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State of Maryland Medical Assistance Manual Revised April 2014

d. Policy Alert 10-04: Assignment of Support Provision Introduction The assignment of support provision is intended to enable an institutionalized person to qualify for Medical Assistance without consideration of spousal assets when the community spouse has refused to make the assets available to the institutionalized person. As a condition of this provision, the institutionalized spouse must cooperate in taking criminal action for non-support and must sign an agreement that any support paid will be given to the State as reimbursement for the care provided. Policy and Procedures An institutionalized person will not be determined ineligible for Medical Assistance due to the counting of spousal asset if all of the following conditions are met: (1) The institutionalized person, or that person’s guardian or attorney in fact, has no legal authority to withdraw, liquidate or otherwise access the asset; and (2) Payments for cost of care are not being made; and (3) The institutionalized person, or that person’s guardian or attorney in fact, agrees to cooperate with the State in bringing criminal action for non-support against the community spouse; and (4) All support rights have been assigned to the State. Condition 1: No access to assets When there is more than one asset being considered, this provision only applies to those specific assets to which the applicant has no access. If there are other assets to which the applicant does have access, those assets are to be considered. The institutionalized spouse does not have access if all of the following circumstances exist: (a) The institutionalized person has no ownership interest in the asset and the person, or the person’s guardian or attorney in fact, has no legal authority to withdraw, liquidate or otherwise access the asset; and (b) The community spouse has refused to pay for the cost of care and payments for any health care has not been made by or on behalf of the institutionalized spouse prior to the month of application, or during or after the month of application, and (c) The institutionalized spouse, or that person’s person guardian attorney in fact, has not assisted in making the asset inaccessible. The “no access” condition is unlikely to be met when the community spouse is the guardian or attorney is fact for the institutionalized spouse. Item (c) above is not met if both husband and wife are represented by the same legal counsel on any matter related to obtaining Medical Assistance or spousal support. The presumption is that an attorney could not act as an advocate for the institutionalized spouse while assisting the community spouse in depriving the institutionalized spouse of support and/or access to spousal assets. This means that if