| Applicant, Institutionalized Spouse: |
|
|
|
|
Spreadsheet
last revised 1/10/12 |
|
| Client
Identification Number: |
|
|
Use at your own
risk!!!!!!!!!!!!!!!!!!!! |
|
| Community Spouse: |
|
|
|
POST-7/1/2011 |
|
|
NOTE: You can "format" these rows as
"hide" when printing |
|
|
|
Instructions: Input ACTUAL figures into blue cells, the
rest computes itself |
|
|
|
REMEMBER TO UPDATE
FIGURES IN RED! |
|
|
|
CELLS CONTAINING FORMULAE
ARE LOCKED if using Excel - not web |
|
|
|
YOU CAN EDIT THE REST |
|
|
|
| DIVERSION OF INCOME
TO COMMUNITY SPOUSE / ENHANCEMENT OF
CSPA AFTER HEARING |
|
|
Step #1: Compute MMNA; Compute CSA (diversion of
institutionalized spouse's income to community spouse) |
|
|
|
Monthly expense: |
|
|
$ |
750.00 |
RENT / MORTGAGE / CONDO
FEES |
|
|
+ |
0.00 |
PROPERTY TAXES |
|
|
+ |
0.00 |
HOUSE
INSURANCE |
|
|
+ |
683.00 |
UTILITY STANDARD eff. 10/1/11 |
|
|
= |
1,433.00 |
TOTAL SHELTER COSTS |
|
|
- |
551.63 |
30% OF 150% OF POVERTY
LEVEL FOR 2 (shelter allowance) eff 7/1/11 |
|
|
= |
881.37 |
EXCESS SHELTER COSTS TO
BE ADDED TO MINIMUM MMNA |
|
|
+ |
1,838.75 |
BASE MMNA: 150% OF POVERTY LEVEL FOR 2 eff. 7/1/11 - it cannot be less than
this |
|
|
= |
2,720.12 |
MMNA - MAXIMUM eff. 1/1/2012 |
$ 2,841.00 |
so it won't exceed this
amount |
|
| minimum and maximum |
- |
547.35 |
COMMUNITY SPOUSE TOTAL INCOME |
|
|
$ |
2,172.77 |
DEFICIT in COMMUNITY
SPOUSE INCOME - MAKEUP REQUIRED |
|
|
- |
1,940.00 |
INCOME OF INSTITUTIONALIZED SPOUSE
DIVERTED TO SPOUSE AS "CSA" |
|
|
$ |
232.77 |
MMNA DEFICIT - -MIGHT BE MADE UP FROM
ENHANCEMENT OF CSPA AS SHOWN BELOW |
|
|
But only after Fair
Hearing! |
|
|
| *************************************************************************************************************** |
| COMMUNITY SPOUSE INCOME |
|
INSTITUTIONALIZED SPOUSE
INCOME |
|
|
| GROSS* SSA |
$ |
500.00 |
|
GROSS* SSA |
$ |
2,000.00 |
*You must
add back |
|
|
|
|
|
0 |
the Medicare premiums; these may vary |
|
| GROSS** PENSION |
+ |
- |
|
GROSS** PENSION |
+ |
0.00 |
based on income! |
|
|
|
|
|
0 |
|
**
REMEMBER |
|
| OTHER (EARNINGS, ETC) |
+ |
- |
|
OTHER: |
+ |
0.00 |
|
to add back payroll or |
|
|
|
0 |
|
pension deductions |
|
| INCOME FROM ASSETS* |
+ |
47.35 |
|
|
|
|
|
|
0 |
|
| TOTAL: |
$ |
547.35 |
|
TOTAL: |
$ |
2,000.00 |
|
|
|
0 |
|
|
|
- |
60.00 |
PNA eff. 7/1/2011 (nursing home) |
|
| Assets on snapshot date |
|
$ |
550,000.00 |
|
|
|
( OR $1816 for home care program eff
7/1/11) |
| Initial CSPA |
|
|
113,641.00 |
|
- |
1,940.00 |
Community Spouse
Allowance (if actually paid) |
| maximum eff. 7/1/11 |
|
$113,641 |
|
|
- |
|
Family allowance, if applicable |
|
| minimum |
|
$22,728 |
|
- |
99.90 |
Medicare premium ONLY if IS income too
high for |
|
|
|
|
|
Medicare savings plans (QMB, etc.) |
|
| *
Actual interest rate earned on initial CSPA: |
0.50% |
|
- |
0.00 |
Health insurance premium, if any |
|
| If more than one asset, compute using separate sheet. |
|
|
$ |
0.00 |
= APPLIED INCOME -- due EACH MONTH of
eligibility |
| income/mo
@ actual rates* |
$ |
47.35 |
/ mo. |
|
|
if not enough for all
these, |
|
|
|
|
|
|
|
|
drop Medicare or reduce allowances |
|
|
|
|
|
|
|
|
|
|
|
|
Step #2: How much could
you enhance the CSPA at a Fair Hearing, to meet the MMNA of Community Spouse? |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| If
there is a deficit in the MMNA even after CSA
diverted to Community Spouse: compute
additional assets to be retained using GREATER |
|
|
|
|
|
|
|
| of
actual rate of return or rate computed by average
3 highest rates of CT banks on www.bankrate.com as of date of Fair Hearing |
|
|
|
|
|
|
|
| Keep
in mind that a Fair Hearing may take 1-2+ months
to schedule and a decision might take another 2+ months - use with caution |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| 0.75% |
LOCAL bankrate.com for
Bank A, city, CT, date of hearing |
Thus: |
478,840.29 |
assets needed to produce
monthly |
| 0.35% |
LOCAL bankrate.com for
Bank B, city, CT, date of hearing |
|
|
232.77 |
income for spouse |
|
| 0.65% |
LOCAL bankrate.com for
Bank C, city, CT, date of hearing |
|
|
|
|
| 0.58% |
(average of top 3 rates
OR actual rate if higher) |
|
|
Thus, enhanced CSPA if
enhancement required: |
| 0.58% |
= highest rate: higher of actual or bankrate average |
|
| *LOCAL bank per UPM
+ case of Griswold v. Commissioner |
|
Original CSPA = |
$ |
113,641.00 |
|
http://www.sharinglaw.net/elder/Griswold.pdf |
|
|
Plus additional assets = |
+ |
478,840.29 |
|
|
|
|
|
|
|
Potential Enhanced CSPA = |
$ |
592,481.29 |
|
|
|
|
|
|
|
|
|
|
|
|