Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 26 - SPOUSAL IMPOVERISHMENT MEDICAID PROGRAM (SIMP)
Section 477-26-002 - DEFINITIONS
Current through March 20, 2024
For the purposes of these rules and regulations, the following definitions apply.
002.01 COMMUNITY SPOUSE. The spouse of an institutionalized spouse, as defined below. A community spouse may not reside in a medical institution, nursing facility, receive Home and Community-Based Services (HCBS), or participate in Program for All-inclusive Care for the Elderly (PACE).
002.02 DEPENDENT FAMILY MEMBERS. Minor children residing with a community spouse, dependent parents, or siblings of the community spouse or institutionalized spouse who reside with the community spouse and could be claimed as dependents for tax purposes.
002.03 EXCESS SHELTER COSTS. The amount by which the combined rent or mortgage; property taxes; homeowner's insurance; and condominium or cooperative fees, if applicable, exceed 30% of the minimum maintenance needs amount.
002.04 FAMILY MAINTENANCE ALLOWANCE. The amount deducted from an institutionalized spouse's income to meet the maintenance needs of the community spouse and family members.
002.05 INSTITUTIONAL LEVEL OF CARE. The level of care, based on medical and functional criteria, which is normally required by the Department to reside in a nursing facility, intermediate care facility for the developmentally disabled, or to receive Home and Community-Based Services (HCBS).
002.06 INSTITUTIONALIZED SPOUSE. An individual who is in a medical institution, nursing facility, intermediate care facility for the developmentally disabled, or meets the requirements to receive Home and Community-Based Services (HCBS) for at least 30 consecutive days and who is married to a spouse who does not reside in a medical institution, nursing facility, intermediate care facility for the developmentally disabled, or meet the requirements to receive Home and Community-Based Services.
002.07 MAINTENANCE NEED STANDARD. The income standard to which the community spouse's and other dependent family members' income is compared for the purpose of determining the amount of allowance that may be made from the institutionalized spouse's income. The maintenance need standard is determined by need and is subject to a minimum and maximum amount.
