A few days ago I received a call from a client whose husband has been receiving Medicaid Long Term Care benefits for many years without issue. She has completed the Medicaid annual benefit review on his behalf on her own, or with the assistance of the nursing home staff and each year the Medicaid benefits have been renewed. This year after sending in the required information she received a notice requesting updated information regarding the assets she owns individually. Since the time her husband initially applied and was approved for Long Term Care Medicaid benefits her countable assets have grown and are now greater than then Community Spouse Resource Allowance of $119,220.
Unfortunately, the ESS caseworker evaluating her husband’s eligibility, and upon review of determining her countable assets are greater than the $119,220 limit, has determined her husband no longer meets the Long Term Care Medicaid eligibility requirements and has sent a notice stating her husband’s benefits are going to terminate. The wife has asked “What can I do to get my husband’s Long Term Care Medicaid benefits approved?”
Florida Medicaid ESS Policy 1640.0314.01 Assets Available to Spouse after Approval provides the following:
“Following approval, none of the assets solely owned by the community spouse are included as available to the institutional spouse.” The amount of assets allocated to the community spouse which belong to the institutional spouse and are available to the institutional spouse must be transferred to the community spouse. The eligibility specialist must work with the individual to assure that the assets are transferred to the community spouse; however, the assets will not be counted as available to the institutional spouse until the first scheduled complete redetermination is conducted. In no instance should the failure to transfer the assets to the community spouse within the prescribed time limits result in overpayment.
The community spouse had moved all of the assets into her name at the time of the initial Long Term Care Medicaid application, leaving her husband’s countable assets below the $2,000 asset limit. She has maintained his countable assets below the $2,000 limit. Since the initial Medicaid application she has continued to work and her countable assets have increased slightly over the community resource allowance of $119,220.
The Florida Medicaid ESS Policy 1640.0314.01 continues to state the following:
Any assets received by the institutionalized spouse after approval, which cause the total assets to exceed the asset standard, will not affect the individual’s eligibility if they are transferred to an allowable person (see Section 1640.0600) within the month of receipt or if the individual receives equitable value. If the assets are still available to the institutionalized spouse the month after receipt, the value of the new assets is considered a countable asset to the institutionalized spouse the month after the assets are received. If the individual returns home and the case is closed, the couple’s assets must be reevaluated if the individual reapplies after a 30 day absence from the institutional facility. This policy does not apply if the individual returns to the institutional facility within 30 days.
The community spouse’s assets may increase and be greater than the Community Spouse Resource Allowance once the institutionalized spouse has been approved for Long Term Care Medicaid benefits. The community spouse’s assets are only reevaluated under the terms stated above.
In this instance we will review the rule with the ESS Caseworker making this determination and hopefully after speaking with them and reviewing the Policy above the ESS Caseworker will understand the Long Term Care Medicaid benefits should have not been terminated. If we are unsuccessful with the ESS Caseworker our office will need to request a Fair Hearing with the Department of Children and Families.
Unfortunately over the last two years we have had many individuals reach out to our office in a panic upon receiving notices their Long Term Care Medicaid benefits are going to be terminated. Many times we are able to determine there has been a mistake made regarding the termination and have had benefits successfully reinstated after the request to the Department of Children and Families for a Fair Hearing.