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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 239 Rev. 07/01/21 MASSHEALTH FINANCIAL ELIGIBILITY Chapter 520 Page 520.016 (1 of 2)

520.016: Long-term Care: Treatment of Assets

130 CMR 520.016 describes the treatment of countable assets when one member of a couple is institutionalized, the post-eligibility transfer of assets, and the allowable income deductions for applicants and members who are residents of a long-term-care facility.

(A) Institutionalized Individuals. The total value of assets owned by an institutionalized single individual or by a member of an institutionalized couple must not exceed $2,000.

(B) Treatment of a Married Couple’s Assets When One Spouse Is Institutionalized. (1) Assessment. (a) Requirement. The MassHealth agency completes an assessment of the total value of a couple's combined countable assets and computes the community spouse’s asset allowance as of the date of the beginning of the most recent continuous period of institutionalization of one spouse. (b) Right to Request an Assessment. When one spouse has entered a medical institution and is expected to remain institutionalized for at least 30 days, either spouse may request the MassHealth agency to make this assessment, even if the institutionalized spouse is not applying for MassHealth Standard at that time. The period of institutionalization must be continuous and expected to last for at least 30 days. (c) Right to Appeal. The MassHealth agency must give each spouse a copy of the assessment and the documentation used to make such assessment. Each spouse must be notified that he or she has the right to appeal the determination of countable assets and the community spouse's asset allowance when the institutionalized spouse (or authorized representative) applies for MassHealth Standard. (2) Determination of Eligibility for the Institutionalized Spouse. At the time that the institutionalized spouse applies for MassHealth Standard, the MassHealth agency must determine the couple's current total countable assets, regardless of the form of ownership between the couple, and the amount of assets allowed for the community spouse as follows. The community spouse’s asset allowance is not considered available to the institutionalized spouse when determining the institutionalized spouse’s eligibility for MassHealth Standard. (a) Deduct the community spouse’s asset allowance, based on countable assets as of the date of the beginning of the most recent continuous period of institutionalization of the institutionalized spouse, from the remaining assets. The community spouse’s asset allowance is the greatest of the following amounts: 1. the combined total countable assets of the institutionalized spouse and the community spouse, not to exceed $109,560; 2. a court-ordered amount; or 3. an amount determined after a fair hearing in accordance with 130 CMR 520.017.