Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.075 - Prevention of spousal impoverishment

Current through June 24, 2024
(1) APPLICABILITY.
				For resource eligibility, this section applies to all institutionalized
				applicants for and recipients of MA who began a continuous period of
				institutionalization on or after September 30, 1989, and to their spouses. For
				purposes of computing income available towards the cost of an institutionalized
				individual's care, this section applies to all institutionalized applicants for
				and recipients of MA who were residing in an institution on October 1, 1989, or
				who entered an institution subsequent to that date, and to their
				spouses.
(2) PURPOSE. This section
				implements s.
				49.455,
				Stats., which provides for protection of a couple's income and resources when
				one spouse is institutionalized and the other spouse lives in the
				community.
(3) DEFINITIONS. In this
				section:
(a) "Community spouse" means an
				individual who is legally married as recognized under state law to an
				institutionalized spouse but is not himself or herself an institutionalized
				individual.
(b) "Consumer price
				index" means the consumer price index for all urban consumers, U.S. city
				average, as determined by the U.S. department of labor.
(c) "Continuous period of
				institutionalization" means an individual has resided in or is likely to remain
				in an institution for at least 30 consecutive days.
(d) "Family member" means a minor or
				dependent child, dependent parent or dependent sibling of an institutionalized
				or community spouse who resides with the community spouse.
(e) "Institutionalized spouse" means either
				an individual who is in a medical institution or nursing facility and is
				legally married to an individual who is not in a medical institution or nursing
				facility or an individual who receives services under a waiver under
				42 USC
				1396 n(c) or (d) and is legally married to an
				individual who is not in a medical institution or nursing facility and does not
				receive services under a waiver under
				42 USC
				1396 n(c) or (d).
(f) "Medical institution" means a facility
				that:
1. Is organized to provide medical care,
				including nursing and convalescent care;
2. Has the necessary professional personnel,
				equipment and facilities to manage the medical, nursing and other health care
				needs of patients on a continuing basis in accordance with accepted
				professional standards;
3. Is
				authorized under state law to provide medical care; and
4. Is staffed by professional personnel who
				are responsible for professional medical and nursing services. The professional
				medical and nursing services shall include adequate and continual medical care
				and supervision by a physician, registered nurse or licensed practical nurse
				supervision and services and nurses' aide services sufficient to meet nursing
				care needs and a physician's guidance on the professional aspects of operating
				the institution.
(g)
				"Resources" does not include items excluded under
				42 USC
				1382 b(a) or (d) or items that would be
				excluded under
				42 USC
				1382 b(a) (2) (A) but for the limitation on
				total value established under that provision.