Post Eligibility Treatment of Income 510-05-85-25

(Revised 11/1/06 ML #3047)

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(N.D.A.C. Sections 75-02-02.1-34(6) and  75-02-02.1-38.1)

 

 

This section prescribes specific financial requirements for determining the treatment of income and application of income to the cost of care for individuals with a certification of need or who are screened as requiring nursing care services, and who are residing in nursing facilities, the state hospital, the Anne Carlsen facility, the Prairie at St. John's center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), intermediate care facilities for the mentally retarded (ICF-MR), and individuals receiving swing bed care in hospitals.

  1. The following types of income may be disregarded in determining Medicaid eligibility:

  1. Occasional small gifts;

  2. For so long as 38 U.S.C. 5503 remains effective, ninety dollars of Veteran's Administration improved pensions paid to a veteran, or a surviving spouse of a veteran, who has neither spouse nor child, and who resides in a Medicaid-approved nursing facility;

  3. Payments to certain United States citizens of Japanese ancestry, resident Japanese aliens, and eligible Aleuts made under the Wartime Relocation of Civilians Reparations Act;

  4. Agent Orange payments;

  5. German Reparation payments made to survivors of the holocaust, and reparation payments made under sections 500 through 506 of the Austrian General Social Insurance Act;

  6. Netherlands Reparation payments based on Nazi, but not Japanese, persecution during World War II, Public Law 103-286;

  7. Radiation Exposure Compensation, Public Law 101-426; and

  8. Interest or dividend income from liquid assets.

  1. The mandatory payroll deductions under FICA and Medicare are allowed from earned income.

  2. In establishing the application of income to the cost of care, the following deductions are allowed in the following order:

  1. The nursing care income level;

  2. Amounts provided to a spouse or family member for maintenance needs;

  3. Medical expenses for necessary medical or remedial care. Each medical or remedial care expense 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. An expense may be deducted only if it is:

  1. Incurred 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. The cost of Medicare and health insurance premiums. A health insurance premium may be deducted from income in the month the premium is paid or may be prorated and deducted from income in the months for which the premium affords coverage. 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. The cost of long term care insurance premiums, for insurance carried by the recipient or the recipient’s spouse. The premium 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.

  2. 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.

  1. Payments from any source, which are or may be received as a result of a medical expense or increased medical need, such as health or long-term care insurance payments, VA Aid and Attendance, VA homebound benefits intended for medical expenses, or VA reimbursements for unusual medical expenses, must be added to the remaining income to determine recipient liability.