Income Allocations

An individual in LTC can choose to allocate income to:

The Community Spouse who is residing in the home.
Minor children who are residing with the Community Spouse.
Certain dependent family members who are residing in the home with the Community Spouse.

Dependent Family Members

A dependent family member is limited to minor or dependent children, parent(s) or sibling(s) of either the Institutionalized or Community Spouse, provided that the individual resides in the home with the Community Spouse. Dependency can be physical, emotional or financial.

Exception: An unborn is not eligible for a family member allocation.

Proof of Dependency

Dependency must be documented by obtaining a written statement from the LTC individual. If dependency is questionable, the EW must require:

A statement from the client’s physician which verifies the knowledge of medical or emotional support of the individual by the LTC individual, or
A sworn affidavit from the Community Spouse verifying the family member's financial dependency. (If the LTC individual is incompetent, the Community Spouse or the person completing the Statement of Facts can complete the affidavit.)

No written statement is required for:

A dependent family member that is blind or disabled; however, the EW must document this dependency in Maintain Case Comments.
A child age 18 or younger.

Maximum Allocation to Community Spouse

The maximum allocations from an ABD Institutionalized Spouse to the Community Spouse and/or to dependent family members are adjusted annually based on the Consumer Price Index. Refer to Medi-Cal Chart Book.

The Community Spouse Income Allocation (Maintenance Need) is the greater of:

The base allocation, or
The amount established by a court order, or
The amount ordered by a fair hearing decision.

Court Order

A court order must be the result of an order against the Institutionalized Spouse for the support of the Community Spouse. It must not be the result of a request by the Institutionalized Spouse for permission to give money to the Community Spouse or, an “authorization to pay.” It can be a preexisting court order.

If the applicant has requested a court order but chooses not to delay the application while waiting for the order, the share of cost must be computed allowing the base allocation amount. The higher amount ordered by the court applies from the date of the order forward.

Fair Hearing

A Fair Hearing judge will only allow additional income to be kept by the Community Spouse due to exceptional circumstances which will result in financial duress, (i.e., special health care needs, the necessity of home repairs, increased utility costs due to special medical needs or equipment, etc.)

Verification of Community Spouse Income Allocation

The Community Spouse Allowance should only be deducted from the income of the Institutionalized Spouse if it is actually made available to the Community Spouse.

Verification of the Spousal Income Allocation actually being given/transferred to the community spouse is required before the Share of Cost (SOC) is calculated at intake or for retroactive months. Verification is not necessary in the case of couples with joint bank accounts.

Verify the Community Spouse Income Allocation at intake and redetermination by a canceled check written from the Institutionalized Spouse to the Community Spouse, checking or savings account statement, etc. A written or verbal affidavit is an allowable form of verification if paper documentation is unavailable. The Institutionalized Spouse or the Community Spouse can sign the affidavit stating that the income is being transferred.

Verification of Dependent: Family Member Maximum Base Allocation

The Family Member Maximum Base Allocation (FMMBA) amount for dependent family members is updated annually in July.

The dependent family member must:

Be residing with the Community Spouse
Verify his/her income.

Note: Dependent family members are NOT required to apply for other income.

The family member allocation must be deducted from the income of the Institutionalized Spouse, regardless of whether or not it is actually transferred to the family members.

Total Allocation

The total amount allocated from the Institutionalized Spouse to the Community Spouse and to dependent family members cannot exceed the Institutionalized Spouse’s actual available income. When the maximum allocation allowance exceeds the available income of the Institutionalized Spouse, they must designate which family members will receive an income allocation, and how much will be given to each person.