624.05 Cost of Care: HCBC-ABD Medical Assistance SR 99-40, 08/99 (AAM-A)

After the individual is determined eligible for HCBC-ABD medical assistance-only, the individual is responsible for applying any of their net income toward the cost of care. Use the following steps to determine the amount of 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 to the net earned income. The result is net income.

3. Subtract the $50 personal needs allowance if the individual lives in an independent living arrangement.

4. Subtract the payment standard which corresponds to the individual’s living arrangement to represent the individual’s maintenance allowance.

If the individual lives in an independent living arrangement with their spouse, use a standard of need for a group size of 2.

5. Subtract the amount of the Medicare Part B premium if the individual:

- receives Medicare Part B, and

- is not buy-in eligible. See Part 709, Buy-In.

6. Subtract medical expenses incurred by the individual that are not subject to third-party payment including:

- health insurance premiums, deductibles, or coinsurance;

- necessary medical and remedial care that would be covered by medical assistance, except that allowable payment limits have been exceeded;

- necessary medical or remedial care recognized under state law but not covered by medical assistance. See the Medical Assistance Manual, Item 902; and

- currently obligated, unpaid prior medical debts.

7. Add VA Aid and Attendance Allowance.

 The result is the amount of income the individual must apply toward the cost of care.

8. Complete Form 517-C, Payment Toward Cost of Care Agreement.