8143 Income Provisions
When a husband or wife enters a
medical institution (whether or not the facility is Medicaid approved)
for at least 30 consecutive days, only the separate income of the
institutionalized spouse shall be used in determining his or her eligibility
beginning with the month the arrangement begins. In the case of income
which is received in both names, of the income shall be considered
available to each unless otherwise established. In the case of income
which is received by either or both spouses and to another person
or persons, the income shall be considered available to each spouse
in proportion to their interest or equally divided if the interest
is not specified.
These provisions are only applicable in those instances
in which one spouse lives in the community (including HCBS arrangements)
and the other spouse resides in the institutional setting. If both
a husband and wife begin institutional care or if one or both enter
a nonmedical institution, the provisions of (2) below shall apply.
If the community spouse is also an applicant or recipient
(including persons receiving HCBS or assessed and chosen HCBS) only
his or her own income as well as any income contributed to the community
spouse shall be considered for the community spouse beginning in the
month the care arrangement begins.
When both a husband and/or wife
enters an institutional living arrangement (whether or not the facility
is Medicaid approved) for other than a temporary stay as defined in
8113 or either or both spouses enter
a non-medical institution, the total income of husband and wife shall
be considered in determining eligibility for the month the arrangement
starts. Thereafter, only the applicant/ recipient's own income as
well as any income actually contributed can be considered in determining
eligibility or amount of patient obligation. (See item 4 below for
allocation of income).
Income identifiable as belonging
specifically to a child in an institutional arrangement (such as Social
Security and VA benefits) must be considered (unless otherwise exempt)
as available to the child in determining eligibility regardless of
who is payee. When a child under age 18 enters an institutional living
arrangement (whether or not the facility is Medicaid approved) a minimum
of 30 days, income of the parent(s) shall not be considered available
to the child in determining eligibility beginning with the month the
institutional arrangement begins. However, parents of children in
state institutions may retain a legal obligation for payment of costs
above those covered by the medical program. Parental obligation will
be established by institutional personnel.
When the stay does not exceed 30 days, independent living methodologies
apply and the income of the parent(s) is countable if required by
the specific medical assistance program.
Upon leaving the institution, the parents' income shall
again be considered beginning with the month following the month of
discharge from the institutional arrangement.
All income allocated by an individual
receiving long term care in a Medicaid approved institutional living
arrangement for the support of a minor child who is not living with
the community spouse (or where a community spouse does not exist)
and who is without sufficient income to meet his or her maintenance
needs shall be exempt. This provision is not, however, applicable
to persons in adult care homes whose financial eligibility is determined
based on the spenddown provisions of 8172.2
(2)(b).
If there is a community spouse or a community spouse and minor child in the home, income shall be allocated in accordance with the spousal impoverishment provisions of 8144.2.
The allocation shall be calculated by using the Determination of Need
(Medical Assistance) worksheet (ES-3104.5).
The amount of the allocation when added to the nonexempt gross earned
and unearned income of the children and any legally responsible person
with whom they live cannot exceed the protected income level for the
appropriate number of persons in independent living. Income exempt
under the provisions of 6310 and
6410 and subsections shall not be
considered. Allocation will be permitted even though it may render
the children ineligible for cash assistance or SSI.
If requested, eligibility of the children for medical will be determined based on their resources and considering the allocated amount as income. A separate application is required. Ineligibility of the child for medical does not prevent the individual receiving long term care from allocating.