Section 29-966. SPECIAL INCOME AND RESOURCE ALLOWANCES FOR COMMUNITY SPOUSES OF CERTAIN INSTITUTIONALIZED PERSONS

 

966.1If an institutionalized person is determined eligible for medical assistance, and has a spouse living in the community, and income of the institutionalized spouse is made available to (or for the benefit of) the community spouse, the amount of the institutionalized spouse’s monthly income that must be paid toward his or her cost of care shall be calculated in accordance with this section.

 

966.2To determine the amount to be contributed toward the cost of care, there shall be deducted from the institutionalized spouse’s monthly income the following amounts in the following order:

 

(a)A personal needs allowance of sixty dollars ($60) per month;

 

(b)The monthly income allowance for the community spouse, as determined under § 966.3;

 

(c)A family allowance, for each family member, equal to one-third (1/3) of the amount by which the minimum monthly maintenance needs allowance for a community spouse exceeds the amount of the monthly income of that family member;

 

(d)Amounts for incurred expenses for medical or remedial care for the institutionalized spouse (as provided under § 1902(r) of the Social Security Act) (42 U.S.C. § 1396(a));

 

(e)Amounts, if applicable, for guardianship or conservatorship fees authorized by court order; and

 

(f)Fees for representative payees as allowed under § 5105 of the Omnibus Budget Reconciliation Act of 1990.

 

966.3The community spouse monthly income allowance shall be the sum of the following:

 

(a)The minimum monthly maintenance needs allowance; plus

 

(b)Any excess shelter allowance if applicable; and minus

 

(c)The monthly income of the community spouse.

 

966.4If the sum of paragraphs (a), (b), and (c) in §966.3 exceeds one thousand five hundred and sixty-five dollars ($1,565) per month, the allowable sum shall be reduced to one-thousand five hundred and sixty-five dollars ($1,565), unless an additional amount is added as a result of a fair hearing decision or court order.

 

966.5The one thousand five hundred and sixty-five dollars ($1,565) figure in §966.4 shall be indexed for inflation.

 

966.6In calculating the excess shelter allowance, the utility allowance shall be calculated by the utilization of one of the following:

 

(a)The Standard Utility Allowance, which includes twenty-one dollars ($21) telephone allowance, under the Food Stamp program; or

 

(b)The actual utility expense for each utility.

 

966.7If the community spouse elects to use actual utility expenses, the community spouse shall submit three (3) months of actual utility cost for each utility including one (1) water bill.

 

966.8For purposes of the requirements of § 966.7, the phrase “for each utility” shall mean electric, gas, heating oil and water.

 

966.9Utility expenses for a six (6) month period shall be determined by averaging three (3) months of actual cost for each utility.

 

966.10If the community spouse elects to use the actual utility expense allowance, the community spouse shall be eligible for a “telephone only” allowance of twenty-one dollars ($21).

 

966.11At the time of recertification, the community spouse shall have an opportunity to change the method used in calculating the utility expense allowance.

 

966.12For purposes of the requirements of § 966.11, the phrase “change the method used” shall mean the community spouse shall be allowed to switch from the Standard Utility Allowance under the Food Stamp program to the actual utility expense or switch from the actual utility expense to the Standard Utility Allowance.

 

966.13The total value of the countable resources of an institutionalized spouse and community spouse shall be computed as of the date of the beginning of the institutionalized spouse’s first continuous period of institutionalization, and each spouse shall be deemed to have a spousal share equal to one-half (1/2) of the total value.

 

966.14In determining the resources of an institutionalized spouse at the time of application for medical assistance, the resources deemed to be available to the institutionalized spouse shall be the couple’s total resources minus the community spouse resource allowance computed in accordance with this section.

 

966.15The community spouse resource allowance shall be the amount (if any) by which the greatest of one (1) of the following exceeds the amount of the resources otherwise available to the community spouse (determined without regard to such an allowance):

 

(a)Twelve thousand five hundred and sixteen dollars ($12,516) indexed for inflation annually;

 

(b)The spousal share computed under § 966.13, up to a ceiling of sixty-two thousand five hundred and eighty dollars ($62,580) indexed annually for inflation;

 

(c)The amount transferred under a court support order; or

 

(d)The amount designated by a fair hearing officer pursuant to § 1924(e) of the Social Security Act (42 U.S.C. §1396r-5).

 

966.16In accordance with Departmental procedures for a fair hearing, the community spouse or the institutional spouse shall be entitled to a fair hearing with respect to eligibility determination if an application for benefits under Medicaid has been made on behalf of the institutionalized spouse.

 

966.17All hearings and appeals shall be in accordance with D.C. Official Code, 2001 Ed. §§ 4-210.1 to 4-210.18.

 

966.18Any fair hearing on the determination of the community spouse resource allowance shall be held within thirty (30) days of the date of the request for a hearing.

 

966.19The institutionalized spouse or the community spouse shall be entitled to a fair hearing if they are dissatisfied with a determination of one of the following:

 

(a)The community spouse monthly income allowance;

 

(b)The amount of monthly income otherwise available to the community spouse (as described in § 966.2 of these rules);

 

(c)The computation of the spousal share of resources;

 

(d)The attribution of resources; or

 

(e)The determination of the community spouse resource allowance (as described in § 966.15).

 

966.20If either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance, due to exceptional circumstances resulting in significant financial duress, there shall be substituted for the minimum monthly maintenance needs allowance an amount adequate to provide the additional income that is necessary.

 

966.21If either spouse establishes that the community spouse resource allowance (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse’s monthly income to the minimum monthly maintenance needs allowance, there shall be substituted for the community spouse resource allowance described in § 966.15 an amount adequate to provide a minimum monthly maintenance needs allowance.

 

authority

An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-359)); Commissioner’s Order 70-83 (March 6, 1970), as amended by Mayor’s Order 79-144 (July 11, 1979); and Section 1924 of the Social Security Act (42 U.S.C. 1396r-5).

source

inal Rulemaking published at 38 DCR 3634 (June 7, 1991).