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477-000-042

REV. FEBRUARY 1, 2022 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-042 – SIMP Assessment for HCBS Waiver/PACE For definitions of institutionalized spouse, community spouse, institutional level of care, Assessment of Resources, and other SIMP components and processes, see 477 NAC Chapter 26. HCBS – Home and Community-Based Services PACE – Program of All-Inclusive Care for the Elderly A Spousal Impoverishment (SIMP) Assessment of Resources may be completed when it is likely that 30 days of nursing home level of care is necessary for an individual either in the home (e.g. HCBS waiver or PACE) or in a medical institution. The institutionalized spouse may receive HCBS waiver or PACE when a couple has spent down the community spouse’s reserved resource amount (based on the signed Assessment of Resources) plus the $4,000 resource maximum for the institutionalized spouse, or the community spouse has the minimum reserved resource amount or less (refer to 477-000-012 for the current amount). If the institutionalized spouse has not been residing in a medical institution for more than 30 days, then a level of care assessment is needed to verify that the 30-day requirement has been met in order to begin the Assessment of Resources process. • The completion of an HCBS waiver or PACE level of care assessment (when level of care is met) meets the criteria for the likely 30-day period. OR • If the institutionalized spouse has not already met the 30-day continuous stay, the facility may declare that the stay is likely to be at least 30 days. Examples: One Spouse is requesting Medicaid and HCBS Waiver or PACE: 1) It is verified that the spouse requesting HCBS Waiver or PACE has met the likely 30-day period requirement. 2) An Assessment of Resources is completed. a. Current resources must be no more than the reserved resource amount plus $4,000 in resources for the institutionalized spouse. 3) SIMP budgeting begins the month HCBS waiver or PACE services actually begin. 4) Medicaid eligibility for the community spouse is re-determined (when applicable).