419.03 Determining the Protected Resource Amount SR 19-01, 01/19 (AAM-A)

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Determine the protected resource amount for the community spouse when the institutionalized individual files an application for medical assistance. The protected resource amount is the highest of the following figures:

• the spousal share, up to a maximum of $126,420; or

• the minimum spousal resource standard of $25,284; or

• an amount transferred to community spouse by a court support order; or

• an amount determined by the Administrative Appeals Unit.

Set the protected amount to the spousal share if it is between the minimum spousal resource standard and the spousal share maximum, or set it equal to the minimum or maximum limit as appropriate, regardless of the client’s or community spouse’s claim that the protected amount set creates a hardship for the community spouse.

If either member of the couple is dissatisfied with the amount set by the Division, either may appeal the protected amount through the administrative appeals process or court system.

The Appeals Officer may also increase the community spouse resource allowance by an amount sufficient to generate additional income to the community spouse, if both of the following conditions are met:

• the institutionalized spouse has allocated the maximum amount of income available for allocation; and

• the Appeals Officer has determined that the community spouse resource allowance, in relation to the amount of income it generates, is inadequate to raise the community spouse’s income to the level of the maximum maintenance allowance (see Section 627.03, Allocation to a Community Spouse).

References: He-W 856.01(b) and (c), 42 USC 1396r-5(f) and (g)