'Division of Assets' refers to the policy that allows a spouse who remains in the community to retain a portion of the couple's assets while the institutionalized spouse becomes eligible for MO HealthNet institutional coverage (vendor NF or HCB). The legal basis for this determination is found in 208.010 RSMo and 13 CSR 40-2.030.
NOTE: The Division of Assets is the ONLY resources policy in effect for married individuals who begin a period of institutionalization on or after September 30, 1989. A Division of Assets is REQUIRED even if the participant or spouse was receiving assistance prior to the institutionalization.
With regard to Division of Assets, the following definitions apply:
Community Spouse - The spouse of an institutionalized individual. Included in this definition is the concept of 'spouse with whom the participant is living'. Apply the Division of Assets policy only if the community spouse was married to and living with the institutionalized spouse at the time of the institutionalization. This includes cases where there is involuntary separation because one member of the couple is out of the home to receive medical or nursing home care.
Institutionalized Spouse – An individual who enters a nursing facility or medical institution; AND is expected to be in the medical institution or nursing facility for at least 30 days; AND is married to a spouse who is not confined to a nursing facility or medical institution.
HCB Waiver Services participants also meet the definition of institutionalized spouse.
Medical institution– A medical hospital or a mental hospital.
Nursing Facility – A nursing facility licensed by the Missouri Department of Health and Senior Services (DHSS) as an Intermediate Care Facility (ICF) or Skilled Nursing Facility. Licensure information is available by viewing the DHSS Internet link: www.dhss.mo.gov/showmelongtermcare/ “Locate a Long Term Care Facility”. For the purposes of Division of Assets, Nursing Facility also includes a mental health (ICF-MR) facility.
Continuous Period of Institutionalization - A period in a medical institution and/or nursing facility that is likely to be at least 30 consecutive days. Transfers between beds either within or between facilities or medical institutions does not break the continuous period of institutionalization.
The Missouri Court of Appeals Western District in its December 2006 opinion reversed the Family Support Division’s decision to deactivate Gee’s Division of Assets on the basis that she did not meet the definition of an institutionalized spouse because she was not in a Medicaid certified bed. Thereafter, the definition of institutionalized spouse is changed to comply with the Court’s decision in the Gee case. The definition now includes individuals residing in an Intermediate Care Facility (ICF) or Skilled Nursing Facility. Prior to the Gee decision, the individual was required to reside in a Medicaid certified bed to qualify for a Division of Assets.
The following briefly describes the four steps to determine resource eligibility for an institutionalized spouse based on a division of assets.
Complete only one (1) assessment per case. If the institutionalized spouse leaves the nursing facility and subsequently returns, use the assessment completed for the beginning of the first continuous period of institutionalization that began on or after September 30, 1989 to determine vendor eligibility.
| Effective Date | Minimum Spousal Share | Maximum Spousal Share |
|---|---|---|
| 09-30-89 | $12,000 | $60,000 |
| 01-01-90 | $12,516 | $62,580 |
| 01-01-91 | $13,296 | $66,480 |
| 01-01-92 | $13,740 | $68,700 |
| 01-01-93 | $14,148 | $70,740 |
| 01-01-94 | $14,532 | $72,660 |
| 01-01-95 | $14,964 | $74,820 |
| 01-01-96 | $15,348 | $76,740 |
| 01-01-97 | $15,804 | $79,020 |
| 01-01-98 | $16,152 | $80,760 |
| 01-01-99 | $16,392 | $81,960 |
| 01-01-00 | $16,824 | $84,120 |
| 01-01-01 | $17,004 | $87,000 |
| 01-01-02 | $17,856 | $89,280 |
| 01-01-03 | $18,132 | $90,660 |
| 01-01-04 | $18,552 | $92,760 |
| 01-01-05 | $19,020 | $95,100 |
| 01-01-06 | $19,908 | $99,540 |
| 01-01-07 | $20,328 | $101,640 |
| 01-01-08 | $20,880 | $104,400 |
| 01-01-09 | $21,912 | $109,560 |
| 01-01-12 | $22,728 | $113,640 |
| 01-01-13 | $23,184 | $115,920 |
| 01-01-14 | $23,448 | $117,240 |
| 01-01-15 | $23,844 | $119,220 |
| 01-01-17 | $24,180 | $120,900 |
| 01-01-18 | $24,720 | $123,600 |
| 01-01-19 | $25,284 | $126,420 |
NOTE: Division of Assets affects only vendor or HCB cases. A Division of Assets does not affect eligibility determinations for Supplemental Nursing Care (SNC), MHABD Spenddown, MHABD Non Spenddown, or TWHA. SNC and non vendor programs do not allow for a disregard of spousal share in determining eligibility even though an individual residing in a non MO HealthNet certified bed in an Intermediate Care Facility or a Skilled Nursing Facility may qualify for a Division of Assets.
After vendor eligibility is established, assets in the name of the community spouse are not considered available to the institutionalized spouse. 1030.035.15 ASSESSMENT OF ASSETS
To be eligible for an assessment of assets, there must be an institutionalized spouse. If not previously requested, an assessment of assets is required when an institutionalized spouse applies for vendor benefits.
Either member of the couple or their representative must complete the Declaration and Assessment of Assets form (IM-78) for the month in which the institutionalization begins regardless of when the request for assessment is made. An application for vendor benefits is not required for the completion of an assessment.
EXAMPLE: Mr. Basic was admitted to a Skilled Nursing Facility on November 15, 2007. He is likely to be institutionalized for 30 days. For the assessment of assets, the couple must declare assets owned in November 2007. Verify the equity value of non-exempt assets owned in November 2007.
The county where the institutionalized spouse resides completes the assessment. Follow the policy covering Location of Case Records. When an institutionalized spouse moves to another county before or after an assessment request is completed, transfer the assessment record in the same manner as any other record.
To be eligible for an assessment of assets, the first continuous period of institutionalization must begin on or after September 30, 1989 or receive HCB Waiver Services effective January 1, 1993 or after.
NOTE: For individuals who began their first continuous period of institutionalization before September 30, 1989, eligibility for vendor is based on the non-vendor MO HealthNet for Aged, Blind, and Disabled (MHABD) policy (available resources must be at or below $2,000 or $4,000 if using AB criteria). However, these individuals qualify for a Division of Assets if they leave an ICF or Skilled Nursing Facility for 30 days or longer and re-enter an ICF or Skilled Nursing Facility on or after September 30, 1989 or receive HCB Waiver Services on January 1, 1993 or after.
EXAMPLE: Mr. Lawrence has been residing in a Skilled Nursing Facility since October 4, 1987. Mrs. Lawrence remained in the couple’s home in the community. Mr. Lawrence returned home from the facility on May 1, 1991. On June 3, 1991, Mr. Lawrence moved back into a Skilled Nursing Facility. The Lawrence's are eligible for a Division of Assets for the month of June 1991.
Complete assessments within 45 days from the date of request.
Consider the following information when completing an assessment:
If the request for an assessment is made after 30 or more days of residing in the institution, verify the participant�s period of continuous institutionalization. Contact the nursing facility or hospital and establish that the participant has resided in an Intermediate Care Facility or Skilled Nursing Facility bed or hospital for at least 30 days since the institutionalization began. Accept the nursing facility or hospital's oral verification.
NOTE: It may be necessary to contact more than one facility as transfers between beds in nursing facilities or between nursing facilities or between nursing facilities and hospitals does not break the continuous period.
Non-exempt assets are the same as available resources as described in the AVAILABLE RESOURCES (OAA and PTD) policy. Follow normal procedures for verification of assets (resources) even when there is no application for vendor benefits. Verification of assets declared may be provided by the couple or through the use of the Financial Information Request (IM-7), Insurance and Prepaid Burial Letter (IM-9), or any other FSD form as necessary to verify information furnished by the couple.
EXAMPLE: Mr. Basic, who was institutionalized in November 1990, requests an assessment of assets in January 1991. The couple will declare assets owned in November 1990. Verify the equity value of the non-exempt assets owned in November 1990 in order to complete the assessment. If a vendor application was also requested in January 1991, the couple will declare assets owned in November 1990 (Declaration and Assessment of Assets form) and in January 1991 (Application/Eligibility Statement). Verify the equity value of non-exempt assets owned in November 1990 (for the assessment) and in January 1991 (for the vendor application).
When a request for an assessment cannot be completed (couple does not cooperate, institutionalization not likely to be 30 days or longer, etc.), notify each member of the couple. These requests are considered denied.
NOTE: If either spouse dies prior to the completion of the assessment and there is an application for vendor benefits, complete the assessment and determine eligibility for vendor for the period when both spouses were alive. De-activate the assessment after the application for vendor is processed.
If the assessment is completed and later becomes invalid (institutionalized or community spouse dies or the community spouse is institutionalized AND applies for MO HealthNet vendor benefits or HCB), the assessments are considered de-activated. It is not necessary to notify the couple when an assessment is de-activated. Retain the original Declaration and Assessment of Assets and verification for 5 years after deactivating the assessment.
If the assessment is complete and there is no application for vendor benefits, the assessment is active and cannot be destroyed. Should the institutionalized spouse apply for vendor benefits or HCB at a later date, use the spousal share as determined at the beginning of the first continuous period of institutionalization.
For cases where the assessment is complete and the institutionalized spouse is receiving vendor benefits, keep the assessment in the case record.
If the assessment is complete and the institutionalized spouse is eligible for vendor or HCB, AND the community spouse goes into an Intermediate Care Facility (ICF) or Skilled Nursing Facility bed but does not apply for MO HealthNet do not deactivate the Division of Assets.
Keep the Declaration and Assessment of Assets for five years after the assessment becomes inactive.
Nursing homes are required to give information about the Division of Assets and MO HealthNet for the Aged, Blind and Disabled (MHABD) eligibility to all new residents when they are admitted to the facility. Nursing homes are encouraged to have ALL new married residents contact the local FSD offices to have the assessment of assets completed in the month the institutionalization begins.
The spousal share is the greater of $25,284 or one half the couple's combined non-exempt assets not to exceed $126,420.
To determine the spousal share:
If the equity value of the couple's total non-exempt assets is less than or equal to the minimum spousal share amount, the spousal share is that minimum amount. The spousal share can never exceed the maximum spousal share amount. Consider any amount over the maximum amount an available resource to the institutionalized spouse.
EXAMPLE #1: Mrs. Jones requested an assessment of assets on September 11. Mr. Jones was admitted to a Nursing Facility on September 8 and is likely to remain 30 days. The couple's total non-exempt assets are $4,000. The spousal share is $25,284. ($4,000 / 2 = $2,000, but the minimum spousal share is $25,284).
NOTE: Mr. and Mrs. Jones are eligible for a Division of Assets because Mr. Jones is in a Nursing Facility. The Division of Assets is used in the eligibility determination for vendor benefits. The Division of Assets is not used when determining eligibility for any non-vendor program.
EXAMPLE #2: Mr. Big requested an assessment of assets on October 29. Mrs. Big was admitted to a Nursing Facility on October 15 and is likely to remain 30 days. The couple's total non-exempt assets are $345,000. Mr. Big's spousal share is $126,420 ($345,000 / 2 = $172,500, but the maximum spousal share is $126,420).
NOTE: Mr. and Mrs. Big are eligible for a Division of Assets because Mr. Big is in a Nursing Facility. The Division of Assets is used in the eligibility determination for vendor benefits. The Division of Assets is not used when determining eligibility for any non-vendor program.
The spousal share is determined at the beginning of the first continuous period of institutionalization and does not change during any subsequent periods of institutionalization.
Subsequent changes in the amount of assets not change the spousal share amount. Only adjust the spousal share amount when it is determined that inaccurate or incomplete information was used when the initial calculation was completed. The spousal share may be adjusted as a result of a hearing decision or court order (Refer to Section 1030.035.20.05).
If the institutionalized spouse has not applied for vendor benefits and the determination of the spousal share is complete, retain the agency copy of the Declaration and Assessment of Assets in the county. After sending each member of the couple a copy of the Declaration and Assessment of Assets, no further action is required until the institutionalized spouse applies for vendor benefits.
Section 1924 of the Social Security Act allows a hearing officer to increase the spousal share and allow additional assets to be transferred to the community spouse. This is done if the hearing establishes that the community spouse share determined under Section 1030.035.20 (in relation to the amount of income generated by it) is inadequate to raise the community spouse's income to the minimum monthly maintenance needs allowance (MMNA). Only a hearing officer or a court may increase the spousal share for this purpose.
For vendor applications made on or after August 28, 2005, subsection 12 of RSMo. Section 208.010 requires the allotment of an institutionalized spouse's income to the community spouse prior to the raising of the community spouse's share of the couple's assets. When making a decision on the need for a higher spousal share, the hearing officer will look at the couple's income first. If the income of the community spouse is less than the current MMMA, the hearing officer will determine the maximum amount of the institutionalized spouse's income that could be allocated to the community spouse. If that amount is enough to raise the community spouse's income to the MMMA, the spousal share of the assets will not be raised. If the income of the institutionalized spouse is not sufficient to raise the community spouse's income to the MMMA, the community spouse's share of the assets may be raised.
NOTE: Income that is deposited into a qualifying income trust, see 1025.015.04.01.02, may be reallocated to a community spouse pursuant only to a hearing under 42 USC 1396r-5(e)(2).
Couples who request an assessment, but are not applying for benefit benefits are not entitled to a hearing on the amount of the spousal share. When application is made for vendor benefits, either spouse may request a hearing on the determination of the spousal share.
In determining the resources of an institutionalized spouse at the time of application for vendor benefits, all non-exempt assets held by either the institutionalized spouse or the community spouse, or both, are considered available to the institutionalized spouse only to the extent that the assets exceed the spousal share, provided the institutionalized spouse intends to transfer the excess assets to the community spouse. Refer to the policy covering Required Transfer of Assets (Spouse Vendor Case) for spouse vendor cases.
To determine the initial vendor eligibility of the institutionalized spouse:
Verify the equity value of all the non-exempt assets owned by the institutionalized and community spouse for the month in which the first continuous period of institutionalization began. (Verify the continuous period.)
NOTE: If the assessment was completed prior to the vendor application, the total non-exempt asset at institutionalization and the spousal share would already have been determined.
Verify the equity value of all non-exempt assets owned by the institutionalized and community spouse for the month in which the application was made.
If the remainder is at or below the resource maximum for a single person the institutionalized spouse is initially eligible for vendor benefits based on resource availability subject to the Required Transfer of Assets (Spouse Vendor Case) policy.
EXAMPLE #1: On October 7 Mr. Taylor applied for MHABD vendor for his spouse and requested an assessment of assets. Mrs. Taylor was admitted to a MO HealthNet certified NF bed on February 6 and is likely to remain 30 days. The couple's total non-exempt assets consist of one $5,000 savings account. The spousal share is $25,284. ($5,000 / 2 = $2,500, but the minimum spousal share is $25,284). For the initial MO HealthNet vendor eligibility determination, Mrs. Taylor has no resources to consider. ($5,000 - $25,284 < 0.)
EXAMPLE #2: Mrs. Lawrence (institutionalized spouse) was admitted to a MO HealthNet certified NF bed on September 15 and is likely to remain 30 days. Mr. Lawrence (community spouse) requests an assessment of assets on September 16. The total non-exempt assets amount to $300,000. Mr. Lawrence’s spousal share is $126,420. ($300,000 / 2 = $150,000; however, the maximum spousal share is $126,420). Mrs. Lawrence resides in a MO HealthNet certified bed in the facility and therefore may qualify for MO HealthNet vendor benefits. When Mrs. Lawrence applies for vendor benefits, whether at the time she becomes institutionalized or later, $126,420 will be deducted from the verified non-exempt assets at the time of the application. If the remainder of those assets is at or below the resource maximum for a single person, Mrs. Lawrence will be initially eligible for vendor benefits based on the resource eligibility factor.
After initial vendor eligibility for the institutionalized spouse is determined, the assets of the community spouse are NOT considered available to the institutionalized spouse during any continuous period of institutionalization. This provision is subject to the policy governing Required Transfer of Assets (Spouse Vendor Case).
Consider only the assets in the name of the institutionalized spouse when determining continued eligibility for vendor benefits. The institutionalized spouse's assets are CONSIDERED AVAILABLE to the community spouse if that spouse applies for IM assistance. Should the community spouse apply for IM assistance, consider the application as a couple case.
NOTE: Division of Assets affects only vendor or HCB cases. A Division of Assets does not affect eligibility determinations for Supplemental Nursing Care (SNC), MHABD Spenddown, MHABD Non Spenddown, or TWHA. SNC and non vendor programs do not allow for a disregard of spousal share in determining eligibility even though an individual residing in a non MO HealthNet certified bed in an Intermediate Care Facility or a Skilled Nursing Facility may qualify for a Division of Assets.
The transfer of assets policy outlined here explains when the institutionalized spouse must transfer assets to the community spouse and applies ONLY to institutionalized individuals with a community spouse. If other transfers occur either by the institutionalized or community spouse, refer to the policy covering Transfer of Property in Section 1040.000.00.
To continue vendor eligibility, assets in the name of the institutionalized spouse must be at or less than the resource maximum for a single person or the institutionalized spouse must declare intent to transfer assets out of his/her name within 90 days of the date vendor eligibility is established. If the assets in the name after the institutionalized spouse are greater than the appropriate resource maximum, the spousal share cannot be disregarded until the institutionalized spouse declares intent to transfer the assets out of his/her name.
The institutionalized spouse must declare in writing intent to actually transfer the assets to the community spouse before the vendor application can be approved. Use the “Intent to Transfer Assets Agreement” (IM-79) form for this declaration. If the institutionalized spouse has assets that must be transferred to the community spouse, the vendor application cannot be approved until the IM-79 is signed. Complete the IM-79 at the time of the vendor application.
Once the intent to transfer assets is declared, the institutionalized spouse has 90 days from the date initial vendor eligibility is determined to actually transfer the assets. This 90 days is called a 'protected period'.
NOTE: Exercise judgment when applying the 90-day rule. Delays for sale of property, intervention of the courts, or a pending hearing decision are some legitimate reasons for not meeting the 90-day time frame. Should these types of situations occur, clear them through normal supervisory channels.
Set priorities for 90 days from the date initial eligibility was established; however, the caseworker and claimant need to discuss the progress of the transfer of assets prior to the expiration of the 90 days.
Do not delay approving the application until after the transfer of assets is completed. If the intended transfer of assets will result in eligibility for the institutionalized spouse, approve the applica-tion after the Intent to Transfer Assets Agreement (IM-79) is signed.
When initial vendor eligibility is established, notify the institutionalized spouse of the requirement to transfer assets by sending the Notification of Requirement to Transfer Assets (IM-79A) form. The notification should identify the non-exempt assets and explain to the claimant the assets must be transferred within 90 days to continue vendor eligibility.
To transfer assets, the couple is required to set up separate bank accounts, change ownership on titles and deeds, liquidate property, and so on. It is important that after the division of assets each spouse's share is clearly designated and separately identifiable, (i.e., his assets in his name, her assets in her name). Jointly owned assets are consid-ered available to the institutionalized spouse.
Ask the couple to provide verification of the transfer. Contact the bank, insurance company, etc. if additional verification is necessary. It MUST be established that the institutionalized spouse transferred the assets according to the Required Transfer of Assets policy AND that the assets remaining in the name of the institutionalized spouse are at or below the resource maximum for a single person.
If the couple does not take action to have the assets transferred in 90 days (without good cause), consider ALL the non-exempt assets in the institutionalized spouse's name including jointly owned assets as available to the institutionalized spouse. If these assets are above the resource maximum for a single person, begin case closing procedures based on an excess of available resources. No Medicaid claim is necessary for the initial eligibility period (time from the date of application to the initial approval for vendor) and the 90-day protected period.
In cases where the couple's total non-exempt assets are less than the minimum spousal share, the institutionalized spouse receives an additional 90-day protected period to transfer assets received after approval for assistance, provided there is a new Intent to Transfer Assets Agreement signed. The additional protected period applies ONLY when the community spouse does not have non-exempt assets equaling the minimum spousal share amount. Do not consider the additional assets available to the institutionalized spouse during this 90 days. Protected periods apply until the minimum spousal share amount is reached.
EXAMPLE: Mr. Baker was admitted to a MO HealthNet certified bed on February 20. Mrs. Baker requested an assessment of assets and an MHABD vendor application on February 21. The couple's total non-exempt assets were $7,000. The spousal share was the minimum. Mr. Baker transferred the assets to Mrs. Baker within the 90-day protected period. Mr. Baker has remained in a MO HealthNet certified bed since February 20. On July 23, Mr. Baker received a $4,000 inheritance. Because the Baker's total non-exempt assets in February were only $7,000, Mr. Baker has 90 days from the date of receipt of the $4,000 to transfer it to Mrs. Baker without affecting his vendor eligibility provided he signs another Intent to Transfer Assets Agreement.
On November 4, Mr. Baker received an insurance settlement of $1,000. The total amount of non-exempt assets he has transferred to his wife are $11,000 ($7,000 in February and $4,000 in July). Therefore, Mr. Baker has 90 days to transfer the $1,000 to Mrs. Baker without affecting his vendor eligibility if he signs an Intent to Transfer Assets Agreement.
If the spousal share was equal to or greater than the minimum and the institutionalized spouse receives additional non-exempt assets, consider the additional non-exempt assets available to the institutionalized spouse immediately.
Once an institutionalized spouse is determined MO HealthNet eligible the subsequent institutionalization of the community spouse has no effect on the original institutionalized spouse's eligibility, unless the community spouse applies for MO HealthNet vendor benefits. This policy is based on a Missouri Court of Appeals decision, Maples v. Department of Social Services. When a community spouse enters a MO HealthNet certified Nursing Facility bed, do not deactivate the assessment of assets (refer to 1030.035.15.03 DISPOSTION OF ASSESSMENTS) nor count the community spouse's resources as available to the institutionalized spouse if:
If the community spouse becomes institutionalized and applies for Medicaid, spousal impoverishment rules no longer apply. Eligibility for both spouses will be determined as a regular couple case.
When approving a vendor application the spousal share may be deducted for each month in the prior quarter once the Intent to Transfer Assets Agreement (IM-79) is signed, with one exception. The spousal share cannot be deducted in any month in the prior quarter when the case was previously determined ineligible due to the refusal of the institutionalized spouse to sign an Intent to Transfer Assets Agreement.