Long Term Care (LTC)

This chapter contains applicable Medi-Cal (MC) policies, regulations, processes and procedures specifically applicable to individuals who are in LTC. Other rules and regulations not specific to LTC remain in their respective chapter, although they may also be applicable to LTC individuals. All LTC individuals should be evaluated for MAGI eligibility first. If they are ineligible for MAGI, the rules in this chapter apply.

Definitions

Community Spouse Update #18-40

A Community Spouse is an individual who is not an inpatient in a medical or nursing facility and who is married to an institutionalized individual. Registered Domestic Partners (RDP) and same-sex spouses meet the definition of Community Spouse. Throughout this chapter, the term Community Spouse will refer to the spouse/same-sex spouse/RDP who is not institutionalized.

Note: A Community Spouse may be a resident in a board and care facility, assisted living facility or other non-medical living arrangement.

Institutionalized Spouse

Beginning with the date of admission into the nursing facility or medical institution, an Institutionalized Spouse is one who meets all of the following criteria:

Has applied for MC on or after 1/1/1990.
Has begun a Continuous Period of Institutionalization on or after 9/30/1989.
Has a Community Spouse.
Is not eligible to AFDC-MN.

Note: Couples with cash-linked MC are eligible for the AFDC-MN MC Program. Spousal allocation and CSRA are not applicable. They are in the same MFBU.

If Medically Indigent (MI) couples meet the definition of Institutionalized Spouse above, Spousal Allocation and CSRA rules apply. They are separate MFBUs beginning in the month of institutionalization.

Community Spouse Income Allowance (CSIA)

The CSMIA is the amount of income the Community Spouse can have that will not be required to be paid toward the cost of care for the LTC individual.This is also referred to as Minimum Monthly Maintenance Needs Allowance in court orders.

Community Spouse Resource Allowance (CSRA)

The CSRA is the amount of combined non-exempt community and separate property belonging to either of the Institutionalized and/or Community Spouse which the Community Spouse is allowed to retain when the Institutionalized Spouse applies for MC.

Registered Domestic Partners/ Same-Sex Spouse

Federal law does not recognize RDP or same-sex relationships. However, individuals in LTC with a same-sex spouses/RDP may be eligible for certain state-funded MC programs because they are treated as a Community Spouse under state law.

If one same-sex spouse/RDP is not federally eligible (ABD) then he/she must be placed in State-funded LTC for Medically Indigent Adults (MIA, aid code 53) if otherwise eligible, until they turn 65 or become disabled.

Individuals in LTC with a same-sex spouse/RDP who are aged, blind, or disabled are eligible for federal MC benefits (i.e., aid code 13, 23, or 63) and may have CSRA property rules and spousal income allocation applied to them as long as their spouse/RDP is not an inpatient in a medical institution or nursing facility.

Verification

Same-sex spouses/RDPs are not required to provide a copy of the marriage license or registered domestic partner certificate; Sworn statement is sufficient.