Current through Register No. 40, October 3, 2024
(a) If the individual refuses or fails to
verify a claimed allocation, the unverified amount shall not be an allowable
deduction.
(b) An institutionalized
individual, as defined in He-W 601.05, who has a spouse living in the
community, shall provide verification of the following:
(1) The need for institutionalization of at
least 30 days;
(2) The income and
shelter expenses of the spouse who resides in the community, if
applicable;
(3) Marital
status;
(4) Incurred medical
expenses of the institutionalized individual, if applicable;
(5) Legal dependent status and income of
individuals claimed as dependents, if applicable;
(6) Identity of the dependent and
relationship of the dependent to the institutionalized individual or spouse who
supports the dependent, if applicable; and
(7) Court ordered support against the
institutionalized individual, if applicable.
(c) Acceptable verification of (b)(1) through
(7) above, shall include the documentation listed below:
(1) A signed and dated statement from the
admitting physician, caseworker, hospital social worker, bureau of elderly and
adult services social worker, or representative of the institution, which
indicates that based on available medical data, the institutionalized
individual requires a minimum of 30 days of institutionalization;
(2) Documentation that substantiates the
amount and frequency of income as specified in He-W 606.59;
(3) A marriage certificate, a record of
marriage from the town clerk's office, or other document that provides proof of
marriage;
(4) Documentation which
is no more than 2 months old and which substantiates the community spouse's
shelter expenses, such as:
a. Rent receipts
which indicate the amount and frequency of payment;
b. A bill or receipt for the mortgage
payment;
c. Property
taxes;
d. Homeowner insurance
premiums;
e. Manufactured housing
lot rent;
f. Utility expenses;
or
g. Condominium fees;
(5) Bills or receipts that
substantiate that the institutionalized spouse has incurred non-reimbursable
medical expenses and the frequency of such expenses;
(6) A copy of the most recent filed internal
revenue service income tax return or other documentation that substantiates
legal dependency status;
(7) A
driver's license, military record, voter registration card, school or hospital
record, or any other document that establishes the identity of the
dependent;
(8) A birth certificate,
baptismal record, marriage certificate, or other documentation which
establishes the relationship between the dependent and the spouse who provides
support; and
(9) A copy of the
court order or other documentation that substantiates that the
institutionalized spouse has been ordered to pay support and which indicates
the amount and frequency of such support payments.
(d) The allocation from the institutionalized
individual's income to the community spouse shall take effect in the month that
the institutionalized individual provides documentation of the items cited in
(b) above.
(e) If documentation
described in (d) above is provided within 10 calendar days of the department
request, the allocation shall take effect the month in which the request was
made.
(See Revision Note at Chapter Heading He-W 600) #5171,
eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss by #6614,
eff 10-24-97; ss by #8452, eff
10-22-05
