§ 178.124. Resource eligibility for the institutionalized spouse.
(a) Determining initial resource eligibility.
(1) The couple’s countable verified resources are totaled at the time of the MA application.
(2) If the spousal share determined under § 178.122 or § 178.123 (relating to determining the spousal share of resources if the institutionalized spouse is not applying for MA; and determining the spousal share of resources at the same time the institutionalized spouse applies for MA) is equal to, or more than, the couple’s total countable verified resources at the time of the MA application, the institutionalized spouse is resource eligible.
(3) If the spousal share determined under § 178.122 or § 178.123 is less than the couple’s total countable resources at the time of the MA application, deduct from the couple’s countable verified resources at the time of the MA application, the greater of the following amounts:
(i) The community spouse share, not to exceed the maximum community spouse resource standard in 42 U.S.C.A. § 1396r-5(f)(2)(A) subject to adjustment under 42 U.S.C.A. § 1396r-5(g) in years after 1989 effective January 1 of each year based on the same percentage as the percentage increase in the Consumer Price Index (CPI) for all urban consumers—all items, United States city average—between the period of September to September of the previous year. Revisions required by Federal law and regulations to the amount will be published as a notice in the Pennsylvania Bulletin and will be made available upon request at the CAOs.
(ii) The standard community spouse resource standard in 42 U.S.C.A. § 1396r-5(f)(2)(A)(i) subject to adjustment under 42 U.S.C.A. § 1396r-5(g) in the years after 1989 effective January 1 of each year based on the same percentage as the percentage increase in the CPI for all urban consumers—all items, United States city average—between the period of September to September of the previous year. Revisions required by Federal law and regulations to the amounts will be published as a notice in the Pennsylvania Bulletin and will be made available upon request at the CAOs.
(iii) The amount of the resources in excess of the maximum community spouse resource standard transferred by the institutionalized spouse to the community spouse under a court support order. The fair consideration requirements at 42 U.S.C.A. 1396p do not apply to amounts of resources transferred under an order of support.
(iv) The amount designated by a Departmental hearing decision.
(4) Compare the remaining resources to the one person resource limit in Appendix A for the appropriate MA program.
(5) If the remaining resources are equal to, or less than, the appropriate MA resource limit in Appendix A for the appropriate MA program, the institutionalized spouse is resource eligible.
(6) The institutionalized spouse is not ineligible for MA on the basis of excess resources if the CAO determines that the denial of MA would cause undue hardship as defined in § 178.2 (relating to definitions).
(b) Allowance revision. The community spouse resource allowance may be revised if either spouse establishes at a Departmental hearing, based on evidence acceptable to the Department, that:
(1) The spousal share determination was not correct.
(2) Income generated by the community spouse resource allowance is not sufficient to raise the community spouse’s income to the monthly standard community spouse maintenance need allowance amount described in § 181.452(c)(2)((ii) (relating to posteligibility determination of income available from an MA eligible person toward his cost of care). The Department hearing officer will establish a resource amount adequate to assure that the community spouse has income up to the community spouse maintenance need allowance amount. This applies only if the institutionalized spouse actually gives the community spouse maintenance need allowance to the community spouse.
(3) The initial spouse share determination was based on inaccurate information.
(c) Resource reapplications for the institutionalized spouse.
(1) After the initial resource eligibility for MA has been determined, resource eligibility at reapplication is based on resources owned solely by the institutionalized spouse.
(2) Resources of the community spouse are not deemed available to the institutionalized spouse beginning the month following the month of the initial eligibility determination as specified in § 178.91(c) (relating to deeming of resources).
(3) Resources owned by the institutionalized spouse are compared to the one person resource limit in Appendix A for the appropriate MA program.
Source The provisions of this § 178.124 adopted August 28, 1992, effective upon publication and apply retroactively to October 1, 1989, 22 Pa.B. 4432.
Cross References This section cited in 55 Pa. Code § 178.121 (relating to general); and 55 Pa. Code § 178.125 (relating to transfer of resources from the institutionalized spouse to the community spouse).
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