Texas Health and Human Services Commission
Medicaid for the Elderly
and People with Disabilities Handbook
Effective: September 1, 2013
Spousal Initial Application
Upon receiving an application for Medicaid, calculate the couple's combined countable resources, without regard to community or separate property laws or the spouses' respective ownership interests, as of 12:01 a.m. on the first day of the month in which eligibility is being determined.
See Section J-2200, Spousal Treatment of Resources.
If an assessment of resources to determine the spousal protected resource amount (SPRA) has not previously been completed, determine the SPRA at initial application, using Section J-4000, Assessment and SPRA.
When the assessment is complete, send Form H1274, Medicaid Eligibility Resource Assessment Notification. If the institutionalized spouse is found eligible for Medicaid, ensure Form H1279, Spousal Impoverishment Notification, is sent at certification along with the eligibility notice.
If the SPRA determined at assessment is either the federal minimum or maximum resource amount, and the federal minimum or maximum resource amount increases before completion of the initial application for Medicaid, use the federal minimum and maximum resource amounts in effect at the time of completion of the initial application.
If the institutionalized spouse is found ineligible for Medicaid at the initial application and reapplies, deduct the same SPRA for subsequent applications.
If an institutionalized spouse, after having been certified (even if there are ineligible months within the three months prior, month of application and any months through certification), is subsequently denied and reapplies for Medicaid:
- if the institutionalized spouse should never have been certified and was denied because of unreported resources, calculate a new SPRA at reapplication, taking into account the previously unreported resources; and
- if the institutionalized spouse was denied for any other reason, do not deduct the SPRA and count only the institutionalized spouse's resources at reapplication.
Note: A case is not considered “certified” until a decision or certification has taken place and there may be both ineligible as well as eligible months within this certification decision. The total countable combined resources of the couple are considered within the certification decision. See Section J-8000, After Initial Eligibility Period, for treatment of resources after certification.
J-5100 Spousal Steps at Application
Steps in determining countable resources for a spousal application:
|Determine the couple's countable resources at 12:01 a.m. on the first day of the month of application (and three months prior).|
|Determine if an assessment of the SPRA was previously completed.
If so, continue.
Determine if the SPRA will be automatic, institutional or waiver.
Institutional — Determine the SPRA based on the countable resources as of 12:01 a.m. of the first day of the month of medical facility entry. The medical facility entry can start at the date of hospital admission if the person transfers directly from the hospital to the nursing facility without returning to a community setting.
Waiver — Determine the waiver SPRA based on the countable resources as of 12:01 a.m. of the first day of the month of receipt of the application.
|Determine the SPRA, which is the greater of:
|Subtract the SPRA from the combined countable resources.|
|Compare the remainder to the appropriate resource limit for an individual.|