614.01 Cost of Care: HCBC-DD/ABD SR 10-21, 07/10 (FAM-A)

Individuals requesting services through Home and Community-Based Care for the Developmentally Disabled (HCBC-DD) or Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD) who meet the categorically-needy or medically-needy financial eligibility requirements for any category of financial or medical assistance, have no cost of care liability. Only individuals who are eligible for HCBC-DD/ABD services by way of the "Nursing Facility CAP" income limit are potentially liable for their cost of care.

For those individual responsible for their cost of care, 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 from gross earned income:

- the 50% Earned Income Disregard (EID) for each employed FANF-related individual;

- the $90 EID for each employed poverty-level individual; and

- the child/dependent care deduction.

The result is net earned income.

2.  Add countable gross unearned income and SSI payments to net earned income.

3.  Subtract the $65 personal needs allowance.

4.  Subtract the FANF payment standard that corresponds to the individual’s living arrangement.

- Adjust the payment standard to include the individual’s spouse and/or children/budgetary unit members.

5.  Subtract all Medicare Premiums if the individual:

- receives Medicare Part A, Part B, Part C, or Part D; and

- is not eligible for:

a. the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) programs, see PART 717, BUY-IN OF MEDICARE; or

b. the Low Income Subsidy (LIS) for Medicare Part D.

6.  Subtract other 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 levels have been exceeded;

- necessary medical or remedial care recognized under state law but not covered by medical assistance; and

- currently obligated, prior unpaid medical debts.

7. Subtract SSI.

8.  Add the VA Aid and Attendance Allowance.

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

New HEIGHTS automatically generates AE0105, HCBC/CFI Patient Liability Letter, when the individual is liable for cost of care. If New HEIGHTS is unavailable, use paper Form 517C, the paper backup to the New HEIGHTS-generated AE0105.

Payment for Cost of Care: HCBC-DD/ABD

The recipient sends cost of care payments directly to the area agency. The area agency tracks cost of care payments.