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REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-029

Example 2 Mr. and Mrs. Bird have been living in their own home. On 12/9/2013, Mrs. Bird is admitted to a nursing home. Mr. Bird contacts the Department on 4/5/2014 and requests an assessment of their resources. The worker completes Form IM-73. Total resources owned as of 12/2013 are $10,000. Since $10,000 is less than the minimum amount for 2013, the minimum amount is used. The amount reserved for the community spouse is at least the minimum. Form IM-73 is signed by Mr. Bird (Mrs. Bird is unable to sign). Two copies are given to Mr. Bird, and one is retained for the Department record. Since the client is already within resource limits, an application for ABD is completed on 4/5/2014. The worker also completes Form IM-74. The community spouse amount is $10,000 and the applicant's share is $0. Resources consist of: Community Spouse Allowance Alternate Care Spouse Savings Account #1 $ 8,500

Checking Account #2 $ 1,500

TOTAL $10,000

TOTAL $0.00

Example 3 Mr. and Mrs. Jones have been living in their own home. On 11/19/2012 Mr. Jones is admitted to a nursing home. On 3/26/2013 Mrs. Jones contacts the Department and requests an assessment of their resources. The worker completes Form IM-73 and determines what total countable resources were at the time Mr. Jones entered the nursing home. The total resources as of 11/2012 are $500,000. The maximum community spouse allowance in 2012 was $113,640. Form IM-73 is signed by both Mr. and Mrs. Jones. Each is given a copy, and a copy is retained for the Department record. On 6/5/2013 Mr. Jones returns to the home with his wife. The assessment completed for 11/2012 becomes invalid. On 1/24/2014 Mr. Jones is readmitted to the nursing home. The assessment completed on 11/2012 is again valid. Example 4 Mr. and Mrs. Brown have been living in a house they rent. Mr. Brown was admitted to the nursing home on 2/15/2014. Mrs. Brown gave notice to her landlord and moved to an assisted living facility near the nursing home. On 4/28/2014 Mrs. Brown requests assistance to help with her husband’s nursing home bills. Mrs. Brown does not need Medicaid for herself and requests an assessment of resources. Since Mrs. Brown does not reside in a hospital or nursing home or want assistance for herself, she may be a community spouse. The worker completes the IM-73 for 2/2014, the month of entry to the nursing home, and countable resources total $30,000. Half of $30,000 is less than the year 2014 minimum reserved amount. Since the community spouse retains at least the minimum, the minimum amount is entered on the IM-73.