Protecting income for community spouse
(1) Allowances to be offset from income of institutionalized spouse
(1)Allowances to be offset from income of institutionalized spouse#
After an institutionalized spouse is determined or redetermined to be eligible for medical assistance, in determining the amount of the spouse’s income that is to be applied monthly to payment for the costs of care in the institution, there shall be deducted from the spouse’s monthly income the following amounts in the following order:
(A) A personal needs allowance (described in section 1396a(q)(1) of this title ), in an amount not less than the amount specified in section 1396a(q)(2) of this title .
(B) A community spouse monthly income allowance (as defined in paragraph (2)), but only to the extent income of the institutionalized spouse is made available to (or for the benefit of) the community spouse.
(C) A family allowance, for each family member, equal to at least ⅓ of the amount by which the amount described in paragraph (3)(A)(i) exceeds the amount of the monthly income of that family member.
(D) Amounts for incurred expenses for medical or remedial care for the institutionalized spouse (as provided under section 1396a(r) of this title ).
In subparagraph (C), the term “family member” only includes minor or dependent children, dependent parents, or dependent siblings of the institutionalized or community spouse who are residing with the community spouse.
(1)(A)#
A personal needs allowance (described in section 1396a(q)(1) of this title ), in an amount not less than the amount specified in section 1396a(q)(2) of this title .
(1)(B)#
(2)Community spouse monthly income allowance defined#
In this section (except as provided in paragraph (5)), the “community spouse monthly income allowance” for a community spouse is an amount by which—
(A) except as provided in subsection (e), the minimum monthly maintenance needs allowance (established under and in accordance with paragraph (3)) for the spouse, exceeds
(B) the amount of monthly income otherwise available to the community spouse (determined without regard to such an allowance).
(2)(A)#
except as provided in subsection (e), the minimum monthly maintenance needs allowance (established under and in accordance with paragraph (3)) for the spouse, exceeds
(2)(B)#
the amount of monthly income otherwise available to the community spouse (determined without regard to such an allowance).
(3)Establishment of minimum monthly maintenance needs allowance#
(A) In general Each State shall establish a minimum monthly maintenance needs allowance for each community spouse which, subject to subparagraph (C), is equal to or exceeds— (i) the applicable percent (described in subparagraph (B)) of 1 ⁄ 12 of the income official poverty line (defined by the Office of Management and Budget and revised annually in accordance with section 9902(2) of this title ) for a family unit of 2 members; plus (ii) an excess shelter allowance (as defined in paragraph (4)). A revision of the official poverty line referred to in clause (i) shall apply to medical assistance furnished during and after the second calendar quarter that begins after the date of publication of the revision.
(B) Applicable percent For purposes of subparagraph (A)(i), the “applicable percent” described in this paragraph, effective as of— (i) September 30, 1989 , is 122 percent, (ii) July 1, 1991 , is 133 percent, and (iii) July 1, 1992 , is 150 percent.
(C) Cap on minimum monthly maintenance needs allowance The minimum monthly maintenance needs allowance established under subparagraph (A) may not exceed $1,500 (subject to adjustment under subsections (e) and (g)).
(3)(A)In general#
Each State shall establish a minimum monthly maintenance needs allowance for each community spouse which, subject to subparagraph (C), is equal to or exceeds—
(i) the applicable percent (described in subparagraph (B)) of 1 ⁄ 12 of the income official poverty line (defined by the Office of Management and Budget and revised annually in accordance with section 9902(2) of this title ) for a family unit of 2 members; plus
(ii) an excess shelter allowance (as defined in paragraph (4)).
A revision of the official poverty line referred to in clause (i) shall apply to medical assistance furnished during and after the second calendar quarter that begins after the date of publication of the revision.
(4)Excess shelter allowance defined#
In paragraph (3)(A)(ii), the term “excess shelter allowance” means, for a community spouse, the amount by which the sum of—
(A) the spouse’s expenses for rent or mortgage payment (including principal and interest), taxes and insurance and, in the case of a condominium or cooperative, required maintenance charge, for the community spouse’s principal residence, and
(B) the standard utility allowance (used by the State under section 2014(e) of title 7 ) or, if the State does not use such an allowance, the spouse’s actual utility expenses,
exceeds 30 percent of the amount described in paragraph (3)(A)(i), except that, in the case of a condominium or cooperative, for which a maintenance charge is included under subparagraph (A), any allowance under subparagraph (B) shall be reduced to the extent the maintenance charge includes utility expenses.
(4)(A)#
the spouse’s expenses for rent or mortgage payment (including principal and interest), taxes and insurance and, in the case of a condominium or cooperative, required maintenance charge, for the community spouse’s principal residence, and
(4)(B)#
the standard utility allowance (used by the State under section 2014(e) of title 7 ) or, if the State does not use such an allowance, the spouse’s actual utility expenses,
(5)Court ordered support#
If a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse, the community spouse monthly income allowance for the spouse shall be not less than the amount of the monthly income so ordered.
(6)Application of “income first” rule to revision of community spouse resource allowance#
For purposes of this subsection and subsections (c) and (e), a State must consider that all income of the institutionalized spouse that could be made available to a community spouse, in accordance with the calculation of the community spouse monthly income allowance under this subsection, has been made available before the State allocates to the community spouse an amount of resources adequate to provide the difference between the minimum monthly maintenance needs allowance and all income available to the community spouse.