Spousal impoverishment protections for the MAC and TSOA programs

Revised date
Purpose statement

This section describes the how spousal impoverishment protections apply to a married person who applies for MAC or TSOA.

WAC 182-513-1660 Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA) - Spousal Impoverishment

WAC 182-513-1660 Medicaid alternative care (MAC) and tailored supports for older adults (TSOA)—Spousal impoverishment.

Effective February 25, 2023

  1. The medicaid agency or the agency's designee determines financial eligibility for medicaid alternative care (MAC) or tailored supports for older adults (TSOA) using spousal impoverishment protections under this section, when an applicant or recipient:
    1. Is married to, or marries a person not in a medical institution; and
    2. Is ineligible for a noninstitutional categorically needy (CN) SSI-related program or the TSOA program due to:
      1. Spousal deeming rules under WAC 182-512-0920 for MAC;
      2. Exceeding the resource limit in WAC 182-512-0010 for MAC, or the limit under WAC 182-513-1640 for TSOA; or
      3. Both (b)(i) and (ii) of this subsection.
  2. When a resource test applies, the agency or the agency's designee determines countable resources using the SSI-related resource rules under chapter 182-512 WAC, except pension funds owned by the spousal impoverishment protections community (SIPC) spouse are not excluded as described under WAC 182-512-0550:
    1. Resource standards:
      1. For MAC, the resource standard is $2,000; or
      2. For TSOA, the resource standard is $53,100.
    2. Before determining countable resources used to establish eligibility for the applicant, the agency or the agency's designee allocates the state spousal resource standard to the SIPC spouse.
    3. The resources of the SIPC spouse are unavailable to the spousal impoverishment protections institutionalized (SIPI) spouse the month after eligibility for MAC or TSOA services is established.
  3. The SIPI spouse has until the end of the month of the first regularly scheduled eligibility review to transfer countable resources in excess of $2,000 (for MAC) or $53,100 (for TSOA) to the SIPC spouse.
  4. Income eligibility:
    1. For MAC:
      1. The agency or the agency's designee determines countable income using the SSI-related income rules under chapter 182-512 WAC, but uses only the applicant or recipient's income;
      2. If the applicant's or recipient's countable income is at or below the SSI categorically needy income level (CNIL), the applicant or recipient is considered a SIPI spouse and is income eligible for noninstitutional CN coverage and MAC services;
    2. For TSOA, see WAC 182-513-1635.
  5. Once a person no longer receives MAC services, eligibility is redetermined without using spousal impoverishment protections under WAC 182-504-0125.
  6. If the applicant's separate countable income is above the standards described in subsection (4) of this section, the applicant is not income eligible for MAC or TSOA services.
  7. The spousal impoverishment protections described in this section are time-limited for MAC clients and expire on September 30, 2027.
  8. Standards described in this chapter are located at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

Under Section 1924 of the Social Security Act, married people who receive coverage under an 1115 waiver demonstration project are considered to be an institutionalized spouse for the purposes of applying spousal impoverishment protections.  Spousal impoverishment protections do therefore apply to both MAC and TSOA clients if the spouse of the MAC/TSOA applicant doesn't reside in an institution.

For married TSOA applicants: the spousal impoverishment protections community (SIPC) spouse is allowed to have resources of $55,547 (effective 7/1/17) before any resources are counted towards the applicant’s $53,100 limit. The $53,100 standard does not change, however the state spousal resource standard ($55,547) may adjust every odd year in July. 

Combined resources must be at or below the state resource standard for a married couple plus $53,100 ($108,647 as 7/1/2017) for initial eligibility. Once eligibility is determined, the spouse receiving services has one year to transfer resources in their name over $53,100 to his or her spouse.

For TSOA income determinations, the name on check rule applies in that only the income of the TSOA applicant is counted, and not that of the community spouse.  For TSOA, the community income rule (add both spouses income together and divide by two) isn’t permitted.

For married MAC applicants: for the most part MAC applicants will already be eligible for CN or ABP Medicaid.  However, in the following circumstances a second review of the person’s income and resources is required:

  • A married MAC applicant is not eligible for SSI-related CN Medicaid (for example, the person is active on S95 medically needy coverage, or pending spenddown on S99 due to the deemed income of their spouse.
  • SSI-related Medicaid is denied due to the couple being over the $3000 resource limit.

If the MAC applicant’s separate income is below the SSI-related CNIL and the couples joint resources are below the combined standard of $2000 for the applicant plus $55,547 for the community spouse, the applicant is eligible for SSI-related CN coverage (S02) as a spousal impoverishment protections institutional (SIPI) spouse. 

A person who is approved for SSI-related CN coverage as a SIPI spouse receives a 12 month certification regardless of whether they receive ongoing MAC services throughout the certification period. 

Note: For working clients who are potentially eligible for HWD, the same spousal impoverishment income protections apply.

Under current statute the spousal impoverishment protections are time-limited for MAC applicants and will end on December 31, 2018. This does not affect spousal impoverishment protections for TSOA applicants.

Worker Responsibilities

Use an ACES workaround to approve S02 or S08 coverage for SIPI MAC recipients, by coding the community spouse as a nonmember in the assistance unit. Code all resources over the $2000 resource limit on the spouse’s resource screens. Manually generate a notice to notify the applicant of the requirement to transfer all resources in excess of $2000 to their spouse prior to the first eligibility review.

Text to include with the letter: “We will review your case in (last day of review month). The amount of resources in your name must be $2,000 or less by the end of the review month. You can transfer any resources over $2,000 to your spouse. We will need proof of these transfers. See WAC 182-513-1660 for more information.”

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