How to Determine if There is an Institutionalized Spouse

STEP 1:

Has Person A entered a nursing facility or medical hospital?

• • If NO, go to Step 2.
  • If YES, go to Step 3.

STEP 2:

Is Person A married, living with spouse and certified to receive HCB services?

• • If NO, stop. No institutionalized spouse exists.
  • If YES, Person A is considered an institutionalized spouse. Determine month of assessment.

STEP 3:

Was Person A married and living with his/her spouse (Person B) prior to entering the nursing facility or hospital?

• • If NO, stop. No institutionalized spouse exists.
  • If YES, verify marriage and record in FAMIS RELATION screen. Go to Step 4.

STEP 4:

Is Person A expected to remain in the hospital and/or nursing facility at least 30 days?

• • If NO, stop. No institutionalized spouse exists.
  • If YES, verify through physician, hospital social worker, DA-124C or nursing facility. Go to Step 5.

STEP 5:

If Person A is in a nursing facility, is Person A in a licensed Skilled Nursing Facility or Intermediate Care Facility bed?

• • If NO, stop. No institutionalized spouse exists.
  • If YES, verify through oral statement from nursing facility. Go to Step 6.

STEP 6:

Is Person B in a medical hospital or nursing facility and expected to stay for less than 30 days?

• • If YES, stop. No institutionalized spouse exists.
  • If NO, Person A is an institutionalized spouse. Person B is the community spouse. Determine month of assessment.