621.05 Cost of Care: HCBC-ECI Financial or Medical Assistance SR 98-48, 01/99 (AAM-A) |
After the individual is determined eligible for HCBC-ECI (financial or medical assistance), the individual is responsible for applying their net income toward the cost of care. Use the following steps to determine the amount of income the individual must apply toward the cost of care.
1. Subtract the following from the gross earned income:
- Employment Expense Disregard (EED) for OAA and ANB individuals.
- Earned Income Disregard (EID) for APTD individuals.
The result is net earned income.
2. Add countable gross unearned income and SSI payments to the net earned income. The result is net income.
3. Subtract a standard allowance based on the following table:
|
If the HCBC-ECI individual lives with... |
the standard allowance is... |
|
. no spouse or dependents, |
. PIL for one person. See Section 601, Table A, Medically Needy MA Income Limits. |
|
. non-HCBC-ECI spouse or . other dependents, |
. PIL for the appropriate group size including the individual, non-eligible spouse or dependents. |
|
. their spouse who is also eligible for HCBC-ECI, but there are no other dependents in the household, |
. each spouse is allowed the PIL for 1 person as the standard allowance for their own case. |
|
If the HCBC-ECI individual lives with... |
the standard allowance is... |
|
. their spouse who is also eligible for HCBC-ECI and has other dependents in the household, |
. PIL for the number of dependents plus 1, for 1 of the HCBC-ECI spouses, . the other HCBC-ECI spouse is allowed the PIL for 1 person. |
4. Subtract an additional maintenance allowance based on the following table:
|
If the HCBC-ECI individual... |
the additional maintenance allowance is... |
|
. is a group size of 1 person |
. $50 |
|
If the HCBC-ECI individual... |
add an additional... |
|
. lives with a non-HCBC-ECI spouse |
. $35 |
|
. has additional dependents |
. $60 for each additional dependent. |
5. Subtract the amount of the Medicare Part B premium if the individual:
- receives Medicare Part B, and
- is not buy-in eligible (see Chapter 700, Miscellaneous, Part 709.
6. Subtract other medical expenses incurred and not subject to third-party payment including:
- health insurance premiums, deductibles, or coinsurance, and
- necessary medical or remedial care recognized under state law but not covered by medical assistance. See the Medical Assistance Manual, Item 902.
7. Add the VA Aid and Attendance Allowance.
8. The result is the amount of income the individual must apply toward the cost of care.
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Example HCBC-ECI recipient lives with non-HCBC-ECI spouse, and receives a gross monthly SSA benefit of $700 and $200 in monthly A &A benefits. $700.00 countable gross unearned income -514.00 standard allowance (PIL) 186.00 -85.00 additional maintenance allowance 101.00 -45.50 Medicare Part B $55.50 +200.00 Aid and Attendance Allowance $255.50 cost share |