:

  • Do not develop the expanded SPRA for a waiver if, after diverting all of the waiver individual's available income (i.e., the waiver individual's gross income minus the current Supplemental Security Income [SSI] federal benefit rate [FBR] for an individual) to the community ineligible spouse, the community ineligible spouse's resulting total income is equal to or more than the current MMMNA.
  • Calculate the expanded SPRA for a waiver if, after diverting all of the waiver individual's available income (i.e., the waiver individual's gross income minus the current SSI FBR for an individual) to the community ineligible spouse, the community ineligible spouse's resulting total income is less than the current MMMNA.

Procedure for Increased SPRA Consideration for SPW in an Assisted Living Facility/Adult Foster Care Setting

Step Procedure

1

The waiver individual (i.e., the institutionalized spouse) diverts all of the waiver individual's available income (i.e., the waiver individual's gross non-resource produced [NRP] income minus the current SSI FBR) to the community ineligible spouse.

Gross NRP income
− SSI FBR for individual
= Amount available for diversion

2

Add the community ineligible spouse's gross NRP income to the amount from step 1.

Spouse's gross NRP income
+ Amount available for diversion
= Spouse's resulting total income

3

If the community ineligible spouse's resulting total income is less than the current MMMNA, increase the SPRA.

If the community ineligible spouse's resulting total income is equal to or more than the current MMMNA, do not increase the SPRA.

 

See Appendix XXXI, Budget Reference Chart, for the current amounts.

 

J-6400 SPRA Expansion before Sept. 1, 2004

Revision 12-4; Effective December 1, 2012

 

If the first continuous period of institutionalization was before Sept. 1, 2004, follow a resource-first methodology, which allows the $1 diversion procedure to calculate the expanded SPRA. The expanded SPRA looks at only the community spouse's income, plus an income diversion from the spouse in the nursing home, and only $1 diversion is required from the spouse in the nursing home when using the resource-first methodology. (Use Appendix XXVII, Worksheet for Expanded SPRA on Appeal.)

In nursing facility and waiver cases with a community spouse, the applicant/recipient can appeal to increase the SPRA to produce additional income for the spouse. The eligibility specialist or hearing officer may increase the SPRA to a level adequate to produce income up to but not to exceed the monthly maintenance needs allowance.

The couple can protect additional resources. The resources can be equal to the dollar amount that must be deposited in a one-year certificate of deposit (CD), at current interest rates, to produce interest income equal to the difference between the monthly maintenance needs allowance (in effect at the time of the filing of the appeal) and other countable income not generated by either spouse's countable resources. The couple is not required to invest in the CD as a condition of eligibility.

To determine the amount of the increased SPRA, the eligibility specialist or hearing officer determines the current interest rate of a one-year CD as published in the local paper or provided by a local bank that offers one-year CDs. The eligibility specialist or hearing officer then determines the amount of resources required to produce income, at the specified interest rate, that would increase the spouse's income to the monthly maintenance needs allowance.

Determine the protected amount of resources by using the formula specified in the following steps. This formula is to be used to determine the maximum amount of resources to be protected regardless of the actual income a resource may or may not be producing at the time of the original SPRA or at the time of the appeal hearing. (Use Appendix XXVII.)

 

Step Procedure
1 Subtract the community spouse's non-resource-producing income (including income diverted by the applicant/recipient, if any) from the monthly maintenance needs allowance (MMNA). The difference is additional monthly income needed by the community spouse.
2 Multiply additional monthly income needed by the community spouse from Step 1 by 12. The product equals annual income needed by the community spouse.
3 Multiply annual income needed by the community spouse from Step 2 by 100.
4 Divide the product from Step 3 by the interest rate for a one-year CD (do not use a percentage).

Note: The expanded SPRA may not exceed the value of the couple's combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

 

Example

Description Amount
Community Spouse's own income = $608.50
Income diverted from applicant/recipient = + $750
Community spouse's total income = $1,358.50
CD interest rate = 6%

 

Step 1:

Amount Description
$2,610.00 MMNA in effect at the time of the filing of the appeal
– $1,358.50 community spouse's total income
$1,251.50 monthly income needed

Step 2:

 

Amount Description
$1,251.50 monthly income needed
× 12 months
$15,018 annual income needed

 

Step 3:

Amount Description
$15,018 annual income needed
× 100 multiplier
$1,501,800 product

 

Step 4:

Amount Description
$1,501,800 annual income needed
÷ 6 CD interest rate
$250,300 amount needed to increase SPRA to meet MMNA

 

Step 5:

The expanded SPRA is the lesser of:

  • $250,300, or
  • the value of the couple's total combined countable resources as of the first month of entry to a medical care facility for a continuous stay.

When determining the post-eligibility co-payment and the amount available for spousal diversion, the eligibility specialist uses the actual dollar amount produced if the actual amount is in excess of the amount a one-year CD would produce. However, if the actual amount a resource produces is less than the amount a one-year CD would produce, the eligibility specialist uses the amount a one-year CD would produce. (Use Appendix XXVIII.)

Note: Form H1275, Request for Expanded Spousal Protected Resource Assessment, must be signed by the applicant/authorized representative.

 

J-6410 Sharing Required Information

Revision 09-4; Effective December 1, 2009

 

If institutionalization was before Sept. 1, 2004, the eligibility specialist must know how much income the institutionalized spouse wishes to divert to the community spouse to determine the value of additional resources to be protected.

Hearing officers or eligibility specialists should inform the couple or the couple's authorized representative (AR) that the lower the income diversion amount, the higher the expanded SPRA, and that the institutionalized spouse must agree to divert at least $1 for the SPRA to be expanded.

The hearing officer or eligibility specialist should further inform the couple or the couple's AR that once the SPRA is expanded, an additional amount may be diverted to the community spouse whose total income (including income from the expanded SPRA) is less than the MMMNA. The new spousal diversion amount (after the SPRA is expanded) may be recalculated by either the hearing officer or the eligibility specialist.

After the expanded SPRA appeal, income attributed to the institutionalized spouse (for both eligibility and co-payment purposes) is:

  • the total actual income from resources to which the institutionalized spouse has sole title; plus
  • one-half of actual income from resources to which the institutionalized spouse and the community spouse have joint title.

After the expanded SPRA appeal, income attributed to the community spouse (for purposes of determining the spousal diversion) is the higher of:

  • the total actual income from all resources to which the community spouse has sole title, plus one-half of actual income from resources to which the institutionalized spouse and community spouse have joint title; or
  • imputed income from all resources included in the expanded SPRA (whether or not the community spouse has title to those resources).

Consider the imputed income only during the initial eligibility period. After the initial eligibility period, actual income generated by a resource is countable to whichever spouse holds title. If the spouses have joint title, one-half of the actual income is countable to each spouse.