619 BUDGETING: Nursing Facility (MAM)

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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 as categorically or medically needy.

Determining Income Eligibility as Categorically Needy

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. Compare the result obtained in Step 1 to the “CAP” income limit (See Table A Income Limits). If gross income is at or below the CAP and is no higher than the Medicaid rate of the facility (see BEAS’ Appendix A of the Medicaid Manual, “Nursing Facility Rates”), consider the individual to be categorically needy for nursing facility care and determine the individual’s cost of care (See Section 619.01).

Determining Income Eligibility as Medically Needy

If the individual is not categorically needy, determine eligibility as medically needy:

1. Subtract the earned income disregard (EID) from the gross earned income amount determined above:to obtain net income. See Section 603.01, Earned Income Disregard.

2. Add countable gross unearned income to the net earned income calculated in Step 1.

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

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

4. Compare net income to the monthly Medicaid rate of the facility. See BEAS’ Appendix A of the Medicaid Manual, “Nursing Facility Rates.”

- If net income is below the rate of the facility determine the individual’s cost of care. See Section 619.01, 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.