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Medical Services Policy Manual, Section H

H-200 Spousal Impoverishment

H 207 Retroactive Eligibility

EXAMPLE: The IS above left the Nursing Facility for 60 days and then reenters. The couple has combined countable resources of $65,000 at reentry; the spousal share earlier computed was $70,000. Since total combined resources are now only $65,000, which is less than the spousal share, all of the resources may be attributed to the CS, and the IS is eligible for LTSS. H-207 Retroactive Eligibility MS Manual 01/01/14 Retroactive eligibility may be given under these rules, provided all eligibility requirements are met. For example, application is made January 1, 2014, after entry into a Nursing Facility on October 1, 2013. The assessment of resources owned by the couple as of October 1, 2013, will be made and, if eligible, the case may be opened retroactively to October 1, 2013. (MS A-211) H-208 Appeal Rights Regarding Changing the CSMNA and/or CSRA MS Manual 07/13/15 If either spouse is dissatisfied with the determination of: • the CS’s monthly income allowance, • the amount of monthly income otherwise available to the CS, • the computation of the spousal share of resources, or • the attribution of resources or the CS’s resource allowance, such spouse is entitled to a hearing, if application has been made on behalf of the IS. (Re. MS L- 110). Any hearing regarding the determination of the CS’s resource allowance shall be held within 30 days of the date of the request for the hearing. REVISION OF MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE If it is established that the CS needs income above the level provided by the minimum monthly maintenance needs allowance (CSMNA) due to exceptional circumstances resulting in significant financial duress, a greater allowance may be substituted by a hearing officer, but only to the extent the IS is willing to make the IS’s income available to the CS. “Exceptional circumstances resulting in extreme financial duress” are defined as circumstances other than those taken into account in establishing the maintenance standards for the CS, such as unreimbursed medical expenses or household repair and maintenance for which the income allowance calculated by the caseworker on the DCO-712, Post Eligibility Income Worksheet, along with the CS’s income, is inadequate to pay.