Institutionalized Spouse or Home and Community Based Services (HCBS) Spouse Asset Limit 510-05-65-15

(Revised 4/1/12 ML #3321)

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(N.D.A.C. Section 75-02-02.1-24(2))

An institutionalized or HCBS spouse is allowed the medically needy asset limit of three thousand dollars. The value of any assets owned jointly with the community spouse are considered in full.

An institutionalized or HCBS spouse is asset eligible if the total value of all countable assets owned by both spouses, is less than the total of the community spouse asset allowance and the institutionalized or HCBS spouse asset limit .

After eligibility has been established, the institutionalized or HCBS spouse must reduce his or her countable assets (solely or jointly owned) to be within the medically needy asset limit ($3,000) not later than the next regularly scheduled review.

If the assets are not reduced to the asset limit by the next regularly scheduled review, the individual's case must be closed. Verification of the reduction in assets must be provided.

When an eligible institutionalized or HCBS spouse exceeds the asset limit due to an increase in the value of, a change in the exclusion of, or the receipt of assets, a new period, until the next regularly scheduled review, may be allowed in order to transfer the excess assets to the community spouse. The amount of assets to which this new period applies is an amount equal to the difference between the current community spouse's asset allowance and the value of assets owned by the community spouse at the time eligibility was established, less the value of assets transferred to the community spouse.

Example: The community spouse has an asset allowance of $70,000. At the time eligibility was established, the community spouse owned $30,000 and the institutionalized spouse transferred $25,000 to the community spouse by the first review. If the institutionalized spouse received new assets in excess of the $3,000 asset limit, the institutionalized spouse is allowed until the next regularly scheduled review to transfer up to $15,000 to the community spouse ($70,000 less $30,000 owned by community spouse less $25,000 previously transferred to community spouse equals $15,000 that can still be transferred).

This new period is not allowed if:

The community spouse had assets equal to the community spouse asset allowance at the time the institutionalized or HCBS spouse became eligible; or

The community spouse has since received assets from the institutionalized or HCBS spouse up to the community spouse asset allowance.

The following examples illustrate:

Example 1: The community spouse had an asset allowance of $90,000. At the time of eligibility, the community spouse owned all $90,000 in countable assets. No new period is allowed to transfer additional assets to the community spouse.

Example 2: The community spouse had an asset allowance of $80,000. At the time of eligibility the community spouse owned $50,000 in countable assets. The institutionalized spouse has since transferred an additional $30,000 to the community spouse. The community spouse has received assets up to the community spouse asset allowance so no new period is allowed to transfer additional assets to the community spouse.

Example 3: The community spouse had an asset allowance of $25,000. At application, the couple has $12,000 in countable assets and they have until the next review to transfer at least $9,000 to the community spouse, which they do. Several months later, the institutionalized spouse inherits $12,000. Because the community spouse still may receive an additional $16,000 and the institutionalized spouse has only $12,000 over his $3,000 asset limit, the institutionalized spouse can have until the next review to transfer at least $12,000 to the community spouse. The transfer is made, bringing the community spouse’s total countable/received assets up to $21,000. The institutionalized spouse inherits another $10,000. The community spouse has already received $21,000 of the $25,000 asset allowance. Because the amount that the institutionalized spouse’s asset limit is exceeded is greater than the amount that would allow for another transfer period, no new transfer period is allowed. Unless the institutionalized spouse transfers the excess amount to the community spouse in the month it was received, his case must be closed for excess assets.

During the continuous period in which the spouse is in an institution or receives HCBS and after the month in which the spouse is determined to be eligible for benefits under this chapter, no countable assets of the community spouse may be deemed available to the institutionalized or HCBS spouse. Assets owned by the community spouse are not considered available to the institutionalized or HCBS spouse during the continuous period; however, a disqualifying transfer of those assets (or of income) by the community spouse will affect the institutionalized or HCBS spouse’s continued eligibility for coverage of nursing care services. See Section 05-80 for more information about the disqualifying transfer provision.

If a spousal impoverishment case closes, or otherwise ceases to include an institutionalized or HCBS spouse and a community spouse, spousal impoverishment provisions no longer apply. If the couple again pursues coverage under the spousal impoverishment provisions, they must meet the current asset limits within the appropriate time frames.