Applicant, Institutionalized Spouse:     Spreadsheet last revised 7/15/09
Client Identification Number:   Use at your own risk!!!!!!!!!!!!!!!!!!!!
Community Spouse:  
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:
$ 0.00 RENT / MORTGAGE / CONDO FEES
+ 0.00 PROPERTY TAXES
+ 0.00 HOUSE INSURANCE 
+ 720.00 UTILITY STANDARD eff. 10/1/08
= 720.00 TOTAL SHELTER COSTS
- 546.00 30% OF 150% OF POVERTY LEVEL FOR 2 (shelter allowance) eff 7/1/09
= 174.00 EXCESS SHELTER COSTS TO BE ADDED TO MINIMUM MMNA
+ 1,821.25 BASE MMNA:  150% OF POVERTY LEVEL FOR 2 eff. 7/1/09 - it cannot be less than this
adjusted to reflect
= 1,995.25 MMNA  - MAXIMUM eff. 1/1/2009:  $         2,739.00 so it won't exceed this amount
minimum and maximum - 750.00 COMMUNITY SPOUSE TOTAL INCOME  
$ 1,245.25 DEFICIT in COMMUNITY SPOUSE INCOME - MAKEUP REQUIRED
- 431.00     INCOME OF INSTITUTIONALIZED SPOUSE DIVERTED TO SPOUSE AS "CSA"
$ 814.25    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 $ 500.00  *You must add back 
0   the Medicare premiums
GROSS** PENSION  +               -   GROSS** PENSION  + 0.00
0 ** REMEMBER 
OTHER (EARNINGS, ETC)  +               -   OTHER:  + 0.00  to add back payroll or
0  pension deductions
INCOME FROM ASSETS*  + 250.00  
0
TOTAL: $ 750.00 TOTAL: $ 500.00
0
- 69.00 PNA eff. 7/1/2009 (nursing home)
Assets on snapshot date $ 200,000.00   ( OR $1805 for home care program eff 7/1/09)
Initial CSPA (1/2 @ snapshot date… but: 100,000.00 - 431.00 Community Spouse Allowance (if actually paid)
eff 1/1/2009 may not exceed: $109,560  or minimum:  $       21,912.00 )
- 96.40   Medicare premiums, supplemental insurance
* Actual interest rate earned on initial CSPA: 3.00%
  If more than one asset, compute using separate sheet. $ 0.00  = APPLIED INCOME -- due each month for which
income/mo @ actual rates* $ 250.00  / mo.  eligibility is being sought.
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
1.50% LOCAL bankrate.com for Bank A, city, CT, date of hearing Thus: 325,700.00 assets needed to produce monthly
1.50% LOCAL bankrate.com for Bank B, city, CT, date of hearing
 
814.25 income for spouse
1.50% LOCAL bankrate.com for Bank C, city, CT, date of hearing
1.50% (average of top 3 rates OR actual rate if higher) Thus, enhanced CSPA if enhancement required:
3.00%  = highest rate:  higher of actual or bankrate average
 *LOCAL bank per case of  Griswold v. Commissioner Original CSPA =  $ 100,000.00
http://www.sharinglaw.net/elder/Griswold.pdf Plus additional assets =  + 325,700.00
Enhanced CSPA = $ 425,700.00
Applicant, Institutionalized Spouse:     Spreadsheet last revised 7/15/09
Client Identification Number:     Use at your own risk!!!!!!!!!!!!!!!!!!!!
Community Spouse:    
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:
$ 0.00 RENT / MORTGAGE / CONDO FEES
+ 0.00 PROPERTY TAXES
+ 0.00 HOUSE INSURANCE 
+ 720.00 UTILITY STANDARD eff. 10/1/08
= 720.00 TOTAL SHELTER COSTS
- 546.00 30% OF 150% OF POVERTY LEVEL FOR 2 (shelter allowance) eff 7/1/09
= 174.00 EXCESS SHELTER COSTS TO BE ADDED TO MINIMUM MMNA
+ 1,821.25 BASE MMNA:  150% OF POVERTY LEVEL FOR 2 eff. 7/1/09 - it cannot be less than this
adjusted to reflect
= 1,995.25 MMNA  - MAXIMUM eff. 1/1/2009:  $         2,739.00 so it won't exceed this amount
minimum and maximum - 750.00 COMMUNITY SPOUSE TOTAL INCOME  
$ 1,245.25 DEFICIT in COMMUNITY SPOUSE INCOME - MAKEUP REQUIRED
- 431.00     INCOME OF INSTITUTIONALIZED SPOUSE DIVERTED TO SPOUSE AS "CSA"
$ 814.25    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 $ 500.00  *You must add back 
0   the Medicare premiums
GROSS** PENSION  +               -   GROSS** PENSION  + 0.00
0 ** REMEMBER 
OTHER (EARNINGS, ETC)  +               -   OTHER:  + 0.00  to add back payroll or
0  pension deductions
INCOME FROM ASSETS*  + 250.00  
0
TOTAL: $ 750.00 TOTAL: $ 500.00
0
- 69.00 PNA eff. 7/1/2009 (nursing home)
Assets on snapshot date $ 200,000.00   ( OR $1805 for home care program eff 7/1/09)
Initial CSPA (1/2 @ snapshot date… but: 100,000.00 - 431.00 Community Spouse Allowance (if actually paid)
eff 1/1/2009 may not exceed: $109,560  or minimum:  $       21,912.00 )
- 96.40   Medicare premiums, supplemental insurance
* Actual interest rate earned on initial CSPA: 3.00%
  If more than one asset, compute using separate sheet. $ 0.00  = APPLIED INCOME -- due each month for which
income/mo @ actual rates* $ 250.00  / mo.  eligibility is being sought.
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
1.50% LOCAL bankrate.com for Bank A, city, CT, date of hearing Thus: 325,700.00 assets needed to produce monthly
1.50% LOCAL bankrate.com for Bank B, city, CT, date of hearing
 
814.25 income for spouse
1.50% LOCAL bankrate.com for Bank C, city, CT, date of hearing
1.50% (average of top 3 rates OR actual rate if higher) Thus, enhanced CSPA if enhancement required:
3.00%  = highest rate:  higher of actual or bankrate average
                          *LOCAL bank per case of  Griswold v. Commissioner Original CSPA =  $ 100,000.00
                           http://www.sharinglaw.net/elder/Griswold.pdf Plus additional assets =  + 325,700.00
Enhanced CSPA = $ 425,700.00