Definitions for Spousal Impoverishment 510-05-65-10

(Revised 4/1/11 ML #3263)

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(N.D.A.C. Section 75-02-02.1-24(1))

 

For purposes of the spousal impoverishment sections:

 

1. "Community spouse," means the spouse of an institutionalized spouse or the spouse of a Home and Community Based Services (HCBS) spouse who is:

• Not financially responsible for a child who is in receipt of Medicaid;
• Not in receipt of Medicaid other than coverage under the Medicare Savings Programs; and
• Not requiring care in a medical institution, a nursing facility, a swing bed, or in the state hospital, unless the total length of the stay is anticipated to be less than a full calendar month.

2. "Family member" means only minor or dependent children, dependent parents, or dependent siblings of the institutionalized or HCBS or community spouse who are residing with the community spouse.  For purposes of applying this definition, a family member is dependent only if that family member is, and may properly be, claimed as a dependent on the federal income tax return filed by the institutionalized, HCBS, or community spouse.  
3. "Institutionalized spouse" means an individual who:

• Requires care in a medical institution, a nursing facility, a swing bed, or the state hospital and, at the beginning of his or her institutionalization, was likely to be in the facility for at least thirty consecutive days even if the individual does not actually remain in the facility for thirty consecutive days; and
• Is married to a spouse who resides in the community at least one day of the month.

4. "Home and Community Based Services (HCBS) Spouse" means an individual who:

• Requires care of the type provided in a nursing facility, but chooses to receive HCBS in the community; and
• Is married to a spouse who resides in the community at least one day of the month.

5. "First continuous period" means the first period in which:

• An institutionalized spouse requires care in, and enters a medical institution, a nursing facility, or a swing bed, or when a HCBS spouse begins receiving HCBS, and the institutionalized or HCBS spouse is expected to continue to receive that level of care for at least 30 consecutive days; or
• The date on which a medical doctor, a physician's assistant, a nurse practitioner, or Dual Diagnosis Management has determined that a spouse requires nursing care services for at least 30 consecutive days and the community spouse or a private HCBS agency provides those services.