The Affordable Care Act broadened the definition of an “institutionalized spouse” to include HCBS recipients and persons who have requested HCBS and generally reside at home or in the community. DHCS ACWDL 17-25 (July 19, 2018) initially extended spousal impoverishment rules from institutionalized spouses in long term care settings to applicants and recipients of other HCBS and waiver programs. DHCS has clarified that the spousal impoverishment provisions apply to registered domestic partners.
Spousal impoverishment rules apply to the first month when a request for HCBS or IHSS has been made and the individual meets a nursing facility level care. These rules must be applied to HCBS spouses who request IHSS and provide a verification form. These provisions should be applied retroactively; DHCS provides examples of how to apply these rules.
The Letter walks through the process of applying spousal impoverishment rules to the HCBS spouse and community spouse. First, the county needs to characterize property and apply any CSRA protections. Next, the county would calculate income. An eligible individual would be placed in a budget unit separate from the community spouse once the couple’s property meets the CSRA limit plus $2000.
The HCBS spouse will remain eligible (short of change in circumstance) unless and until the county denies the HCBS request. At annual renewal, the HCBS spouse only needs to confirm continued HCBS participation. Continuous eligibility ends when the HCBS spouse or institutionalized spouse does not receive HCBS waiver services or inpatient care for a full calendar month.
If the community spouse applies for Medi-Cal, that spouse will need to spend down non-exempt countable property before the end of the month of application. A spousal income allocation is still permitted. However, if the community spouse requests HCBS, there is no longer a community spouse. The letter also goes through applying these rules retroactively, including reimbursement through the Conlan process.
DHCS ACWDL 18-19 (August 21, 2018)