Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 26 - SPOUSAL IMPOVERISHMENT MEDICAID PROGRAM (SIMP)
Section 477-26-003 - RESOURCES

003.01(A) FORM USED. The IM-73 form is used to catalog all resources owned and available to the couple for the spousal impoverishment Medicaid program.

003.01(B) TIMELINE FOR COMPLETION. A married couple is allowed one assessment. Either spouse may request the assessment of resources when one spouse has already received institutional level of care for at least 30 days, is likely to need an institutional level of care for more than 30 continuous days, or would have received such care except for death. The month that the institutional spouse was first able to request an assessment is the month used to complete the IM-73, regardless of when the form is completed. The couple does not need to apply for Medicaid in order to complete an assessment of resources.

003.01(C) RESOURCES INCLUDED ON THE ASSESSMENT. All countable resources owned or available to the couple must be verified and accounted for on the assessment of resources. This includes any resource owned individually, jointly, or owned with other parties. For the purposes of the spousal impoverishment Medicaid program (SIMP), prenuptial agreements or laws or principles of marital property do not apply.

003.01(D) RESOURCES NOT INCLUDED ON THE ASSESSMENT. Resources which are excluded in determining Medicaid eligibility are also excluded for the assessment of resources. An excluded resource owned by the couple at the time of the assessment which later loses its exclusion cannot be added to the assessment of resources when the exclusion is lost. Resources acquired after the assessment is completed, resources which were not disclosed, and resources which were discovered after completion of the IM-73 cannot be later added in order to increase the amount reserved for the community spouse.

003.01(E) RESOURCES RESERVED FOR THE COMMUNITY SPOUSE. After all resources have been accounted for on the assessment of resources form, the amount of resources to be reserved for the community spouse is calculated. The community spouse may reserve up to half of the couple's combined resources, subject to a minimum and maximum reserved amount. The minimum and maximum amounts used on an assessment of resources are the minimum and maximum amounts in effect for the date used to assess the resources. The minimum amount may always be reserved, even if the combined resources are below the minimum. A community spouse may not reserve more than the maximum amount. The minimum and maximum amounts are adjusted annually according to the consumer price index. See 477-000-029.

003.01(F) APPLICABILITY OF THE ASSESSMENT. The amount of resources reserved for the community spouse that is calculated on the assessment of resources is used when Medicaid eligibility is determined for the institutionalized spouse. If the institutionalized spouse stops receiving services which require an institutional level of care, then eligibility for the spousal impoverishment program (SIMP) ends. If one spouse later needs an institutional level of care, then the original assessment of resources and reserved amount is used in determining Medicaid eligibility.

003.01(G) APPEAL OF THE ASSESSMENT. The assessment of resources notifies the couple that they may appeal the assessment. The couple may appeal the value assigned to the resources, the amount reserved for the community spouse, or both. In order to appeal, the institutionalized spouse must apply for Medicaid. If the community spouse alleges that it is necessary to reserve additional resources, the community spouse must first show that the need cannot be met by allocating additional income from the institutionalized spouse. If the community spouse prevails on appeal, then additional resources may be reserved.

003.02(A) FORM USED. The IM-74 form is used to account for all resources owned by the institutionalized and community spouses. The form is used to designate which resource will be considered available to each spouse.

003.02(B) TIMELINE FOR COMPLETION. A designation of resources must be completed when Medicaid eligibility for the spousal impoverishment Medicaid program (SIMP) is determined. The institutionalized spouse must have submitted a Medicaid application before the designation is completed and eligibility is determined.

003.02(C) RESOURCES INCLUDED ON THE DESIGNATION. All resources owned and available to the couple at the time that Medicaid eligibility is being requested are included on the designation of resources. The value of all resources on the designation must be verified before being included on the form. The institutionalized spouse must have countable resources below four thousand ($4,000) to be eligible. The community spouse cannot have countable resources above the amount reserved on the assessment of resources for the institutionalized spouse to be eligible.

003.02(D) INTERSPOUSAL TRANSFERS. The IM-74 may be completed, and Medicaid eligibility determined before all resources have changed title to reflect the arrangement on the form. The ownership of all resources is verified again at the time of the institutionalized spouse's first Medicaid renewal. If any necessary transfers have not been completed at that time, and the institutionalized spouse retains ownership in more than four thousand ($4,000) in resources, Medicaid must be closed due to excess resources. Transfer of resources between spouses is an exception to the deprivation of resource provisions unless the resources transferred from the institutionalized spouse would result in the community spouse having countable resources above the reserved amount. The amount transferred in excess of the community spouse's reserved amount is counted as a deprivation of resources.

003.02(E) RESOURCES NOT INCLUDED ON THE DESIGNATION. A resource which is acquired, omitted, or that loses its exclusion after the designation of resources has been completed is treated as follows:

003.02(F) APPLICABILITY OF THE DESIGNATION. The IM-74 is in effect while the institutionalized spouse remains eligible for the spousal impoverishment Medicaid program (SIMP). This is true even when the institutionalized spouse moves from one institutional living arrangement to another. If the institutionalized spouse resides in the home with the community spouse without receiving institutional services, then eligibility for spousal impoverishment ends and the designation of resources no longer applies. If the community spouse begins to receive institutional services, then eligibility for spousal impoverishment ends and the designation of resources does not apply.

003.03(A) INSTITUTIONALIZED SPOUSE. The institutionalized spouse in the spousal impoverishment Medicaid program must have four thousand ($4,000) or less in countable resources to be eligible. The institutionalized spouse may transfer resource to the community spouse without penalty up to the amount reserved for the community spouse on the IM-73.

003.03(B) COMMUNITY SPOUSE. The community spouse must reduce countable resources to the amount calculated on the IM-73 before the institutionalized spouse may become eligible.

003.03(C) RESIDING WITH COMMUNITY SPOUSE. If the institutionalized spouse resides with the community spouse without being eligible to receive Home and Community-Based Services (HCBS) or Program for All-inclusive Care for the Elderly (PACE), then eligibility for the spousal impoverishment Medicaid program ends. The couple would have a resource limit of six thousand ($6,000) in order to be eligible under other Medicaid programs for the aged, blind, or disabled.

003.03(D) COMMUNITY SPOUSE RECEIVES INSTITUTIONAL CARE. If the community spouse begins to receive institutional care, then eligibility for the spousal impoverishment Medicaid program ends. The couple would need to reduce resources such that each spouse had four thousand ($4,000) or less in countable resources before either would be eligible for other aged, blind, or disabled (ABD) Medicaid programs.