(Revised 8/1/17 ML #3515)
View Archives
Spousal Impoverishment applies to the Medicaid Waiver programs only. The applicant/recipient must be authorized and receiving a Waiver service on a monthly basis.
Institutional Spouse and Community Spouse (both eligible for Medicaid Waiver Services
If both of the spouses are residing in the home and are screened at nursing facility level of care then spousal impoverishment cannot apply.
If institutional spouse resides in a nursing home and the community spouse is in need of services:
If institutional spouse resides in the personal home and the applicant client will receive SPED services:
When determining spousal impoverishment asset and income limits, see Medicaid Program Service Chapter 510-05. (The amounts change annually.)
If a client has a recipient liability or SPED service fee, it is the responsibility of the provider to collect the client's share of the cost directly from the client or their identified legal payee.
County social service boards shall follow the established policies and procedures for the handling of collections in keeping with the acceptable financial management practices and policies of the Department. (See Accounts Receivable Manual, Service Chapter 115-40)
All fees collected by county social service boards shall be reported on Form 119 according to the instructions for completing the form.
Financial information regarding a client shall remain confidential except where otherwise provided by law or departmental policy. (See Accounts Receivable Manual, Service Chapter 115-40)
If a SPED applicant or recipient is eligible for and/or receiving Medicaid Expansion (Sanford plan) and is requesting personal care services the individual must be asked to complete an SFN 1598 Medically Frail Questionnaire to determine if they may be eligible to receive their personal care under traditional Medicaid. The applicant/client is NOT eligible for the SPED program as a result of refusal to complete this process. If it is determined that the individual is considered to be medically frail and they want to receive personal care services they must choose traditional Medicaid so they can access Medicaid State Plan personal care.
If the applicant client was or would be closed due to not meeting recipient liability (after adding the medical expenses, plus the case management fee, plus the cost of their Medicaid State Plan Personal care) then the individual may receive SPED personal care services if they are otherwise eligible.
If there are credible allegations that an individual or their legal representative concealed or misrepresented financial or functional information with the purpose of obtaining eligibility for HCBS, the Department may recoup the overpayment.