Spousal Impoverishment Prevention Cases 450-01-30-25

(Revised 1/15/2011 ML #3253)

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1. Spousal impoverishment cases often involve couples with substantial assets. The same individuals who counsel couples on how to retain the greatest amount of assets while securing Medicaid benefits for an institutionalized spouse are typically present to help resist any Medicaid claim made in the community spouse's estate. If the department lacks access to any record of the asset transfers involved in achieving eligibility, we may be unable to meet our burden of proof when the Medicaid claim is resisted.
2. In spousal impoverishment cases, the department files claims in the estates of community spouses who initially survive the institutionalized Medicaid recipient spouse. Success of these claims may depend on having accurate information on SFN 52, Spousal Assets. If the couple has made transfers in anticipation of meeting the spousal asset requirements, county agency staff must accurately identify all property (account numbers, insurance policy numbers, property descriptions) and correctly indicate in the final two columns the institutionalized spouse’s previous ownership of assets. SFN 52, Spousal Assets, must be used by the county agency in spousal impoverishment cases. This form must be sent to the state office for inclusion in estate files. If this form was not sent in to the state office when the application was approved, it should be sent in immediately upon learning of the estate proceedings.
3. When any Medicaid recipient over age fifty-five dies leaving a surviving spouse, the department cannot enforce a claim during that spouse's lifetime. The department files a claim in the decedent’s estate of the initially surviving spouse. At that time, the claim for repayment of Medicaid benefits furnished to the institutionalized spouse may only be paid out of assets in the community spouse's estate in which the institutionalized spouse once had an interest. Thus, when the department is able to make a claim, the assets must be “traced” in the community spouse's estate back to the community spouse.
4. The asset assessment will be of very limited use if county agency staff rely, without verification, on statements made by the individuals concerning the assets, incomplete descriptions of assets (such as listing bank accounts and insurance policies without identifying numbers), misidentifying ownership of assets (saying assets individually owned when they are actually jointly owned or vice versa), or that fail to identify ownership of all assets.
5. The Medicaid applications, and subsequent redeterminations, often accurately describe the asset transfers that occur in the months following an application. Applications may include accurate asset descriptions and verifications. The file may include correspondence to and from the applicant and those acting on behalf of the applicant. All of this information is extremely valuable to making an effective claim.