419.05 Procedures for Protection of Resources (MAM)

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Determine the protected resource amount and resource eligibility for medical assistance when the institutionalized individual files an application for medical assistance.

1.    Use the completed resource assessment to determine the spousal share.

2.     Determine countable resources of both spouses available at the time of application.

3.     Subtract the protected resource amount. The balance is the countable resources available to the institutionalized individual for purposes of the medical assistance eligibility determination.

4.     Consider the institutionalized individual resource-eligible, if the combined resources in the month of application are equal to or less than the total of the protected resource amount plus $2,500 (medically needy resource limit).

Example

Based on the resource assessment, there was $61,656 in combined resources on the date of institutionalization, which resulted in a spousal share of $30,828.

At the time of application, combined resources were reduced and totaled $33,328.

$33,328 combined resources at application

- $30,828 protected resource amount

$2,500 resources considered to belong to the institutionalized individual

5.     Allow the institutionalized individual to allocate a portion of their resources to the community spouse if the community spouse's own resources are less than the protected resource amount.

- Do not count this portion when determining resource eligibility for the institutionalized individual from the date of application until 1 year later (usually at the first regularly scheduled redetermination). The amount not counted the first year is referred to as the spousal allowance.

Example

At the time of application, the combined resources total $33,328. The protected resource amount is $30,828. The community spouse has a bank account with a $25,828 balance and the institutionalized spouse has a bank account with a $7,500 balance.

$30,828 protected resource amount

- $25,828 community spouse's own resources

$5,000 spousal allowance (institutionalized spouse needs to allocate)

6.    Complete DFA Form 798B, Determination of Resources Considered Available to the Institutionalized Individual at the Time of Application.