Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 14 - INDIVIDUALS IN MEDICAL INSTITUTIONS
Section 144-332-14-4 - INSTITUTIONAL ASSET CRITERIA
Current through 2024-38, September 18, 2024
Individuals must use their assets to meet their needs. Specific types and amounts may be retained by the individual and community spouse to meet current and future needs.
All available assets are to be used in determining eligibility. Countable assets are defined in Part 16. Asset limits are defined in Part 7, Section 1.
Unless exempt, a transfer of assets by the individual is subject to a penalty. Refer to Part 15 to assess if a transfer has occurred and if a penalty needs to be applied.
Countable assets of the individual must be under $2000 on any day of the month for which eligibility is determined.
Section 4.1: Long Term Care Partnership Program
This program provides incentives to Maine's citizens to purchase long term care insurance by disregarding some assets of the person, if they must apply for financial assistance for help with their long term care needs.
Section 4.2 Assets of Couples Residing in a Nursing Facility
If the total assets of a couple in the same room in a nursing facility exceed the standard for a couple, they can decide who will be the eligible spouse and assets can be transferred to the ineligible spouse. Each spouse is treated as an individual. Coverage can begin for the eligible spouse effective the month countable assets for the eligible spouse are below the standard for an individual.
If the couple reside in different rooms in the same facility or in different facilities, then each is treated as an individual when determining the asset limit. Coverage can begin for the eligible spouse effective the month countable assets for the eligible spouse are below the standard for an individual.
No spousal allowance of income or assets is determined since the ineligible spouse is not living in the community.
Section 4.3: Assets of the Institutionalized Individual with a community spouse
When an institutionalized individual has a community spouse, the couple's assets are looked at under special rules. These special rules determine how much of the couples assets are attributed to the community spouse and the institutionalized spouse. The amount attributed to the community spouse is called the Community Spouse Asset Allowance. The amount attributed to the institutionalized spouse is an available asset for the individual.
Determine the Community Spouse Asset Allowance
The Community Spouse Asset Allowance may be increased over the Spousal Impoverishment amount of Chart 4.4 if the gross monthly income of the community spouse and the Community Spouse Monthly Income Allocation is less than the Monthly Income Allowance (See Section 6.1.1 in this Part for definitions). This determination is made through the Administrative hearings process described in Section 4.4 of this Part.
The assets required to meet the Monthly Income Allowance shall be based on the Monthly Income Allowance set at the time of application.
Section 4.4: Hearing to Increase the Community Spouse Asset Allowance
Either the community spouse or institutionalized spouse may request a hearing if they have filed an application and they are dissatisfied with the determination of:
The hearing will be held within thirty days of the request.
The Department will make a determination of whether an amount greater than the Community Spouse Asset Allowance (Chart 4.4) is needed to raise the community spouse income to the Monthly Income Allowance.
If the individual agrees with the Department's decision, a hearing is requested using the Consent Decree in Appendix F.
If the individual disagrees with the Department's determination, s/he may request a face-to-face hearing.
A determination is made as follows on whether assets in addition to the Community Spouse Asset Allowance (Chart 4.4) are needed to meet the Monthly Income Allowance:
If the Community Spouse Asset Allowance in Chart 4.4 is greater than the averaged cost of the annuity, there shall be no substitution for the cost of an annuity.;
Section 4.5: Transfer of Assets to the Community Spouse
Once the Community Spouse Asset Allowance has been established, the couple has twelve months to transfer the protected assets to the sole ownership of the Community Spouse.
Section 4.6: Non-Cooperation from the Community Spouse
If the community spouse does not make assets available to the institutionalized spouse, eligibility will not be denied if: