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Title 8: Medicaid Page 19 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Attribution of Resources Revised September 13, 2024 Processing a Medicaid Application After… When Spouses Are Estranged Legal reference: 441 IAC 75 (Rules in Process) Attribute resources for estranged couples. “Estrangement” means a breakdown to the point that the spouses would not be living together if one was not institutionalized or were not living together before one spouse entered the institution. Determine estrangement by talking with the applicant. If the institutionalized spouse is estranged from the community spouse, do not deny eligibility because of excess resources or failure to provide verification if the applicant can show hardship. To prove hardship, the applicant must demonstrate that:  The applicant cannot get information about the community spouse’s resources after exploring all legal means.  The applicant is unable to access the estranged community spouse’s resources after exploring all legal means, even though the community spouse’s resources cause the applicant to be ineligible. Assignment of Support Rights Legal reference: 441 IAC 75 (Rules in Process) Do not deny Medicaid for the institutionalized spouse if the resources owned by the institutionalized spouse are less than eligibility limits and the institutionalized spouse either:  Has assigned any rights to support from the community spouse to the state, or  Lacks the ability to execute an assignment because of physical or mental impairment. To decide if the applicant lacks the ability to assign support rights, determine if the applicant has a guardian or conservator. If the applicant did not voluntarily choose to have a guardian or conservator, the client lacks the ability to assign support rights. No further verification is required. If the applicant chose to have a guardian or conservator but it is alleged that the applicant lacks the ability to assign support rights, verify the lack of assignment ability with a physician’s statement.