When a married person applies for Medicaid benefits to pay for nursing home care (“institutional care”), the first day of the first month of continuous residence in the facility is often referred to as the “snapshot date.” On that date, a “picture is taken” of all of the non-excluded assets owned by the two spouses. A calculation is then made to see if a “spend-down” is required. More often than not, some “spend-down” is indeed required. In other posts over the years, I’ve talked about different methods for the “spend-down,” which typically includes a wide variety of expenses, and sometimes even gifts and annuity purchases. The point of the spend-down is to reduce the non-excluded resources (assets) to the level that enables the applicant to apply for benefits.Half of the snapshot total, up to a specified limit, is called the CSRA — Community Spouse Resource Allowance –– which is the share of the resources that is protected for the spouse. Since asset values can vary, you can see that it is extremely important to know just what date to use for the snapshot so that enough assets can be preserved in the CSRA and so that the application can be filed at the correct time.
New Jersey also provides home health care/custodial care benefits under its Medicaid/MLTSS Home and Community-Based Services program. For married people living at home and applying for this program, there have been problems for years with the snapshot date due to wide divergence among the County Boards of Social Services when they process these applications This means there have been problems with the consequences that flow from that date — how to calculate the CSRA; how much needs to be spent down; when the assets have been reduced sufficiently to apply; and therefore, in some cases, whether a transfer penalty period will be triggered for prior gifts. There is no actual regulation which specifies what the snapshot date is for these cases. For years, this gap in the published rules has left applicants in jeopardy, as they try to “spend down” to achieve eligibility with no law to go by. They eventually learn months later that their applications are denied “due to excess resources,” and they have to start all over again.
In a Final Agency Decision just recently issued by the NJ Division of Medical Assistance and Health Services (DMAHS) in a case called S.W. vs Cumberland County Board of Social Services, the State has pronounced the rule. Keep in mind that a potential applicant has to meet the clinical level of care that is sufficient for the program, and the approval of clinically eligible is confirmed by a “P.A.S.” issued by a state representative based on a clinical assessment.SW v Cumb. CBOSS , HMA 00815-20
S.W.’s application was originally filed while she lived at home. The P.A.S. was issued on February 20th. So she used February 20th as the snapshot date, “spent down” and filed her application. Later on, in April, she had to relocate to a nursing home. The County Board insisted on moving the snapshot date forward to April 1st. Of course this then would mean her spouse had to spend down even more from their few remaining assets. She pursued her appeals. The Director of DMAHS agreed with her. At the end of the decision, the State declared: ” Here, Petitioner’s PAS was completed on February 20, 2019 while Petitioner resided in the community. The PAS certified that as of February 20.2019, Petitioner was clinically eligible for “nursing facility level of care in a Nursing home or home and community-based waiver In accordance with N.J.A.C. 8:85-2.1.” Therefore, Petitioner’s snapshot occurred in February 2019 when she had been determined to be eligible for the level of care provided in a nursing home.”
Finally. A clear statement of the law.
Call for advice and representation on Medicaid eligibility planning, applications and appeals … 732-382-6070