614 COST OF CARE: HCBC-DD/ABD MEDICAL ASSISTANCE SR 97-13, 05/97 (FAM-A)

After the individual is determined eligible for HCBC-DD or ABD (medical assistance-only), the individual is responsible for applying any of their available income toward the cost of care. Use the following steps to determine the amount of cost of care.

1.  Subtract the 20% earned income disregard (EID) and the child/dependent care deduction from gross earned income. The result is net earned income.

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

3.  Subtract the $40 personal needs allowance.

4.  Subtract the TANF payment standard which 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 the amount of the Medicare Part B premium if the individual:

- receives Medicare Part B, and

- is not buy-in eligible. See Chapter 700, Part 717.

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 or remedial care recognized under state law but not covered by medical assistance. See Medical Assistance Manual, Item 902. And

- currently obligated, prior unpaid medical debts.

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.

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

Payment for Cost of Care: HCBC-DD/ABD Medical Assistance

The recipient sends cost of care payments directly to the area agency. The area agency tracks cost of care payments. If the individual fails to pay the correct cost of care payment, the area agency notifies DMHDS of the failure to pay. DMHDS then notifies the District Office to terminate HCBC-DD or ABD services. Eligibility terminates the last day of the second month after payment is delinquent or incorrect.