When the LTC applicant has a Spouse

The intent of this policy is to ensure the community spouse (CS) avoids being left with nothing.

Income is determined separately for an individual and his/her spouse for ADvantage, Nursing Home Care and Home Community Base Waiver/Intellectually Disabled (HCBW/ID) services. If the CS’s monthly gross income is less than the Maximum monthly income standard as shown on Appendix C-1, Schedule XI, the institutionalized spouse (IS) may deem a portion of his/her income sufficient to raise the CS’s income to the Maximum monthly income standard. If the CS’s income exceeds the Maximum monthly income standard, none of the IS’s income will be deemed to the CS.

If the CS receives ADvantage Waiver or Home Community Based Waiver services, the deemed income amount must not cause the CS to exceed the categorically needy standard on Appendix C-1, Schedule VIII B.1.

Resources are determined by adding the total resources that are individually and jointly available to the couple as of the month of the individual’s entry into the nursing facility, regardless of the date of application for Medicaid. For ADvantage and HCBW use the date of application to determine total resources for the couple. The amount determined as the spousal share is used for all subsequent applications for SoonerCare, regardless of changes in the couple’s resources.

The CS may protect up to the Maximum resource standard as shown on Appendix C-1, Schedule XI and the IS may reserve up to the Maximum resource standard as shown on Appendix C-1, Schedule VIIID.1. The couple’s total resources are divided by two. If one-half exceeds the Maximum resource standard as shown on Schedule XI, any excess is deemed to the IS. When one-half of the total resources are less than the Minimum resource standard on Schedule XI, the IS may deem a portion of his/her resources to bring the CS’s resources up to the Minimum resources standard. When the total resources are less than the Minimum resources standard, the CS may retain the total amount. Deemed resources must be transferred to recipient within one year of the Medicaid certification.