Income Deductions 510-05-85-35

(Revised 01/03 ML #2833)

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(N.D.A.C. Section 75-02-02.1-39)

 

This section applies to individuals residing in their own home or in a specialized facility, and to the Medicare Savings Programs, but does not apply to Transitional Medicaid Benefits. For individuals receiving nursing care services in a nursing facility, the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, an intermediate care facility for the mentally retarded (ICF-MR), or receiving swing-bed care in a hospital, refer to the Post Eligibility Treatment of Income, Section05-85-25.

 

The following income deductions are allowed in determining Medicaid eligibility:

  1. The cost of health insurance may be deducted from income in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage. No health insurance premium may be deducted in determining eligibility for the Medicare Savings Programs. For purposes of this deduction, premiums for health insurance include payments made for insurance, health care plans, or nonprofit health service plan contracts which provide benefits for hospital, surgical, and medical care, but do not include payments made for coverage which is:

  1. Limited to disability or income protection coverage;
  2. Automobile medical payment coverage;
  3. Supplemental to liability insurance;
  4. Designed solely to provide payments on a per diem basis, daily indemnity, or nonexpense-incurred basis; or
  5. Credit accident and health insurance.

  1. Medical expenses for necessary medical or remedial care claimed for deduction must be documented in a manner which describes the service, the date of the service, the amount of cost incurred, and the name of the service provider. No medical expense may be deducted in determining eligibility for the Medicare Savings Programs. A medical expense may be deducted only if it is:

  1. Incurred by a member of a Medicaid unit in the month for which eligibility is being determined;
  2. Provided by a medical practitioner licensed to furnish the care;
  3. Not subject to payment by any third party, including Medicaid and Medicare;
  4. Not incurred for nursing facility services, swing bed services, or HCBS during a period of ineligibility because of a disqualifying transfer; and
  5. Claimed.

  1. Reasonable expenses, such as food and veterinarian expenses, necessary to maintain a dog that is trained to detect seizures for a member of the Medicaid unit.

  1. The cost of premiums for long term care insurance carried by an individual or the individual's spouse may be deducted from income in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage. No premium deduction may be made in determining eligibility for the Medicare Savings Programs.

  2. The cost of remedial care for an individual residing in a specialized facility limited to the difference between the recipient’s cost of care at the facility (e.g. room and board in a basic care facility) and the regular medically needy income level may be deducted. No such deduction may be made in determining eligibility for the Medicare Savings Programs.

Example:

   

Recipient’s cost of care at the facility

 $980.00

Less the medically needy income level for one

 - 492.00

Remedial Care Deduction

 $488.00

  1. Transportation expenses may be deducted if necessary to secure medical care provided for a member of the Medicaid unit. No transportation expense deduction may be made in determining eligibility under the Medicare Savings Programs, for recipients in a facility that provides nursing care services, or to the extent the transportation cost is paid by any third partry.

  2. Non-voluntary child and spousal support payments (including surcharges and arrearages) may be deducted if actually paid by a member of the Medicaid unit. If the support payment is withheld from an extra check that is disregarded, the support payment withheld from that check is not allowed as a deduction.

  3. Reasonable child care expenses, not otherwise reimbursed, may be deducted if necessary to engage in employment or training. The child must be a member of the Medicaid unit for the deduction to be allowed.

  4. Reasonable adult dependent care expenses may be deducted. These are costs for care of an incapacitated or disabled adult who is living in the home so a caretaker or a spouse can work or attend training. The incapacitated or disabled adult must be a member of the Medicaid unit for the deduction to be allowed.

  5. The cost to purchase or rent a car safety seat for a child through age ten is allowed as a deduction if a seat is not otherwise reasonably available. State law requires that any child under age three be secured in a car safety seat when riding in any motor vehicle which was equipped with seat belts when it was manufactured. Children age three through ten must be protected by either a safety seat or a seat belt. Safety seats are available in limited supply in many communities for a small deposit and a monthly rental cost through hospitals, community health offices, and civic organizations. The family must provide an original receipt of purchase in order to be eligible for the deduction. This deduction is not allowed if any third party, including TANF, pays the cost.

  6. A disregard of $20 per month is deducted from any income, except income which is based on need, such as SSI, and need-based veterans’ pensions. This deduction applies to all aged, blind and disabled applicants or recipients provided that:

  1. When more than one aged, blind, or disabled persons live together, no more than one $20 disregard may be deducted;
  2. When both earned and unearned income is available, apply the $20 disregard to the unearned income; and
  3. When only earned income is available, the $20 disregard must be applied before the deduction of sixty-five dollars plus one-half of the remaining monthly gross income.

  1. A deduction of payments made for services of a guardian or conservator may be made, up to a maximum deduction equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments.

  2. With respect to each individual in the Medicaid unit who is employed or in training, but who is not aged, blind, or disabled, thirty dollars may be deducted as a work or training allowance, but only if the individual’s income is counted in the eligibility determination.

  3. The deductions described in this subsection may be allowed only on earned income.

  1. For all individuals, except for aged, blind, or disabled applicants or recipients:
  1. Mandatory payroll deductions and union dues withheld, or ninety dollars, whichever is greater;
  2. Mandatory retirement plan deductions;
  3. Union dues actually paid; and
  4. Expenses of a blind person, reasonably attributable to earning income. (This provision applies to individuals who are eligible for Medicaid under the children and family category.)
  1. For all aged, blind, or disabled applicants or recipients, sixty-five dollars plus one-half of the remaining monthly gross earned income; provided that, when more than one aged, blind, or disabled person lives together, no more than sixty-five dollars, plus one-half of the remaining combined earned income, may be deducted. This provision applies separately to the coverage, medically needy or the Medicare Savings Programs, for which eligibility is being determined.