Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-6 - Long-Term Care
Section 5160:1-6-05 - Medicaid: treatment of income and resources for spouses who are both seeking medicaid payment for long-term care (LTC) services
Universal Citation: OH Admin Code 5160:1-6-05
Current through all regulations passed and filed through September 16, 2024
(A) This rule describes the treatment of income and resources for spouses who are both seeking medicaid payment for LTC services.
(B) When both spouses are expected to receive LTC services for less than thirty consecutive days, each spouse's eligibility must be determined in accordance with Chapter 5160:1-3 or 5160:1-4 of the Administrative Code and the rules in Chapter 5160:1-6 of the Administrative Code do not apply.
(C) When both spouses are likely to receive LTC services for more than thirty consecutive days, the following rules apply:
(1)
When the
spouses are no longer living together (for example, one spouse is residing in
a medical
institution and the other spouse is requesting enrollment in a home and
community-based services (HCBS) waiver), determine each spouse's eligibility
independently as follows:
(a) Determine
whether one
or both spouses have base eligibility under
Chapter 5160:1-4 of the Administrative Code.
(b)
When a spouse
does not have base eligibility under Chapter 5160:1-4
of the Administrative Code, beginning the first month following the month the
couple ceased to live together, treat the spouse as an individual and compare
his or her income and resources to the individual income and resource standards
in accordance with Chapter 5160:1-3 of the Administrative Code.
(c)
When a spouse's
income exceeds the individual income standard, then, when applicable,
determine each spouse's eligibility under the special income level (SIL) as
described in rule
5160:1-6-03.1 of the
Administrative Code.
(2)
When the
spouses are living together in the community (for example, both spouses are
requesting enrollment in an HCBS waiver):
(a)
Determine whether one or both spouses have base eligibility under Chapter 5160:1-4 of the
Administrative Code.
(b)
When one or
both of the spouses do not have base eligibility
under Chapter 5160:1-4 of the Administrative Code, determine eligibility for
one or both of the spouses in accordance with Chapter 5160:1-3 of the
Administrative Code.
(c)
When one or
both of the spouses do not have base eligibility
under Chapter 5160:1-3 of the Administrative Code, then determine both spouse's
eligibility independently under the SIL.
(D) When both spouses reside in, or are admitted to, the same room of a medical institution, then the following rules apply:
(1) Determine
whether one
or both spouses have base eligibility under
Chapter 5160:1-4 of the Administrative Code.
(2)
When a spouse
does not have base eligibility under Chapter 5160:1-4
of the Administrative Code, the spouse may choose to be considered as a couple
or as an individual for the purposes of applying the individual or couple
income standards under Chapter 5160:1-3 of the Administrative Code, whichever
is more advantageous to the individual.
(3)
When a spouse's
income exceeds the income standards in Chapter 5160:1-3 of the Administrative
Code, then the spouse's eligibility will be determined under the SIL.
(E) Hardship exception.
(1)
When both spouses
are seeking or receiving LTC services, one spouse may receive an amount that
does not exceed the monthly income allowance (MIA) as calculated in rule
5160:1-6-07 or
5160:1-6-07.1 of the
Administrative Code in the following circumstance:
(a) Only one spouse is subject to a patient
liability; and
(b) The spouse who
is not subject to the patient liability receives HCBS services and needs the
additional income from his or her spouse to remain in the community.
(2) The amount of income received
by the spouse under this section will be considered unearned income to that
spouse.
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