Income Deductions 510-05-85-35

(Revised 7/1/14 ML #3406)

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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, to the Medicare Savings Programs, and to theWorkers with Disabilities and Children with Disabilities coverages. For individuals receiving psychiatric or nursing care services in a nursing facility, the state hospital, the Anne Carlsen facility, the Prairie at St. John's center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), an intermediate care facility for the intellectually disabled (ICF-ID), or receiving swing-bed care in a hospital, refer to the Post Eligibility Treatment of Income, Section 05-85-25.

 

The following income deductions are allowed in determining Medicaid eligibility:

  1. Except in determining eligibility for the Medicare Savings Programs, the cost of premiums for 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. The Workers with Disabilities coverage enrollment fee and premium as well as the Children with Disabilities coverage premium are allowed deductions except the Workers with Disabilities premium is not allowed when determining eligibility for the Workers with Disabilities coverage and the Children with Disabilities premium is not allowed when determining eligibility for the Children with Disabilities 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 automobile 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.

(If questionable, contact the Third party Liability unit for assistance in determining whether a policy fits into one of the above categories.)

  1. Except in determining eligibility for the Medicare Savings Programs, 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. A medical expense may be deducted only if it is:
  1. Incurred:
  1. By a member of aMedicaid unitin the month for which eligibility is being determined; or
  1. By a member of the Medicaid unit (or a spouse or child they were legally responsible for) in a prior month, but was actually paid in the month for which eligibility is being determined, and was not a previous month's client share (recipient liability), or was not previously allowed as a deduction or offset of client share;
  1. Provided by a medical practitioner licensed to furnish the care;
  2. Not subject to payment by any third party, including Medicaid and Medicare;
  3. Not incurred for nursing facility services, swing bed services, orHCBSduring a period of ineligibility because of adisqualifying transfer; and
  4. Claimed.

Examples of expenses that cannot be used to reduce countable income and affect client share:

  1. Extra amounts paid on glasses, such as more expensive frames, tint, etc.;
  2. Expenses that are considered medically necessary, but are applied to client share;
  3. Costs for Lifeline;
  4. Over the counter medications and supplies that Medicaid does not pay for, even if prescribed*;
  5. Other medications and services that Medicaid does not pay for, such as DESI drugs, such as Midrin (for Migraines), Tigan (for nausea).  (DESI drugs -- Drug Efficacy Study Implementation --are determined by the federal government to be safe but less than effective);
  6. Expenses from visiting a provider who is not the individual's Coordinated Services Program (CSP) "lock-in" provider;
  7. Drugs from Canada prescribed by someone other than a United States physician;
  8. Transportation costs for out of state medical care provided to recipients that have not been prior approved;
  9. Up to 15 bed-hold days in a long term care facility that neither Medicare nor Medicaid will cover; or
  10. Any amount of an expense for which the household will be reimbursed, to the extent of the reimbursement.

Examples of expenses that can be used to reduce countable income and affect client share:

  1. Medications and services Medicaid does not pay for only because the provider is not enrolled;
  2. *Over-the-counter medications that Medicaid does cover, such as Antacids (for stomach acid), analgesics (for pain), iron supplements (for anemia), artificial tears (for severe dry eye diseases).  Also, those payable because of rebates, such as Maalox and Advil. (Non-payable are Mylanta and CVS generics).  Medicaid covers drugs with a NDC code on the bottom of the bottle label.  (http://nddrug.rxexplorer.com/ND Dept. of Human Services is a website that workers may use to inquire whether ND Medicaid covers a specified drug.);
  3. Other over-the-counter supplies that Medicaid covers, such as diabetic supplies;
  4. Nicoderm patches;
  5. Drugs from Canada when prescribed by a US physician;
  6. Co-pays; or
  7. Transportation costs:

(a)  Lodging up to the limit.  Hotels can bill the difference to the client if they stay at a hotel that charges more.  (As with meals, we pay per diem and client can eat where they want.)

(b)  Allow the difference to reduce client share if reasonable.  (If they choose to stay in a penthouse suite when other less costly rooms are available, not reasonable.)

(c)  Transportation costs are not paid or allowed as a deduction if the medical services are available locally but client travels elsewhere, even if referred by a physician. The provider must be within the nearest service area, client has choice of providers.

  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.
  2. Except in determining eligibility for the Medicare Savings programs, 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.
  3. Except in determiningeligibility for the Medicare Savings Programs, the cost of remedial care for an individual residing in a specialized facility is limited to the difference between the recipient’s cost of care at the facility(e.g. remedial rate in a basic care facility) and the regular medically needy income level may be deducted.

Example:

   

Recipient’s remedial rate at the facility

  $980

Less the medically needy income level for one

 - 754

Remedial Care Deduction

  $226
  1. Except in determining eligibility under the Medicare Savings Programs, transportation expense may be deducted if necessary to secure medical care provided for a member of the Medicaid unit. Transportation expenses are not allowedfor recipients in a facility that provides nursing care services, or to the extent the transportation cost is paid by any third party.
  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, that the Medicaid unit is responsible to pay, may be deducted if necessary to engage in employment or training. Reasonable child care expenses do not include payments to parents to care for their own children. The child must be a member of the Medicaid unit for the deduction to be allowed. This expense may only be allowed as a deduction from the income of the child or those individuals who are responsible for the child, such as a parent or caretaker.
  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. 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 may be made for the cost of services of an applicant's or recipient's guardian or conservator, up to a maximum 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 non-disabled 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.