Applicant, Institutionalized Spouse:     Spreadsheet last revised 7/14/15
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 
+ 724.00 UTILITY STANDARD eff. 10/1/14
= 724.00 TOTAL SHELTER COSTS
- 597.38 30% OF 150% OF POVERTY LEVEL FOR 2 (shelter allowance) eff 7/1/15
= 126.62 EXCESS SHELTER COSTS TO BE ADDED TO MINIMUM MMNA
+ 1,991.25 BASE MMNA:  150% OF POVERTY LEVEL FOR 2 eff. 7/1/15 - it cannot be less than this
adjusted to reflect
= 2,117.87 MMNA  - MAXIMUM eff. 1/1/2015  $         2,980.50 so it won't exceed this amount
minimum and maximum - 1,031.25 COMMUNITY SPOUSE TOTAL INCOME  
$ 1,086.62 DEFICIT in COMMUNITY SPOUSE INCOME - MAKEUP REQUIRED
- 940.00     INCOME OF INSTITUTIONALIZED SPOUSE DIVERTED TO SPOUSE AS "CSA"
$ 146.62    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 $ 1,000.00 GROSS* SSA $ 1,000.00  *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*  + 31.25  
0
TOTAL: $ 1,031.25 TOTAL: $ 1,000.00
0
- 60.00 PNA eff. 7/1/2011 (nursing home)
Assets on snapshot date $ 150,000.00   ( OR $1945 for home care program eff 7/1/14)
Initial CSPA 75,000.00 - 940.00 Community Spouse Allowance (if actually paid)
maximum eff.1/1/15 $119,220 -      Family allowance, if applicable
minimum eff. 1/1/15 $23,844 - 104.90  Base 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* $ 31.25  / 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
0.35% LOCAL bankrate.com for Bank A, city, CT, date of hearing Thus: 351,888.00 assets needed to produce monthly
0.05% LOCAL bankrate.com for Bank B, city, CT, date of hearing
 
146.62 income for spouse
0.03% LOCAL bankrate.com for Bank C, city, CT, date of hearing
0.14% (average of top 3 ratesr) Thus, enhanced CSPA if enhancement required:
0.50%  = highest rate:  higher of actual or bankrate average
                          *LOCAL bank per UPM + case of  Griswold v. Commissioner Original CSPA =  $ 75,000.00
                           http://www.sharinglaw.net/elder/Griswold.pdf Plus additional assets =  + 351,888.00
Potential Enhanced CSPA = $ 426,888.00
Applicant, Institutionalized Spouse:     Spreadsheet last revised 5/2/17
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 
+ 698.00 UTILITY STANDARD eff. 10/1/16
= 698.00 TOTAL SHELTER COSTS
- 608.75 30% OF 150% OF POVERTY LEVEL FOR 2 (shelter allowance) eff 1/1/17
= 89.25 EXCESS SHELTER COSTS TO BE ADDED TO MINIMUM MMNA
+ 2,029.50 BASE MMNA:  150% OF POVERTY LEVEL FOR 2 eff. 1/1/17 - it cannot be less than this
adjusted to reflect
= 2,118.75 MMNA  - MAXIMUM eff. 1/1/2017 up to  $         3,022.50 so it won't exceed this amount
minimum and maximum - 10.08 COMMUNITY SPOUSE TOTAL INCOME  
$ 2,108.68 DEFICIT in COMMUNITY SPOUSE INCOME - MAKEUP REQUIRED
- 0.00     INCOME OF INSTITUTIONALIZED SPOUSE DIVERTED TO SPOUSE AS "CSA"
$ 2,108.68    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 $ 0.00 GROSS* SSA $ 0.00  *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*  + 10.08  
0
TOTAL: $ 10.08 TOTAL: $ 0.00
0
- 60.00 PNA eff. 7/1/2011 (nursing home)
Assets on snapshot date $ 0.00   ( OR $2005 for home care program eff 1/1/17)
Initial CSPA 24,180.00 - 0.00 Community Spouse Allowance (if actually paid)
maximum eff.1/1/15 $120,900 -      Family allowance, if applicable
minimum eff. 1/1/15 $24,180 - 105.90  Base 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* $ 10.08  / 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
0.35% LOCAL bankrate.com for Bank A, city, CT, date of hearing Thus: 5,060,820.00 assets needed to produce monthly
0.05% LOCAL bankrate.com for Bank B, city, CT, date of hearing
 
2,108.68 income for spouse
0.03% LOCAL bankrate.com for Bank C, city, CT, date of hearing
0.14% (average of top 3 ratesr) Thus, enhanced CSPA if enhancement required:
0.50%  = highest rate:  higher of actual or bankrate average
                          *LOCAL bank per UPM + case of  Griswold v. Commissioner Original CSPA =  $ 24,180.00
                           http://www.sharinglaw.net/elder/Griswold.pdf Plus additional assets =  + 5,060,820.00
Potential Enhanced CSPA = $ 5,085,000.00