PM 07-02-22: Community Spouse Resource Allowance

WAG 07-02-22

The Community Spouse Resource Allowance (CSRA) applies to all long term care (LTC) customers with a community spouse.  LTC customers includes all those who live in nursing homes (NH) or supporting living programs (SLP) and those applying for or receiving DoA HCBS waiver services.

The CSRA is the portion of total non-exempt resources owned by the LTC spouse, the community spouse, or jointly by both, which may be transferred to the community spouse. The CSRA must be directly available to the community spouse or to another person for the sole benefit of the community spouse. The CSRA, up to new manual text $129,084.00, is not considered available to pay for the care of the LTC spouse for applications received on or after 01/01/2024.  This amount also applies at the first redetermination when determining if the CSRA was transferred by the customer or their representative indicated at intake. After subtracting the CSRA from the total non-exempt resources of the LTC spouse and the community spouse, the remainder is available to pay for care of the LTC spouse. The previous amounts can be found at the WAG 25-03-02 (2) Medical Standards.

The LTC spouse is not required to transfer his or her resources  to the community spouse.  However, if the LTC spouse chooses to transfer their resources, it is only allowed to do so until the first redetermination after initial approval of medical benefits. No later than the first redetermination following that year, verify whether  the transfer was completed. If the LTC spouse has not transferred the resources to the community spouse, the resources are considered available to the LTC spouse. Do not review the community spouse's resources at redetermination except to verify transfers for the CSRA. Verification of the CSRA transfer at first redetermination involves verifying the change in ownership of only the resources reported at intake unless there is evidence that one or both spouses failed to accurately report resources at intake. Resources acquired or transferred by the community spouse after initial determination are not subject to review.

Note: If the community spouse acquires a resource, such as an inheritance, after initial eligibility is determined, it does not affect the CSRA which was previously established, and the new resource is not available to the LTC spouse. If the LTC spouse receives a resource after eligibility is determined, it cannot be transferred to the community spouse even if the transfer would bring resources of the community spouse up to the maximum CSRA amount. If, after eligibility is determined, a resource is received by the couple (not legally owned by one or the other alone), half of the resource belongs to the community spouse and the other half is available to the LTC spouse.

In addition to the CSRA amount, a customer is allowed to transfer for the sole benefit of his or her spouse: personal effects, household goods, and one motor vehicle, regardless of their dollar value.

If the community spouse fails to disclose information about his or her resources or transferred resources, the customer is ineligible. Both the applicant and spouse must cooperate by providing information about resources owned by either or both spouses.

If the community spouse begins receiving DoA HCBS waiver services or becomes a resident of an NH or SLF, do not allow the CSRA. If the CSRA has already been determined but the ownership of the resources has not been changed, discontinue the transfer. 

Notify each spouse of the amount of nonexempt resources available to the community spouse and the amount remaining to pay for care of the LTC spouse.

new manual textThe amount allowed as the CSRA may exceed the resource allowance standard of $129,084.00 only in the following situations:

  • a court order establishes a different resource allowance; or
  • an appeal decision determines that the transfer of income-producing resources in excess of the standard CSRA is needed to raise the community spouse's income to the maximum amount permitted as the Community Spouse Maintenance Needs Allowance (CSMNA) (see PM 15-04-04-a).

Appeal of Community Spouse Resource Allowance (CSRA)

Updatd policy manual textThe appeal decision bases the amount of an allowable increase in the CSRA on the cost of a single premium life annuity with fixed monthly payments.  These payments are equal to the amount needed to raise the community spouse's income to the maximum amount permitted as the Community Spouse Maintenance Needs Allowance (CSMNA). See PM 15-04-04-a Diversion of income from the client as the CSMNA is not considered in the appeal decision.

The appellant must provide a quote of the cost to buy the single premium life annuity. The quote must be from a company that offers annuities. If resources are less than the amount needed to buy the annuity, the appellant must provide a quote of the monthly annuity payments using available resources.

The appeal decision informs the Long Term Care Medical Field Offices (LTC MFO) of the amount to permit as the CSRA and of the amount of the fixed monthly annuity payments to treat as available to the community spouse, whether or not the annuity is purchased.

The actual purchase of the annuity is not required. Count the monthly amount the annuity would pay as available to the community spouse, starting with the month following the month the resources are transferred. The monthly amount the annuity would pay is fixed and does not change.