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Definition: A person married to a community spouse who either: resides in a long-term care facility (LTCF) and has resided, or is anticipated to reside, in an LTCF for at least 30 consecutive days, or requests services through an Elderly Waiver, and has received a long-term care consultation (LTCC) that demonstrates the individual requires an institutional level of care and the individual has received, or is anticipated to receive, waiver services for at least 30 consecutive days.

Definition: A person who does not reside in a long-term care facility (LTCF) or receive services through a waiver program (EW, CAC, CADI, DD or BI) who is married to a long-term care (LTC) spouse. A community spouse may receive Medical Assistance (MA) or services through the Alternative Care (AC) program. 

Having a community spouse for MA-LTC clients residing in an LTCF or requesting services through a waiver determines when the client will switch to a household size of one. More information about determining a client’s household size is provided in the next module.

Having a community spouse for certain MA-LTC clients affects asset eligibility in two ways. 

• Deeming rules follow household size. As previously mentioned, having a community spouse for MA-LTC clients determines when the client will become a household size of one and therefore when deeming is no longer required.

• MA-LTC clients with a community spouse who are residing in an LTCF or requesting services through Elderly Waiver are required to complete an asset evaluation using the Community Spouse Asset Allowance (CSAA) rules in order to determine the client’s asset total for MA-LTC. Requesting services through CAC, CADI, BI or DD does not require as asset evaluation using the CSAA. Keep in mind, that the asset evaluation using CSAA is not used to determine eligibility for the Medicare Savings Programs (MSP) for these same folks even when it is required for MA-LTC. More information about asset assessment requirements is provided in the Asset Assessment course.

Whether or not an MA-LTC client residing in an LTCF or requesting services through the EW has a community spouse affects:

• The type of income calculation you will use (Community vs. LTC).
• When to begin and end using an LTC income calculation.
• Whether certain deductions are allowed on the LTC income calculation.

More information about income calculations is provided in the Income and MA-LTC course.