Page 435

2. Spouse 2 was not included in the FTG (e.g., single or not living with Spouse 1) at the time of Spouse 1’s application (see Section 33.9.3 FTG CHANGES), but they are now residing together. a. If Spouse 1’s eligibility was determined at level 2a or 2b, refer to SECTION 33.9.3.1 FTG CHANGES AT LEVEL 2A AND 2B) b. If Spouse 1’s eligibility was determined at level 3, refer to SECTION 33.9.3.2 FTG CHANGES AT LEVEL 3 See 33.9.4 ADDITION OF A SPOUSE SUMMARY TABLE 33.9.2 Adding a Spouse No Change in FTG If Spouse 2’ s participation level is determined after Spouse 1’s and Spouse 2 was included in the original FTG (married and living with Spouse 1 at the time of Spouse 1’s application) the participation level for Spouse 2 is determined based on annual income information provided on Spouse 1’s application. Example 1 Tyler and Anne are married and live together. Tyler has significant prescription drug expenses and applies for SeniorCare. Anne takes no prescription drugs and does not request SeniorCare when Tyler applies in March. Tyler’s participation level is based on a FTG of two. Tyler is found eligible, and his benefit period begins April 1st. In September, Anne is diagnosed with a health problem and begins taking prescription drugs. She applies for SeniorCare on September 15th. The same income information provided in March is used to determine Anne’s eligibility, even though Tyler has since obtained a part-time job and has additional income. Anne’s benefit period is from October 1st through March 31st so her benefit period ends at the same time as Tyler’s. They will report the income from Tyler’s part-time job when their SeniorCare eligibility is reviewed in March. 33.9.2.1 Adding A Spouse, No FTG Change, At Levels 2a and 2b Spouse 2’s deductible is prorated if the couple’s gross annual income is between 160% and 240% of the FPL, and Spouse 2 becomes SeniorCare eligible after Spouse 1’s benefit period has begun. To prorate the deductible, the required deductible amount ($500 or $850) is multiplied by the number of months in Spouse 2’s benefit period and divided by 12. Example 2 Mary and Jim apply for SeniorCare in January. They have an annual income between 160% and 200% of the FPL for a FTG of two (see SECTION 39.11 SENIORCARE INCOME LIMITS AND PARTICIPATION LEVELS). Their income places them in Level 2a with a $500 deductible. Jim is determined eligible for SeniorCare, but Mary’s eligibility for SeniorCare is denied because she is 64. Mary is refunded her enrollment fee. Jim’s 12-month benefit period begins February 1st. Jim has a $500 deductible. In June, Mary will turn 65. At adverse action in the month of May, CARES will process this case through batch. At that time, the application status is updated if the applicant who is turning 65 meets both of the following criteria: 1. Is in an open SeniorCare case 2. Has requested SeniorCare A letter is sent to Mary notifying her that if she still wishes to participate in SeniorCare, she must submit her $30 annual enrollment fee. If Mary’s enrollment fee is received before July 1st, she will be determined eligible beginning July 1st. Because Mary paid her enrollment fee on July 5th, Mary’s benefit period begins August 1st, and ends January 31st, when Jim’s benefit period ends. Mary’s deductible is prorated. Since there are six months in her benefit period, $500 is multiplied by six and the total is divided by 12.