No. 26965 (Amendment): R414-305-3. Spousal Impoverishment Resource Rules for Married Institutionalized Individuals

DAR File No.: 26965
Filed: 02/27/2004, 11:18
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary to extend the time period for transferring assets from the institutionalized client to the community spouse.

 

Summary of the rule or change:

The language in this rulemaking changes the protected period of 90 days after eligibility is established to the next regularly scheduled redetermination for the Medicaid client. This change benefits Medicaid clients because the interim for regularly scheduled redeterminations is substantially longer than 90 days.

 

State statutory or constitutional authorization for this rule:

Section 26-18-3

 

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget as a result of this rulemaking because once eligibility is established, the client is merely allowed more time to transfer assets to the community spouse.

 

local governments:

There is no budget impact to local governments as a result of this rulemaking because once eligibility is established, the client is merely allowed more time to transfer assets to the community spouse.

 

other persons:

There is no budget impact to other persons as a result of this rulemaking because once eligibility is established, the client is merely allowed more time to transfer assets to the community spouse.

 

Compliance costs for affected persons:

There are no compliance costs as a result of this rulemaking because once eligibility is established, the client is merely allowed more time to transfer assets to the community spouse.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule affords Medicaid eligible institutionalized spouses additional time to transfer assets to a spouse still residing in the community. The assets that can lawfully be transferred is not changed. No fiscal impact on business. Scott D. Williams, MD

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

 

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/14/2004

 

This rule may become effective on:

04/15/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-305. Resources.

R414-305-3. Spousal Impoverishment Resource Rules for Married Institutionalized Individuals.

(1) The Department adopts Section 1924 of the Compilation of the Social Security Laws, in effect January 1, 1999, which is incorporated by reference.

(2) The resource limit is $2,000.

(3) The Department shall determine the joint owned resources of married couples as available to each other. One half of the joint owned resources shall count towards the institutional client's resource eligibility determination.

(4) When a client is unable to comply with spousal impoverishment rules and claims undue hardship because of an uncooperative spouse or because the spouse cannot be located, assignment of support rights shall be done by signing the Form 048.

(5) "Undue hardship" in regard to counting a spouse's resources as available to the institutionalized client means:

(a) The client completes the Form 048.

(b) The client will not be able to get the medical care needed without Medicaid.

(c) The client is at risk of death or permanent disability without institutional care.

(6) The client may be eligible for Medicaid without regard to the spouse's resources if both of the following conditions are met:

(a) The spouse cannot be located or will not provide information needed to determine eligibility.

(b) The client signs the Form 048.

(7) The assessed spousal share of resources shall not be less than the minimum amount nor more than the maximum amount mandated by section 1924(f) of the Compilation of the Social Security Laws in effect January 1, 1999.

(8) Any resource owned by the community spouse in excess of the assessed spousal share is counted to determine the institutionalized client's initial Medicaid eligibility.

(9) A protected period, after eligibility is established, [of up to 90 days]lasting until the time of the next regularly scheduled eligibility redetermination is allowed for an institutionalized client to transfer resources to the community spouse.

(10) After eligibility is established for the institutionalized client, those resources held in the name of the community spouse will not be considered available to the institutionalized client.

 

KEY: Medicaid

[July 2, 2003]2004

Notice of Continuation January 31, 2003

26-18