619 BUDGETING: Nursing Facility SR 95-08, 02/95 (AAM-A)

Individuals residing in a licensed and certified nursing care facility are always considered an assistance group of 1. Use the following steps to determine if the individual is income-eligible.

1. Add countable gross earned income to countable gross unearned income. The result is gross income.

Exception: Do not include SSI and VA Aid and Attendance in this step.

2. Subtract the following from Gross Earned Income

• the employment expense disregard (EED) for OAA and ANB cases

• the Earned Income Disregard (EID) for APTD cases.

The result is net earned income.

3. Add countable gross unearned income to the net earned income calculated in Step 2.

4. Subtract any allowable deductions. The result is net income.

Exception: Do not allow allocated income as a deduction in this step.

5. Compare net income to the monthly Medicaid rate of the facility. See the Medical Assistance Manual, Appendix A.

- If net income is below the rate of the facility determine the individual’s cost of care. See Section 619, Cost of Care: Nursing Facility.

- If net income exceeds the rate of the facility, see Part 625, In and Out Medical Assistance, to determine potential In and Out eligibility.

Example

Nursing facility resident age 65 (OAA):

- receives $1,200 per month in a disability pension,

- receives $50 per month from selling handicrafts, and

- pays $20 per month in a court-ordered guardian fee.

1. $50 (earned income) + $1,200 (unearned income) = $1,250 (gross income)

2. $50 (earned income) - $18 (EED) = $32 (net earned income)

3. $1,200 (unearned income) + $38 (net earned income) = $1,238

4. $1,238 - $20 (allowable deduction) = $1,218 (net case income)

5. Compare net income to the monthly Medicaid rate of the facility.