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B. Spousal Resource Protection
B. Spousal Resource Protection
C. Medicare Copayments and Deductibles
B. Remove: MA-2260, Financial Eligibility Regulations – PLA,
pages 14 and 15.
D. Remove: MA-2360, Medicaid Deductible, pages 3-4, 7-8, 15-16, 19-20.
DATE: 12/10/07
Manual: Aged, Blind, and Disabled Medicaid
Change No: 01-08
To: County Directors of Social Services
Effective: 01/01/08
Make the following change(s)
Section 1924 (g) of the Social Security Act contains provisions for the protection of income and resources when an institutionalized spouse (ISP) has a community spouse (CUSP). Each January 1st, there is an increase in the maximum community spouse income allowance (CSIA) and the minimum and maximum community spouse resource allowance (CSRA). This increase is a result of an increase in the Consumer Price Index and is based on the difference between the September 1988 Consumer Price Index and the September 2007 Consumer Price Index.
The Centers for Medicare and Medicaid Services (CMS) has determined that the Consumer Price Index increase from September 1988 to September 2007 is 74 percent. This percentage was used to determine the new spousal impoverishment amounts.
There is no change in the minimum CSIA, dependent family member allowance, or the allowance for excess shelter expenses. These amounts change in July of each year.
The protection of income applies when the applicant/recipient (a/r) is institutionalized and has a CUSP. In order for the CUSP to be eligible for income protection, the a/r must be budgeted long-term care. The protection of income begins the first month of long term care budgeting.
The CSRA applies when the a/r is institutionalized and has a CUSP. In order for the CUSP to be eligible for resource protection, the a/r may be budgeted PLA or long-term care. The protection of resources begins the first month of the continuous period of institutionalization (CPI)
Medicare Premium Rates: | |
Part A |
$423.00 (If less than 30 quarters of Medicare- covered employment, see Admin. Letter 09-07.) |
Part B |
$96.40 |
Medicare Deductible Rates |
|
Part A |
$1,024.00 |
Part B |
$135.00 |
Part A Hospital Coinsurance Rates |
|
61 – 90 days |
$256.00 per day |
60 lifetime reserve days |
$512.00 per day |
Part A Skilled Nursing Facility Rate: |
|
21 – 100 days |
$128.00 per day |
a. Apply the previous maximum CUSP income protection amount to any month in the certification period prior to January 2008, including the retroactive certification period.
a. Apply the previous maximum CUSP income protection amount to any month in the certification period prior to January 2008.
Apply the new CSRA amounts to any month in the certification period beginning January 2008 or later
2. CPI Begins Prior To January 1, 2008
Recalculate the amount of the countable resources of the institutionalized spouse (ISP) effective January 1, 2008, by applying the new CSRA amounts. This may reduce the countable resources of the ISP effective January 1, 2008.
Example: The CSRA determined prior to 1-1-08 was $20,328. The couple’s countable resources on 12-31-07 totaled $22,448. This left $2,120 in countable resources for the ISP ($22,448 - $20,328= $2,120). Effective 1-01-08, increase the CSRA to $20,880. This reduces the countable resources of the ISP to $1,568 ($22,448 - $20,880 = $1,568). Assistance may be authorized for the ISP effective January 1, 2008, provided all other eligibility factors are met.
Example: The couple’s countable resources at institutionalization totaled $210,240. One-half of this amount is $105,120. However, the maximum CSRA of $101,640 was protected for the CUSP.
The couple’s countable resources on 12-31-07 totaled $209,200. This left $107,560 in countable resources for the ISP ($209,200 - $101,640 = $107,560). Effective 1/1/08, increase the CSRA to $104,400. This reduces the countable resources of the ISP to $104,800 ($209,200– $104,400 = 104,800) beginning 1/01/08.
The new Medicare rates apply to eligible medical services incurred on or after January 1, 2008. MA-2270, Long Term Care Need And Budgeting, Tables i and ii, are updated to reflect the new rates.
This policy is effective January 1, 2008. Apply this change to applications taken and redeterminations started on or after January 1, 2008, as well as to those presently in process.
A. Remove: MA-2231, Community Spouse Resource Protection,
pages 7-12
If you have any questions regarding this information, please contact your Medicaid Program Representative. For any issues that are not able to be handled through that venue, Mrs. Angela Floyd, Assistant Director for Provider and Recipient Services, will be your point of contact and can be reached at (919) 855-4050.
William W. Lawrence, Jr., M.D., Acting Director
(This material was researched and written by William Appel, Policy Consultant, Medicaid Eligibility Unit)
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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