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months and they have not been budgeted to return home within six months:

a. Recalculate the LTC budget for all prior LTC budgeting months through the month of discharge and deduct the full medically needy income level for one in addition to the personal needs allowance.

b. Notify the Claims Analysis Unit of the revised PML for the previous months. (Send the revised DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability to the facility when the PML change is entered. (See IX. below)

c. Budget the remaining months in the certification period as PLA based on procedures in MA-2260, Financial Eligibility Regulations-PLA.

VI. THE COMMUNITY SPOUSE INCOME ALLOWANCE (SPOUSE IN PLA)

When computing the patient monthly liability, an allowance may be deducted from the a/b’s income for the needs of their spouse. The following instructions tell you how to do this. See MA-2231, for Community Spouse Resource Protection.

A. Rules For Community Spouse Income Allowance Eligibility 1. Determine when to allow the community spouse allowance and verify that the community spouse actually receives this allowance.

a. If the community spouse is legally married to the a/b and/or separated less than 12 months prior to the institutionalization, you may make an allowance for the community spouse.

b. If the a/b and the community spouse have been separated for more than 12 months prior to institutionalization, do not make an allowance for the community spouse.

2. Do not calculate an allowance if both spouses are institutionalized.

3. A spouse who receives services in an adult care home is not institutionalized and is eligible to receive this allowance.

4. Income allocated through these procedures is countable to the community spouse in all other assistance programs.

5. The community spouse allowance is a pml calculation deduction in Step II of LTC budgeting. Therefore, if the a/b must be budgeted by PLA procedures for any reason, the community spouse is not eligible for the spousal allowance.

6. The maximum community spouse allowance amount is determined by the maximum available from the institutionalized spouse's income after deductions in STEP II (refer to V.C., above). If the maximum available is $0, there is no allowance.

7. The a/b or representative can choose to make a lesser amount actually Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493