CO Code § 25.5-6-101 (2021)
2021 Colorado Code|Title 25.5 - Health Care Policy and Financing|Article 6 - Colorado Medical Assistance Act - Long-Term Care|Part 1 - Long-Term Care Administration|§ 25.5-6-101. Spousal Protection - Protection of Income and Resources for Community Spouse - Definitions - Amounts Retained - Responsibility of State Department - Right to Appeal

  As used in this section, unless the context otherwise requires:   “Community spouse” means the spouse of a person who is in an institution or nursing facility, the spouse of a person who is enrolled in the PACE program authorized pursuant to section 25.5-5-412, or the spouse of a person who is receiving home- and community-based services pursuant to this article.    “Community spouse monthly income allowance” means the amount by which the minimum monthly maintenance needs allowance exceeds the amount of monthly income that is available to the community spouse.    “Community spouse resource allowance” means the amount of assets, excluding the value of the home and other exempt resources under federal law, that the community spouse shall be allowed to retain and that shall not be available to cover an institutionalized spouse's cost of care.      “Institutionalized spouse” means an individual who is in an institution or nursing facility who is married to a spouse who is not in an institution or nursing facility. (d) (I) “Institutionalized spouse” means an individual who is in an institution or nursing facility who is married to a spouse who is not in an institution or nursing facility.    For purposes of this section, “institutionalized spouse” includes an individual who is enrolled in the PACE program authorized pursuant to section 25.5-5-412 or is receiving home- and community-based services pursuant to this article, and who is married to a spouse who is not enrolled in the PACE program or receiving home- and community-based services.           “Minimum monthly maintenance needs allowance” means an amount which is equal to an applicable percent of the nonfarm income official poverty line (increased annually by the consumer price index for all urban consumers), as defined by the federal office of management and budget, for a family unit of two members. (e) (I) (A) “Minimum monthly maintenance needs allowance” means an amount which is equal to an applicable percent of the nonfarm income official poverty line (increased annually by the consumer price index for all urban consumers), as defined by the federal office of management and budget, for a family unit of two members.    For the purposes of sub-subparagraph (A) of this subparagraph (I), the applicable percent shall be: As of September 30, 1989, one hundred twenty-two percent; as of July 1, 1991, one hundred thirty-three percent; as of July 1, 1992, one hundred fifty percent.       Notwithstanding the provisions of subparagraph (I) of this paragraph (e), the minimum monthly maintenance needs allowance may be increased on an individual basis if:   The community spouse has shelter and utilities expenses that exceed thirty percent of the minimum monthly maintenance needs allowance; except that the total allowance shall not exceed fifteen hundred dollars (increased annually by the consumer price index for all urban consumers);    Either spouse is responsible for a dependent family member, including children, parents, or siblings who reside with the community spouse; or    The community spouse has exceptional circumstances which would result in significant financial duress.               In order to implement the medical assistance program in compliance with the federal “Medicare Catastrophic Coverage Act of 1988”, as amended, the state department shall ensure, when an institutionalized spouse is eligible for medical assistance under this article and articles 4 and 5 of this title, that the community spouse retain a community spouse monthly income allowance but only to the extent that income of the institutionalized spouse is made available to the community spouse.      The resources available to the married couple shall be calculated at the beginning of a continuous period of institutionalization of the institutionalized spouse. The community spouse shall retain the remainder of the couple's countable resources up to the federal maximum resource allowance as a community spouse resources allowance. The institutionalized spouse may keep an amount up to the amount of resources allowed under the federal medicaid program. (b) (I) The resources available to the married couple shall be calculated at the beginning of a continuous period of institutionalization of the institutionalized spouse. The community spouse shall retain the remainder of the couple's countable resources up to the federal maximum resource allowance as a community spouse resources allowance. The institutionalized spouse may keep an amount up to the amount of resources allowed under the federal medicaid program.    Notwithstanding the provisions of subparagraph (I) of this paragraph (b), if either spouse establishes that the community spouse resource allowance is inadequate to raise the community spouse's income to the minimum monthly maintenance needs allowance, an amount adequate to provide the minimum monthly maintenance needs allowance shall be substituted.          The state board shall have the authority to promulgate any rules that are necessary to implement the provisions of this section in accordance with the federal “Medicare Catastrophic Coverage Act of 1988”, as amended. The rules adopted by the state board shall include, as a minimum, provisions regarding the following matters:   The treatment of a married couple's income and resources before and after eligibility for medical assistance is established, including the basis for dividing such income and resources between the two parties;    The process for appealing any determinations regarding income and resources that are made pursuant to these rules.        History. Source: L. 2006: Entire article added with relocations, p. 1907, § 7, effective July 1.    Editor's note:   This section is similar to former § 26-4-506 as it existed prior to 2006.   Cross references:   For provisions of the federal “Medicare Catastrophic Coverage Act of 1988” referenced in this section, see section 303 of Pub.L. 100-360, codified at 42 U.S.C. sec. 1396r-5.   ANNOTATION   Subsections (1)(d)(I) and (1)(d)(II) must be read in the disjunctive. In determining whether a spouse is entitled to the community spouse resource allowance, an institutionalized spouse can be either a person described in (1)(d)(I) or in (1)(d)(II). Under federal law, the fact that the wife received home- and community-based services did not make her ineligible to receive the community spouse resource allowance based upon her husband's institutionalization. Koehler v. Colo. Dept. of Health Care Policy & Fin., 252 P.3d 1174 (Colo. App. 2010).