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Treatment of Income from Trust Property 2.15.2

Impoverished Spouse: When determining the income of an institutionalized or community spouse for purposes of the PPA calculation and post-eligibility income determination, use the following policies, regardless of any District laws relating to community property or the division of marital property, to determine ownership in trust property unless otherwise provided in the trust and unless the institutionalized spouse establishes through the fair hearings process that ownership interest is other than that prescribed below (see Chapter 7: Grievances and Fair Hearings in Part VIII):

 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.  If payment of income is made in the names of the institutionalized spouse and the community spouse, one-half of the income shall be considered available to each of them.  If payment of income is made 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.

ADJUSTMENT OF SPEND-DOWN LIABILITY 2.16

If the individual who is entering a LTC facility is already eligible for MA as a community-assistance unit and has a spend-down liability, the spend-down liability must be adjusted. The spend-down liability must be prorated to reflect only the months in the budget period prior to the date of admission to the LTC facility.

If the individual has already met the original spend-down liability, adjust the eligibility dates and the payments made by the LTC resident and the Department to the community medical providers.

THERAPEUTIC LEAVE 2.17

Pursuant to the Medicaid State Plan, the Medical Assistance Administration will continue payment to the facility for up to 18 therapeutic days per 12-month period. Absences of less than 24 hours are not counted toward the total number of therapeutic days. The 12-month period is defined as the District's fiscal year, October 1 through September 30.

Therapeutic leaves include visits with relatives and friends as well as leaves to participate in District- approved therapeutic and rehabilitative programs. Example Mr. Franco is eligible for MA and has a $600 spend-down liability. His monthly spend-down liability is $100. Unexpectedly, he enters a LTC facility in the third month of his budget period. Since he is residing in the LTC facility for the last three months of his budget period, his spend-down liability should be prorated to $300 ($100*3).