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Chapter: 1600 Assets Program: MSSI, SFP 11

1640.0313 Representative Payee or Legal Guardian (MSSI, SFP) Assets received or managed by an individual's representative payee or legal guardian must be included as assets to the individual.

If an individual is a legally designated representative who is managing the funds of another person on his behalf, none of the funds are included as the individual's asset. These funds must be held in a form that clearly shows that they belong to another. 1640.0314.01 Assets Available to Spouse (MSSI) The following policy applies to ICP, ICP-MEDS, and ICP-Hospice individuals admitted to institutions on or after September 30, 1989. This includes SSI recipients applying for institutional services. (If the individual was institutionalized prior to September 30, 1989, refer to Chapter 2200).

Although the assets of a Medicaid recipient's spouse may not have been considered available to the individual in the community (e.g., when the couple is separated), when the individual applies for institutional services, the assets of both spouses must be considered in determining the individual's eligibility for institutional services.

The portion of a couple's assets available to the institutional spouse is the amount remaining after the community spouse's asset allowance is subtracted from the couple's total included assets. If this figure is over the program's allowable asset limit, the individual is ineligible until the assets are reduced to within the program's standard.

If after declaring and verifying his assets, the community spouse refuses to make them available to the individual, the institutionalized spouse may assign his rights of support to the state and obtain institutional care benefits (refer to passages 1640.0314.03 and 1640.0314.04 for policy). The Institutional Spouse may allocate their income available to the community spouse.

If the couple has been separated for a long time and the community spouse cannot be located, there is no "community spouse" and the applicant must be considered an individual when applying income and asset standards.

If either spouse can verify that the community spouse asset allowance determined by the agency is inadequate to generate income to raise the community spouse's income to the minimum monthly maintenance needs allowance, the asset allowance may be revised through the fair hearing process.

A spouse for these purposes is defined in Chapter 2200. 1640.0314.02 Prenuptial Agreements (MSSI) Assets that are included in a prenuptial agreement are considered part of the couple's total assets when determining eligibility for institutional care services.

This policy applies regardless of when the prenuptial agreement was drawn up. 1640.0314.03 Assignment of Rights to Support (MSSI) If the community spouse refuses to make available assets attributed to the institutionalized spouse, including Home and Community Based Services (HCBS) and Program All-Inclusive for the Elderly (PACE), the institutionalized, HCBS OR PACE spouse may assign their rights of support to the state and obtain Long-term care eligibility and coverage. This situation may arise when assets allocated to the individual actually solely belong to the community spouse who, in turn, refuses to make them available to the individual.