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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2231

COMMUNITY SPOUSE RESOURCE PROTECTION

REVISED 12/8/2025 - CHANGE NO. 11-25

I. SPOUSAL PROTECTION RULES Spousal resource protection is a reserve procedure with unique rules used only when a legally married individual needs Medicaid help with cost of nursing home care. Part of this procedure, called assessment, is a formal estimation of how much of the couple's savings or other assets can be kept by the spouse at home. This can be done in advance of the Medicaid application, or at the time of application, but never before one spouse has entered long term care. Whenever placement in a nursing home is expected, spousal resource protection should be explained to the representative and the record documented. A. Definitions of Terms 1. Institutionalized spouse (or ISP) -- An individual applying for or receiving Medicaid who: a. Is in a long term care living arrangement: (1) SNF, ICF, ICF-MR; State Mental Hospital; Swing bed or inappropriate level of care bed; or approved for a CAP waiver program; or (2) General hospital (acute care) after 30 days. AND b. Is married to someone who is not in long term care; AND c. Began his first continuous period of institutionalization (CPI) on or after October 1, 1989. 2. Community spouse (or CUSP) -- The non-institutionalized spouse (at-home or in domiciliary care) of an institutionalized spouse. A community spouse who is approved for CAP remains a community spouse. 3. Community Spouse Resource Allowance (CSRA -- A portion of the total of all countable assets (on first day of month that applicant/beneficiary (a/b) began first CPI): a. Owned and available to either spouse or both spouses according to the rules in MA-2230, Financial Resources, section I.F.