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Aged, Blind and Disabled Manual Policy Manual Number: 125.015 Section: Institutional Medicaid Chapter: Resource Assessment

January 5, 2026 Division of TennCare 6 c. Hardship Hardship may be determined when the institutionalized spouse and/or his spouse have resources in excess of the resource limit, the institutionalized spouse is otherwise eligible, and for whom TennCare Medicaid ineligibility will result in loss of essential nursing care which is not available from any other source.

If the community spouse has available assets, she is legally obligated to provide support. Hardship cannot be determined to exist unless assets have been reallocated as the result of an appeal decision or a court order.

7. CSRMA Appeals a. When the Individual and/or Spouse Has Appeal Rights Appeal rights are considered only after a TennCare Medicaid application has been filed and either spouse alleges that the assessment or eligibility determination decision is incorrect. An assessment completed exclusive of a filed application cannot be appealed.

b. CSRMA Revisions The amount of the community spouse’s resource maintenance allowance may only be revised by TennCare if additional verification or documentation is provided.

The CSRMA may only be revised when:

i. The initial assessment was alleged to be incorrect and an administrative judge confirms the allegations; ii. An administrative judge determines a larger CSRMA is necessary to raise the community spouse’s available income to the Maintenance Needs Standard or to an amount by which exceptional maintenance needs, established at a fair hearing, exceed the community spouse’s income; or iii. A court order is received against an institutionalized spouse for the support of the community spouse and resources are transferred pursuant to the court order.

c. Allocation of Additional Resources to the Community Spouse i. When Additional Resources May be Allocated to the Community Spouse In the event that the institutionalized spouse does not have enough income to provide the community spouse with sufficient income to meet the Maintenance Needs Standard and the CSRMA is not enough to offset the income shortfall, additional resources may be allocated to the community spouse by an appeals hearing officer if the couple has additional resources above the community spouse’s protected amount (CSRMA).