DHS 103.075(2) (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.

DHS 103.075(3) (3) Definitions. In this section:

DHS 103.075(3)(a) (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.

DHS 103.075(3)(b) (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.

DHS 103.075(3)(c) (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.

DHS 103.075(3)(d) (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.

DHS 103.075(3)(e) (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 1396n (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 1396n (c) or (d).

DHS 103.075(3)(f) (f) “Medical institution” means a facility that:

DHS 103.075(3)(f)1. 1. Is organized to provide medical care, including nursing and convalescent care;

DHS 103.075(3)(f)2. 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;

DHS 103.075(3)(f)3. 3. Is authorized under state law to provide medical care; and

DHS 103.075(3)(f)4. 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.

DHS 103.075(3)(g) (g) “Resources” does not include items excluded under 42 USC 1382b (a) or (d) or items that would be excluded under 42 USC 1382b (a) (2) (A) but for the limitation on total value established under that provision.

DHS 103.075(4) (4) Assessment.

DHS 103.075(4)(a) (a) An institutionalized spouse or the community spouse, or a representative acting on the behalf of either spouse, may request that an agency complete an assessment of the couple’s assets for purposes of determining total countable assets of the couple and the community spouse resource allowance. If the request is not part of an application for medical assistance, the agency may charge a fee not exceeding the reasonable expenses of providing and documenting the assessment.

DHS 103.075(4)(b) (b) Both the institutionalized spouse and the community spouse shall verify the assets that they own, jointly or individually, and the value of those assets at the beginning of the most recent continuous period of institutionalization.

DHS 103.075(4)(c) (c) The agency shall:

DHS 103.075(4)(c)1. 1. Complete the assessment within 30 days after the date of the request for an assessment;

DHS 103.075(4)(c)2. 2. Determine and verify the total countable assets of the couple using the procedures under sub. (5) (b) 2.;

DHS 103.075(4)(c)3. 3. Determine the community spouse resource allowance pursuant to s. 49.455 (6) (b), Stats.; and

DHS 103.075(4)(c)4. 4. Notify in writing the institutionalized spouse and the community spouse, or a representative acting on the behalf of either spouse, of the couple’s total countable assets, the community spouse resource allowance and the amount of assets that the couple may retain so that the institutionalized spouse may be asset-eligible for MA and of the right of either spouse to a fair hearing under sub. (8) after an application for medical assistance is filed.

DHS 103.075(5) (5) Assets.

DHS 103.075(5)(a) (a) Applicability. This subsection applies only to individuals who began their most recent continuous period of institutionalization after September 29, 1989. Those individuals who began their most recent continuous period of institutionalization before September 30, 1989, shall have their eligibility determined using asset eligibility criteria under s. DHS 103.06 (1) unless the individual left the institution or lost eligibility for a community-based services waiver program under 42 USC 1396n (c) or (d) for a period of at least 30 days and subsequently began a new continuous period of institutionalization after September 29, 1989.

DHS 103.075(5)(b) (b) Eligibility determination.

DHS 103.075(5)(b)1. 1. Initial determination. The agency shall consider the total countable assets of the institutionalized spouse and his or her community spouse in determining initial MA eligibility for the institutionalized spouse.

DHS 103.075(5)(b)2. 2. Total countable assets. The agency shall count all available assets belonging to either spouse in the month for which eligibility is being determined except for the following:

DHS 103.075(5)(b)2.a. a. Homestead property;

DHS 103.075(5)(b)2.b. b. One vehicle, regardless of value;

DHS 103.075(5)(b)2.c. c. Household and personal effects, regardless of value;