CSRA

The Continuous Period of Institutionalization determination is only used in regard to couples covered by the spousal impoverishment rules. The Continuous Period of Institutionalization determines the effective date of CSRA and the $35 LTC Maintenance Need.

Note: Once the institutionalized spouse leaves the LTC facility, the CSRA rules no longer apply and property must be re-evaluated.

A Community Spouse, for purposes of establishing the CSRA, is in his/her own MFBU at the beginning of the Continuous Period of Institutionalization.

Calculation of the CSRA

The CSRA is calculated by combining the net non-exempt separate and community property, belonging to either or both the Institutionalized and Community Spouse when:

• The Institutionalized Spouse is expected to remain in care for 30 consecutive days.
• The Institutionalized Spouse applies for MC.

Note: The CSRA can be applied to 3-month retroactive MC as long as the couple meets the definitions of Community Spouse and Institutionalized Spouse in the retroactive months and their combined net non-exempt property does not exceed the CSRA plus the property limit for one person, for at least one day in each of the retroactive months.

Maximum CSRA

The maximum CSRA is the greatest of:

• The CSRA amount established by DHCS which is adjusted annually by the Consumer Price Index, or
• An amount established by a court order, or
• An amount awarded through a fair hearing.

Court Order

The CSRA amount can be established by a court order as of the date of, or specified in the court order if the order is “against the Institutionalized Spouse” for the support of the Community Spouse or family member.

• If the Maximum CSRA is established by a court order, use the value of the property as of the date of the order. Disregard any increases in the value of such property when determining eligibility.
• Do not use the court ordered amount if the net market value of the property has since decreased and is now worth less than the other two CSRA options (Maximum CSRA or Fair Hearing amount).
• An application must remain pending if a court order for support is being sought and the couple provides verification.

Note: Federal law cites a pending court order as an exception to the 45-day processing rule for MC.

Fair Hearing

A fair hearing Administrative Law Judge (ALJ) will only increase the CSRA amount when additional property is needed to produce income up to the Minimum Monthly Maintenance Need Allowance (MMMNA). When calculating the necessary CSRA increase, the ALJ must first consider the total income available to the Community Spouse prior to determining the amount of property adequate to provide the difference between the MMMNA and all income available to the Community Spouse. Total income available includes the net non-exempt income of the Institutionalized Spouse that can be allocated to the Community Spouse and the Community Spouse’s own separate income.

ExampleExampleThe 2017CSRA amount is $120,900 and the MMMNA is $3,023. Assume the couple has $350,000 in property and filed for a State hearing to increase the CSRA amount to $350,000 in order for the Institutionalized Spouse to qualify for MC. The Institutionalized Spouse has net non-exempt income of $1400 ($35 LTC maintenance need already deducted) that can be allocated to the Community Spouse. The Community Spouse receives $1000 per month in social security income. The couple who sought to increase the CSRA to $350,000 would have to establish that investing $350,000 would generate $623 or less (since MMMNA is $3023 - 2400 [Community Spouse’s own income $1000 plus allocation from Institutionalized Spouse of $1400].) Otherwise, the couple’s request to increase the CSRA would be denied.

Total Property

In order for the Institutionalized Spouse to be eligible, the couple's net nonexempt property must not exceed the Maximum CSRA amount plus the property limit for one.

If their total property. . .	Then. . .
Is less than or equal to the Maximum CSRA,	The property total is the CSRA.
Exceeds the Maximum CSRA	The Community Spouse receives the Maximum CSRA, the excess is included in the property reserve of the Institutionalized Spouse, and the Institutionalized Spouse is not eligible until his/her property is less than or equal to the property reserve for one.

A CSRA Approval or Denial NOA must be issued explaining what property was counted, how the CSRA was determined, and must define the transfer period.

Transfer of the CSRA to the Community Spouse

The Institutionalized Spouse must transfer into the Community Spouse’s name, all or any portion of the CSRA which:

• Is not already the separate property of the Community Spouse, or
• is not already held solely in the name of the Community Spouse.

Transfer Period

The transfer period begins on the date of the initial determination of eligibility and continues through whichever comes first:

• The end of the month in which the transfer(s) occur, OR
• The end of the month in which the 90 days ends, OR
• The end of the month in which a court enters an order which is necessary to accomplish the transfer. (A probate court order may be needed to accomplish the transfer.)

The property which is included in the CSRA is not considered available to the Institutionalized Spouse during the transfer period. At the end of the transfer period, all of the net non-exempt property still remaining in the name of the Institutionalized Spouse or property which is still community property, must be considered available to the Institutionalized Spouse and be included in the property reserve.

Note: Discontinue the Institutionalized Spouse with a proper 10-day NOA if there is excess property, unless there is undue hardship.

Adding to the CSRA

Once the separate CSRA has been established at application, the Community Spouse can continue to add to the CSRA with no impact to the Institutionalized Spouse. New non-exempt property acquired by the Community Spouse and held in his/her name only is not considered available to the Institutionalized Spouse.

Exception: If there is a break in aid and the Institutionalized Spouse reapplies for MC, then a new CSRA determination would include all of the couple’s property (including the new non-exempt property acquired by the Community Spouse) as of the date of the re-application month.

Undue Hardship for Establishing CSRA

If property is considered to be legally unavailable without the signature of the Community Spouse, then undue hardship exists.

Important: Evidence of undue hardship is required. (i.e., statement from financial institution). Completion of a CSF 2 alone is not sufficient.

Undue hardship exists when:

• The Institutionalized Spouse is otherwise eligible except for the excess property, AND
• He/she is unable to obtain medical care without MC, AND
• The whereabouts of the Community Spouse is unknown or there has been a break in marital ties and the community spouse/same-sex spouse/RDP refuses to cooperate. There must be some evidence of refusal to cooperate (i.e., copies of letters written to or from the Community Spouse).

Married vs. Separated for Purposes of Applying CSRA

For purposes of applying the CSRA and Community Spouse income only, a couple is considered to be married until the marriage is dissolved or annulled. A legal separation still entitles to the individuals to the CSRA plus the property limit for one. In addition, the Institutionalized Spouse may still provide the income allocation to the Community Spouse, however, the EW must use the criteria listed above to document when “undue hardship” exists.

EW Actions in Determining CSRA

The following steps must be taken when determining the CSRA:

1. Verify the Continuous Period of Institutionalization
2. Verify the property and calculate the CSRA.
3. Set a Follow up Task in CalSAWS and document in the Journal page indicating the 90th day for follow-up.
4. Send a specific CSRA Property NOA whenever MC is:
   1. Approved,
   2. Denied due to net non-exempt property in excess of the CSRA plus the property limit for one,
   3. Discontinued because the transfer has not occurred by the end of the transfer period and the client has not submitted evidence of undue hardship.

CSRA Examples

CSRA Includes Separate Property of Community Spouse

ExampleExample

Court Order

ExampleExample

Undue Hardship Exists

ExampleExample

Related Topics

Long Term Care (LTC)

Continuous Period of Institutionalization