Page 1

Aged Blind and Disabled Manual Section: Institutional Medicaid; Policy Manual: 120.015; Chapter: Resource Assessment

Legal Authority: 42 USC 1396r-5(c)(1)(B); 42 USC 1396r-5; Tenn. Comp. R. & Regs. 1200-13-20

1. Policy Statement The Medicare Catastrophic Coverage Act of 1998 amended Medicaid income and asset limit rules so that the community spouse of an individual applying for Institutional Medicaid does not become impoverished as a result of the spouse gaining Medicaid eligibility. When determining eligibility for the institutionalized spouse, a calculated amount of the couple’s assets is allocated to the community spouse to be used for his own needs. The Medicaid rules that govern the special treatment of a community spouse’s income and resource allocation are referred to as spousal impoverishment policy. The main purpose of the spousal impoverishment policy is to ensure that the community spouse has sufficient income and assets to remain in her home.

The process for determining the amount of resources that will be allocated to the community spouse begins by taking a snapshot of all of the couple’s countable resources. The community spouse’s share of resources is determined, and that amount is subtracted from the total resources in order to determine the institutionalized individual’s resource eligibility. Any amount of resources in excess of the $2,000 limit (after the community spouse’s share has been subtracted) must be depleted prior to the applicant gaining TennCare Medicaid eligibility.

2. The Resource Assessment a. Defined The resource assessment is a snapshot of all countable assets owned by a couple at the time of the first period of continuous confinement. For applicants in a medical institution (i.e. Nursing Facility (NF) or Hospital) the first period of continuous confinement is the date of admission to a medical institution. For Home and Community Based Services (HCBS), the first period of continuous confinement begins on the effective date of an approved Pre-Admission Evaluation (PAE).

The resource assessment is conducted when the individual applies or when an assessment is requested prior to application. In the case of an application for HCBS, the resource assessment is a snapshot on the effective date of the approved PAE. If an application for HCBS is filed before a PAE has been approved, and the PAE is approved within 90 days of application, the snapshot date for the resource assessment is the date of application.