PM 15-04-04-a

NH/SLF cases

  1. Verify income of the community spouse (see PM 08-02-00).
  2. To figure the amount of the Community Spouse Maintenance Needs Allowance (CSMNA), subtract the spouse's gross income from the maintenance needs standard. The difference is the amount of the deduction.
  3. Enter the deduction from the person's income for the support of a community spouse in AIS or Revised textNursing Home/Supportive Living Facility Resource Calculation (HFS 2500).
  4. Send the HFS 2500 with the approval notice.
  5. Allow the amount of the deduction as figured on the HFS 2500 unless notified by either spouse of a different amount.

Example: Mr. A resides in a long term care facility Revised text(NH or SLF) and receives RSDI of $950 per month and a pension of $1,250 per month. Total monthly income is $2,200. Mrs. A resides in the community and receives RSDI of $630 per month.

For this case, the CSMNA is equal to the maintenance needs standard of Revised text$2,739 less gross income of the community spouse ($630). Therefore, $2,109 is deducted as the CSMNA. The amount of $2,109 is not available to apply to the cost of long term care if it is given to the community spouse. The remaining amount of the resident's income is available to apply to the cost of long term care.

Medical cases applying for or receiving services through the DoA HCBS waiver

Follow the procedures listed above except enter the deduction from the person's income for the support of a community spouse in AIS or on AABD MANG Computation Sheet - Community Case (Form 2382A).

Enter Code 20 in Item 20 of Form 552 to identify a client who applies for or receives services through the DoA Home and Community Based Services (HCBS) waiver. When Code 20 is entered in Item 20, enter one of the following indicator codes under the SUP. BY column with Item 80 Code 158 CI.

  • Code 3 - determination was made without diverting income to a community spouse or dependent family member; or
  • Code 4 - determination was made diverting income to a community spouse or dependent family member.

Example 1: Mrs. B lives in the community and receives DoA HCBS waiver services. Monthly non-SSI income is $800 per month. Mr. B lives in the community and does not receive DoA HCBS waiver services. Total monthly income is $900 per month.

For this case, the Community Spouse Maintenance Needs Allowance (CSMNA) is equal to the maintenance needs standard of Revised text$2,739 less gross monthly income of the community spouse (Revised text$2,739 - $900 = $1,839). Since this amount is greater than the client's total non-SSI income, enter the amount diverted (if actually contributed to the community spouse) on Form 2382A.

Example 2: Mr. D lives in the community and has applied for DoA HCBS waiver services. Total non-SSI income is $3,279 per month. Mrs. D lives in the community and does not receive DoA HCBS waiver services. Total monthly income is $2,388.

Use the AABD Community Standard for one person and allow a deduction for the CSMNA to determine if remaining monthly excess income is less than or equal to $1,800.

The CSMNA is equal to the maintenance needs standard of Revised text$2,739 less gross monthly income of the community spouse. Therefore, $351 (Revised text$2,739 - $2,388 = $351) is deducted as the CSMNA. After allowing the deduction, the LTC spouse would have a spenddown of $1,972 ($3,279 - $25 disregard - Revised text$931 standard - $351 = $1,972).

Since monthly excess income ($1,972) is greater than $1,800, complete a 2nd determination. Do not determine eligibility separately from Mrs. D. Do not allow a deduction for the CSMNA. Do not treat the person as applying for/receiving DoA HCBS waiver services. Do not enter Code 20 in Item 20.