Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 26 - SPOUSAL IMPOVERISHMENT MEDICAID PROGRAM (SIMP) › Section 477-26-003 - RESOURCES

Current through June 17, 2024
The following provisions apply to resource determinations made for the
	 spousal impoverishment Medicaid program. Unless otherwise stated, these
	 provisions do not alter the methodology for determining and evaluating
	 resources as found elsewhere in this title.
003.01
ASSESSMENT OF
  RESOURCES.
An assessment of resources for the couple is completed
  in accordance with the regulations below.
003.01(A)
FORM USED.
The IM-73 form is used to catalog all resources owned and available to the
  couple for the spousal impoverishment Medicaid program.
003.01(B)
TIMELINE FOR
  COMPLETION.
A married couple is allowed one assessment. Either
  spouse may request the assessment of resources when one spouse has already
  received institutional level of care for at least 30 days, is likely to need an
  institutional level of care for more than 30 continuous days, or would have
  received such care except for death. The month that the institutional spouse
  was first able to request an assessment is the month used to complete the
  IM-73, regardless of when the form is completed. The couple does not need to
  apply for Medicaid in order to complete an assessment of resources.
003.01(C)
RESOURCES INCLUDED ON
  THE ASSESSMENT.
All countable resources owned or available to the
  couple must be verified and accounted for on the assessment of resources. This
  includes any resource owned individually, jointly, or owned with other parties.
  For the purposes of the spousal impoverishment Medicaid program (SIMP),
  prenuptial agreements or laws or principles of marital property do not
  apply.
003.01(D)
RESOURCES NOT INCLUDED ON THE ASSESSMENT.
Resources
  which are excluded in determining Medicaid eligibility are also excluded for
  the assessment of resources. An excluded resource owned by the couple at the
  time of the assessment which later loses its exclusion cannot be added to the
  assessment of resources when the exclusion is lost. Resources acquired after
  the assessment is completed, resources which were not disclosed, and resources
  which were discovered after completion of the IM-73 cannot be later added in
  order to increase the amount reserved for the community spouse.
003.01(E)
RESOURCES RESERVED FOR
  THE COMMUNITY SPOUSE.
After all resources have been accounted for
  on the assessment of resources form, the amount of resources to be reserved for
  the community spouse is calculated. The community spouse may reserve up to half
  of the couple's combined resources, subject to a minimum and maximum reserved
  amount. The minimum and maximum amounts used on an assessment of resources are
  the minimum and maximum amounts in effect for the date used to assess the
  resources. The minimum amount may always be reserved, even if the combined
  resources are below the minimum. A community spouse may not reserve more than
  the maximum amount. The minimum and maximum amounts are adjusted annually
  according to the consumer price index. See 477-000-029.
003.01(F)
APPLICABILITY OF THE
  ASSESSMENT.
The amount of resources reserved for the community
  spouse that is calculated on the assessment of resources is used when Medicaid
  eligibility is determined for the institutionalized spouse. If the
  institutionalized spouse stops receiving services which require an
  institutional level of care, then eligibility for the spousal impoverishment
  program (SIMP) ends. If one spouse later needs an institutional level of care,
  then the original assessment of resources and reserved amount is used in
  determining Medicaid eligibility.
003.01(G)
APPEAL OF THE
  ASSESSMENT.
The assessment of resources notifies the couple that
  they may appeal the assessment. The couple may appeal the value assigned to the
  resources, the amount reserved for the community spouse, or both. In order to
  appeal, the institutionalized spouse must apply for Medicaid. If the community
  spouse alleges that it is necessary to reserve additional resources, the
  community spouse must first show that the need cannot be met by allocating
  additional income from the institutionalized spouse. If the community spouse
  prevails on appeal, then additional resources may be reserved.