2502 Deeming (ABD) | Medicaid

A legal spouse is a member of a couple who has been married by legal ceremony or common-law. Under Georgia law, two individuals are in a common-law marriage if they live together at least one night, they are holding forth to the community as husband and wife, both are free to marry each other because neither is married to another person, and the relationship was established prior to January 1, 1997. Legality matters in relationships established prior to 1/1/97 only when the A/R is in LA-D or applies under an ABD Medically Needy COA.

A legal spouse is a member of a couple who has been married by legal ceremony. This definition of a legal marriage is effective as of January 1, 1997. Common–law marriages established after this date are not considered legal. Legality matters in relationships established on or after 1/1/97 for all ABD Medicaid COAs.

Non-legal spouses are holding out as husband and wife, but they are not free to marry each other. One or both has a legal spouse. Otherwise known as a non-member.

A community spouse is a person who is not living in a setting that provides medical care/services, such as a medical institution or nursing facility, and who is married to:

The community spouse may live in his/her own home (LA-A), in a Personal Care Home/Assisted Living (not A/R in LA-D COA) or in someone else’s home (LA-B). If the A/R in LA-D can only be considered under the AMN COA due to income over the Medicaid Cap (no Qualified Income Trust), the spouse at home does not meet the definition of a Community Spouse, and therefore Spousal Impoverishment regulations do not apply.

If the community spouse is living in a personal care facility, check the bill to see if the spouse is actually living in a medical facility. If the personal care facility is billing room and board only, the spouse meets the definition of a community spouse. If the personal care facility is billing for the services of any medical professional (such as registered nurse [RN], licensed vocational nurse [LVN], doctor, etc.), the spouse does not meet the definition of a community spouse and spousal impoverishment policies does not apply.

An incarcerated spouse is NOT considered a community spouse for spousal impoverishment purposes.

A Medicaid child is a child living with his/her parent(s) who is a SSI or Medicaid eligible under any COA.

An ineligible child is a child living with his/her parent(s) who is not receiving Public Assistance payments, such as SSI, TANF or VA pension, and is not applying for or receiving Medicaid under any COA.

An ineligible parent is the natural, adoptive or stepparent of the Medicaid child or ineligible child and is not a Medicaid A/R. If the Medicaid child lives with the ineligible parent, a portion of the ineligible parent’s income and resources may be considered in determining the child’s eligibility for ABD Medicaid.

Spouse to Spouse Deeming begins the month following the month a marital relationship begins. Refer to Section 2501, Marital Relationship.

Parent to Child Deeming begins the month after a parent(s) and child begin living together in the same household (LA-A, B or C).

Spouse to Spouse Deeming ceases the month following the month a marital relationship ends. Refer to Section 2501, Marital Relationship.

Parent to Child Deeming ceases the month following the month parents and their children cease living together in the same household (LA-A, B or C).

After an A/R ceases living with the financially responsible relative, only income actually made available to the A/R is considered in determining the A/R’s financial eligibility.

When one spouse (or child) enters LA-D, deeming of income ceases for the LA-D A/R the month of admission. Spousal impoverishment resource rules apply the month of admission. If the community spouse is an A/R under a non-LA-D COA, deeming of income and resources ceases for the community spouse the month following the month of admission.

When both spouses enter LA-D, treat both A/Rs as individuals beginning the month of admission in determining income eligibility. See Section 2510-2 for exceptions.

For resource eligibility, treat both A/Rs as a couple the month of admission and as individuals the month following the month of admission.

Deemors are entitled to the same resource exclusions allowed to the A/R. Refer to Chapter 2300, Resources.

The following pension funds owned by an ineligible/community spouse or parent are not deemed to an A/R: (See Section 2332-2)

The following types of income owned by an ineligible spouse or parent are not deemed to the A/R:

Combine the resources of the Medicaid individual and his/her ineligible spouse and apply them to the appropriate couple resource limit.

If the combined resources do not exceed the couple resource limit, the A/R is eligible based on resources.

If the Medicaid individual enters LA-D, has a non-legal ineligible spouse at home, and the non-legal marital relationship was established prior to 1/1/97, combine the resources of the Medicaid individual and his/her ineligible spouse and apply them to the SSI Couple resource limit only for the month of admission to LA-D. (If the non-legal marital relationship was established on or after 1/1/97, use the individual resource limit.)

Consider only the Medicaid individual’s resources beginning the month following the month of admission to LA-D. Use the SSI Individual resource limit.

Follow the steps below to determine the resource eligibility for an A/R in LA-D who meets all the related eligibility criteria and who has a community spouse for each prior month of Medicaid requested. During the application process the A/R and spouse must have resources under the Spousal Impoverishment Limit. The LA-D spouse cannot avoid ineligibility by transferring excess resources to the community spouse.

Combine the countable resources owned by the A/R and the community spouse on the first day of the prior month and apply them to the Spousal Impoverishment resource limit.

If the combined resources are greater than the Spousal Impoverishment resource limit, the A/R is ineligible based on resources. Deny Medicaid for the prior month.

If the combined resources are less than or equal to the Spousal Impoverishment resource limit, the A/R is eligible based on resources for the prior month.

If the A/R meets the eligibility criteria for LOS and LOC, follow the steps below to determine the ongoing resource eligibility for an A/R in LA-D who has a community spouse:

If the A/R receives an additional resource between the initial determination of eligibility and the first annual redetermination, redetermine the A/R’s resource eligibility.

If the additional resource combined with other resources of the A/R does not exceed the SSI Individual resource limit, document the record that the A/R continues to be resource eligible without any further development.

If the additional resource combined with other resources of the A/R exceeds the SSI Individual resource limit, repeat Step 1 above, using the resources of the community spouse for the first day of the month of application and the current month’s first day resources for the A/R.

If the resources of the A/R are less than or equal to the SSI individual resource limit on the first day of the month of the first annual review, consider the A/R to remain eligible based on resources. Verify that the A/R transferred his/her countable assets in excess of the SSI individual resource limit to the community spouse or to a third party for the sole benefit of the community spouse.

If resources of the A/R exceed the SSI individual resource limit on the first day of the month of the review, terminate Medicaid eligibility after giving timely notice. If assets were transferred inappropriately, compute a transfer of assets penalty on the A/R. See Chart 2502.1 and Section 2342, Transfer of Assets.

Follow the steps below when a LA-D Medicaid recipient with a community spouse receives a resource after the first annual review which, combined with other resources, causes the total countable resources of the A/R to exceed the SSI individual resource limit.

Use the following chart to assess a resource transfer made by a LA-D A/R with a community spouse:

Complete Spouse to Spouse Deeming of Income on Form 172 when the A/R is a Medicaid individual living with an ineligible spouse in LA-A or B. Refer to Section 2507, Spouse to Spouse Deeming.

If only one parent is living in the household with the Medicaid child, deem the parent’s resources as follows:

If two parents are living in the household with the Medicaid child, deem the parents' resources as follows:

If the Medicaid child enters LA-D, deem the parent(s)' resources for the month of admission to LA-D. Consider only the child’s resources beginning the month following the month of admission to LA.

Complete parent to child deeming of income on Form 171 if the A/R is a Medicaid child living in the household with his/her parent(s). Refer to Section 2508, Parent to Child Deeming.