Page 37

37

a. Divide the sanction period between the spouses.

b. The total sanction imposed on both spouses cannot exceed the number of months of the sanction period.

2. When the institutionalized spouse is already serving a sanction and the CUSP also becomes institutionalized, evaluate whether the transfer occurred during the CUSP’s lookback. Refer to IV. C. 3 to determine the lookback of each spouse. If so: a. Divide the remaining sanction between the two spouses. If the amount is not equal, the larger amount can be given to either spouse.

b. Determine what is best for both spouses. The total sanction imposed on both spouses cannot exceed the number of months of the sanction period.

3. Evaluate for additional transfer of assets by the former Community Spouse (CUSP) on or after the lookback date. A non-allowable transfer by the CUSP after Medicaid eligibility is established for the Institutionalized Spouse (ISP) is not a sanctionable transfer for the ISP.

Example 1: A 10-month sanction period has been assigned to the institutionalized spouse. After 5 months have passed, the community spouse enters a nursing facility. Divide the remaining 5 months of the sanction period equally between the two. In this case, assign one spouse (e.g. the ISP) a 2-month sanction period and the other spouse (e.g. the CUSP) a 3-month sanction period.

After admission, it is determined that the former CUSP has a 4-month sanction period for additional transfers. The CUSP now has a 7-month sanction period and the ISP a 2-month sanction period.

Example 2: An 80-month sanction period has been assigned to the institutionalized spouse. After 65 months have passed, the community spouse enters a nursing facility. The transfer occurred more than 60 months prior to the former CUSP’s institutionalization and application for Medicaid. The remaining sanction period cannot be divided between spouses. The ISP must serve the remaining sanction period.

E. Other Sanction Situations 1. The sanction period cannot begin until after any existing sanction period has expired. 2. A sanction period cannot be triggered by receipt of in-home health services and supplies. In-home health services can only be sanctioned if they are received in a sanction period that began due to receipt of institutional services.

3. NC FAST will determine the sanction period based upon the evidence entered. Refer to NC FAST Job Aid: Sanction for Transfer of Assets.