THIS ARTICLE IS INTENDED TO SUPPORT THE READER’S AWARENESS AND UNDERSTANDING. IT IS NOT LEGAL ADVICE. IF THE READER SEEKS LEGAL ADVICE CONCERNING HIS OR HER PARTICULAR SITUATION, HE OR SHE SHOULD SEEK OUT AN ATTORNEY IN A LAWYER CLIENT RELATIONSHIP.
The MA-LTC “resource assessment” determines the amount of countable resources the non-institutionalized community spouse (CS) can protect and should be completed when a married person is admitted to an LTC facility regardless of whether he is applying for MA LTC.
The Community Spouse Resource Allowance ( i.e. Spousal Share) and Community Spouse Monthly Maintenance Needs Allowance Are Protected Amounts of Combined Total Countable Income and Resources Concerning MA-LTC . The CS is entitled to protect at a minimum one-half of the combined countable resources (i.e. assets) , subject to a minimum and maximum amount as mandated by the federal government. The CS Maximum Monthly Needs Allowance ( i.e. income ) in 2025 is $ 3948.50. The CS Maximum Protected Share Of Countable Resources (i.e. assets) in 2025 157,920.00 . The Income Limit Of Institutionalized Spouse in 2025 is $ 2901.00. The Institutionalized Spouse Asset ( Resource Limit ) is $ 2000.00 Plus a $ 6000 Disregard.
A resource assessment should be completed when a married person is admitted to an LTC facility regardless of whether he is applying for MA LTC. Either spouse, or a person acting on behalf of either spouse, may request the assessment. If no assessment has been completed and the person is applying for MA LTC at the time of admission or later, the CAO will complete the assessment as part of the application process. See 55 Pa. Code § 178.122 (b) ; 42 USCA § 1396r-5(c ) (2) . PA Long Term Care Handbook 440.91 Resource Assessment
A resource assessment must be completed when a married individual is assessed functionally eligible for HCBS. Regardless of when the assessment is completed, it is based on the resources owned on the date of admission to the LTC facility or the date the spouse is assessed functionally eligible for HCBS. See PA Long Term Care Handbook 440.91 Resource Assessment
The resource assessment determines the amount of countable resources the community spouse (CS) can protect. The couple must provide enough information to establish and verify the value of resources. The resource assessment is based on all resources owned by both spouses on: The date one spouse is admitted to an LTC facility and is applying for MA LTC; the date one spouse is admitted to an LTC facility for a continuous period of at least 30 days; the date the spouse is assessed functionally eligible for HCBS ( i.e. Home and Community Based Services) . See 55 Pa. Code 178.121(g) ; 42 U.S.C.A 1396r-59 (c ) ( 2 ) .
Because resources are combined, it is not necessary to determine the legal share of resources owned by the spouses. See 55 Pa Code § 178. 122( e)
An applicant/recipient is ineligible for MA on the date that his resources exceed the MA resource limit in Appendix A for the appropriate MA Program and he remains resource ineligible until his resources are equal to, or less than, the resource limit. The disposition of excess resources shall meet the fair consideration provisions for the appropriate program. See 55 PA. Code 178.1 (c )
The spousal share is based solely on the total countable verified resources owned by the couple on: the date the spouse is admitted to an LTC facility and is applying for MA LTC; or the date the spouse is admitted to an LTC facility for a continuous period of at least 30 days, or the date the spouse is assessed functionally eligible for HCBS. See 55 Pa. Code 178.123 (b)
The purpose of the Spousal Impoverishment rules is to allow a person applying for or receiving LTC services to protect a minimum level of income and resources for the spouse not in need of LTC services. These rules apply to an institutionalized spouse (IS), who is applying for or receiving payment of services in an LTC facility or in a Home and Community-Based setting. A community spouse (CS) is a person who is married to the IS and lives in the community. Spousal Impoverishment provisions apply to married persons (regardless of a prenuptial or other legal agreement), when one spouse is admitted to an LTC facility and applies for MA LTC, one spouse is admitted to an LTC facility for a continuous period of at least 30 days or is assessed functionally eligible for Home and Community–Based Services (HCBS). Continuous means uninterrupted and expected to last at least 30 days. Resources above the current resource limit must be reduced to the appropriate resource limit for the individual applying for or receiving payment of LTC services. See PA Long Term Care Handbook Chapter 440.9 Spousal Impoverishment
The amount that can be protected is called the Community Spouse Resource Allowance (CSRA). The CS is entitled to protect at a minimum one-half of the combined countable resources, subject to a minimum and maximum amount as mandated by the federal government. The maximum and minimum CSRA is subject to change effective January 1st of each year.. Resources are assessed as of: the day of admission to an LTC facility and the institutionalized spouse is applying for MA LTC ; the day of admission to an LTC facility for a continuous period of at least 30 days.; the date the person is assessed functionally eligible for HCBS. The CAO will count resources owned by both the IS and CS. The amount of resources in excess of the CSRA is considered available to the IS. See 55 Pa. Code §§ 178.2 ; 178.121 : See Also PA Long Term Care Handbook Chapter 440.9 Spousal Impoverishment
The CS may be able to protect additional resources. The CAO must first determine the Community Spouse Monthly Maintenance Needs Allowance (CSMMNA). The CSMMNA is an amount of income that the IS may give to the CS. The IS may contribute a portion of the IS income to the CS if it is determined that a shortfall exists between the CS gross monthly countable income and the calculated CSMMNA. An amount equal to the difference between the CS gross monthly countable income and the CSMMNA can be contributed from the IS to the CS. See PA Long Term Care Handbook Chapter 440.852 Guidelines for assets transfers between spouses
The amount of resources protected for the CS is called the spousal share. It is also called the community spouse resource assessment (CSRA). The CAO determines the spousal share as of: The date the spouse is admitted to an LTC facility and is applying for MA LTC; or The date of admission to an LTC facility for a continuous period of at least 30 days, or The date the spouse is assessed functionally eligible for HCBS. See 55 Pa. Code § 178.123(b) 55 Pa. Code § 178.121(g) ; PA Long Term Care Handbook Chapter 440.92 Spousal Share
A CS may keep resources up to the amount of the spousal share without affecting the eligibility of the spouse who applies for LTC services. See 55 Pa. Code § 178.124(a) 55 Pa. Code § 178.123 ; PA Long Term Care handbook 440.92 Spousal Share
The CS Maximum Monthly Needs Allowance ( i.e. income ) in 2025 is $ 3948.50 . The CS Maximum Protected Share Of Countable Resources (i.e. assets) in 2025 157,920.00 . The Income Limit Of Institutionalized Spouse in 2025 is $ 2901.00. The Institutionalized Spouse Asset ( Resource Limit ) 2000.00 Plus a $ 6000 Disregard. See PA Long Term Care Handbook Section 440 Appendix A