Budget Procedures for Medically Needy and Poverty Level 510-05-90-55

(Revised 1/03 ML #2833)

IM 4985 AMENDED

IM 4985 AMENDED Attachment

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1. Individuals and Families living in their own home: All income of the individuals in the Medicaid unit is considered in determining Medicaid income eligibility. The appropriate medically needy or poverty level income level is used based on household size.

A budget worksheet for the medically needy and poverty level can be found at 05-100-90.

2. Recipients residing in a nursing facility, an intermediate care facility for the mentally retarded (ICF-MR), the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, or receiving swing bed care in a hospital: The recipient is allowed the $50 nursing care income level.

For a single individual under age 21, or if blind or disabled under age 18, parental income is not considered available during any full calendar month the recipient is in the facility. Likewise, for a married recipient, income of the spouse is not considered available during any full calendar month, or when the community spouse is ineligible for Medicaid (spousal impoverishment case), during any full or partial month.

 

If the individual has no source of income, and is ineligible for SSI, the income of the spouse or parents may be deemed in the amount of $50 to meet the maintenance needs of the individual.

 

Individuals between the ages of 21 and 65 are not eligible for Medicaid in the state hospital.

3. Recipients living in a specialized facility: The recipient is allowed the medically needy income level for one. The members of the Medicaid unit remaining in the home are allowed the appropriate income level.

If the individual is under age 21, or if blind or disabled age 18, and enters the specialized facility from a public institution or the parental home, consider the income of the individual and parents.

If the individual is married, the income of the individual and of the spouse must be considered. If the Medicaid unit in the home is not receiving Medicaid, 75% of the excess income shall be disregarded in determining recipient liability.

 

If the individual in the specialized facility is eligible for SSI, do not deem income from the Medicaid unit at home to the individual because the maintenance needs are considered to be met.

 

If the individual in the specialized facility in not eligible for SSI and has no source of income or insufficient income, the family at home may deem income to the individual up to the medically needy income level for one.

 

The services provided in a specialized facility are a type of remedial service which cannot be paid through Medicaid, but can be allowed as a deduction. Remedial services are determined by subtracting the medically needy income level for one from the recipient’s cost of care at the specialized facility. The resulting amount is deducted from the individual's income to determine recipient liability. If the actual remedial expense is less than the calculated amount, use the actual amount.

4. Recipients electing to receive HCBS: The recipient is allowed the medically needy income level for one. A Medicaid unit with a HCBS individual, who has no income or inadequate income, can deem income to that individual, to the medically needy income level for one.

Income of a parent or eligible spouse is not considered available in determining an individual’s eligibility during any full calendar month in which HCBS are received. For a married recipient whose community spouse is ineligible for Medicaid, the income of the spouse is not considered available during any full or partial month.

 

The recipient must be screened for and receiving HCBS.

5. Individuals not in parental home: Parental income is not considered for a single individual under age 21 who is "living independently."

Parent income must be considered for a single individual under age 21 who is only temporarily living outside the parental home.

 

If the individual under the age of 21 is married, the income of the individual and spouse must be considered to determine eligibility.