627.03 Allocation to a Community Spouse (MAM)

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Allow individuals residing in a nursing facility to allocate income to their community spouse, provided the community spouse's income is insufficient to maintain the spouse in the community. Allocate income if the institutionalized individual meets all of the following:

• Is married, with the spouse residing in the community;

- consider legal separation the same as being divorced (not married).

• Voluntarily agrees to make their income available to the community spouse;

• Is likely to be institutionalized 30 consecutive days or more; and

• Resides in an institution that:

- is either a hospital, skilled nursing, or intermediate care facility;

- provides medical care, including nursing and convalescent care; and

- is authorized under state law to provide medical care. Contact the Office of Program Support, Bureau of Health Facilities Licensing, for verification.

Steps to Allocate Income to a Community Spouse

• Use BFA Form 799, Spousal Income Protection, and BFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals.

• Follow the step-by-step procedures.

1. Determine the community spouse's monthly excess shelter cost.

- The excess shelter cost is the amount of shelter expenses that exceed $740 per month.

Shelter expenses include:

• Rent, mortgage, property taxes, insurance, condo and cooperative maintenance fees; and

- Use the actual average monthly costs even if the town/city welfare office has paid for all or part of the shelter costs. If the town/city welfare states that it intends to pay for the shelter costs on an on-going basis, the shelter costs are reduced by the amount of the assistance for the specified period of time.

• Heat and utility expenses.

- Use the appropriate Standard Utilities Allowance for heat and utility expenses. See the Food Stamp Manual, Section 603.09, Other Allowable Deductions: Utility Standards.

2. Add the excess shelter costs to the maximum income standard of $2,465.

- The total is capped at the maximum income allowance of $3,854; or

- A higher amount that is set by an Administrative Appeals Officer based on exceptional circumstances resulting in significant financial duress, or by a court support order. See Section 627.04, Criteria for Increased Income Allocation Due to Significant Financial Duress.

3. Determine the community spouse's countable gross monthly income. Do not allow any disregards or deductions.

4. Subtract the community spouse's countable gross monthly income from the amount determined in Step 2. (If the community spouse's income is higher than the amount determined in Step 2, do not allocate.)

- The result is considered the community spouse's needs.

5. Compare the community spouse's needs to the amount of income the institutionalized individual has available to allocate. See Section 619.01, Cost of Care: Nursing Facility.

6. If the result in Step 5 shows the community spouse's needs are:

- Greater than the income subject to allocation, all of the institutionalized individual's income that is available for allocation may be allocated.

- Less than the income subject to allocation, the amount required to cover the community spouse's needs may be allocated.

7. Allocate the institutionalized individual's income that is subject to allocation. The institutionalized individual must voluntarily want to allocate their income to the community spouse. The institutionalized individual may refuse to allocate some or all of their income to the community spouse. The actual amount allocated is either:

- the figure calculated in Step 6; or

- a smaller amount as determined by the institutionalized individual, even if the community spouse considers the amount inadequate.

o The community spouse may obtain a court support order if they want a higher amount allocated.

If either spouse has dependents residing with the community spouse, any remaining income must be allocated to those dependents. See Section 627.05 Allocation to Dependents Who Reside with the Community Spouse.

References: He-W 806.75; He-W 854.20; 42 CFR 435.725; 42 CFR 435.733; 42 USC 1396r-5(d)(2)-(4)&(g)