8143 Income Provisions
When a husband or wife enters a medical institution (whether or not the facility is Medicaid approved) for at least 30 consecutive days, only the separate income of the institutionalized spouse shall be used in determining his or her eligibility beginning with the month the arrangement begins. In the case of income which is received in both names, of the income shall be considered available to each unless otherwise established. In the case of income which is received by either or both spouses and to another person or persons, the income shall be considered available to each spouse in proportion to their interest or equally divided if the interest is not specified.
These provisions are only applicable in those instances in which one spouse lives in the community (including HCBS arrangements) and the other spouse resides in the institutional setting. If both a husband and wife begin institutional care or if one or both enter a nonmedical institution, the provisions of (2) below shall apply.
If the community spouse is also an applicant or recipient (including persons receiving HCBS or assessed and chosen HCBS) only his or her own income as well as any income contributed to the community spouse shall be considered for the community spouse beginning in the month the care arrangement begins.
When both a husband and/or wife enters an institutional living arrangement (whether or not the facility is Medicaid approved) for other than a temporary stay as defined in 8113 or either or both spouses enter a non-medical institution, the total income of husband and wife shall be considered in determining eligibility for the month the arrangement starts. Thereafter, only the applicant/ recipient's own income as well as any income actually contributed can be considered in determining eligibility or amount of patient obligation. (See item 4 below for allocation of income).
Income identifiable as belonging specifically to a child in an institutional arrangement (such as Social Security and VA benefits) must be considered (unless otherwise exempt) as available to the child in determining eligibility regardless of who is payee. When a child under age 18 enters an institutional living arrangement (whether or not the facility is Medicaid approved) a minimum of 30 days, income of the parent(s) shall not be considered available to the child in determining eligibility beginning with the month the institutional arrangement begins. However, parents of children in state institutions may retain a legal obligation for payment of costs above those covered by the medical program. Parental obligation will be established by institutional personnel.
When the stay does not exceed 30 days, independent living methodologies apply and the income of the parent(s) is countable if required by the specific medical assistance program.
Upon leaving the institution, the parents' income shall again be considered beginning with the month following the month of discharge from the institutional arrangement.
All income allocated by an individual receiving long term care in a Medicaid approved institutional living arrangement for the support of a minor child who is not living with the community spouse (or where a community spouse does not exist) and who is without sufficient income to meet his or her maintenance needs shall be exempt. This provision is not, however, applicable to persons in adult care homes whose financial eligibility is determined based on the spenddown provisions of 8172.2 (2)(b).
If there is a community spouse or a community spouse and minor child in the home, income shall be allocated in accordance with the spousal impoverishment provisions of 8144.2.
The allocation shall be calculated by using the Determination of Need (Medical Assistance) worksheet (ES-3104.5). The amount of the allocation when added to the nonexempt gross earned and unearned income of the children and any legally responsible person with whom they live cannot exceed the protected income level for the appropriate number of persons in independent living. Income exempt under the provisions of 6310 and 6410 and subsections shall not be considered. Allocation will be permitted even though it may render the children ineligible for cash assistance or SSI.
If requested, eligibility of the children for medical will be determined based on their resources and considering the allocated amount as income. A separate application is required. Ineligibility of the child for medical does not prevent the individual receiving long term care from allocating.