J-7000, Income for Eligibility and Co-Payment

Revision 19-3; Effective September 1, 2019

 

If the recipient does not make the entire spousal allowance available at certification and each redetermination, obtain a written statement from the recipient or the recipient's authorized representative as to the amount that is being made available and deduct only that amount.

A written statement is not required at redetermination if:

  • the community spouse is a Supplemental Security Income recipient;
  • zero ($0) amount is being diverted to the community spouse; or
  • the amount of the spousal diversion at redetermination remains the same.

Diversion of VA income to the community-based spouse may affect the VA income amount. Inform the couple of this possibility and give them the option of not diverting VA income to the community-based spouse. Their decision should be documented in a signed statement.

Financial duress is defined as having insufficient funds to meet living expenses because of debts incurred for medical expenses for the institutionalized spouse, community-based spouse or dependent, or because of replacement of a resource lost through theft or acts of God.

 

J-7100 Spousal Companion Budget

Revision 09-4; Effective December 1, 2009

 

Using the special income limit for an individual, HHSC considers only the person's income in determining eligibility. The ineligible spouse's income is considered in determining the amount of co-payment.

 

J-7200 Spousal Co-Payment

Revision 19-1; Effective March 1, 2019

 

Budget Steps

To determine the co-payment for a spousal companion case, HHSC nets the individual's and spouse's earned income each month by subtracting the following mandatory payroll deductions:

  • income tax;
  • Social Security tax;
  • required retirement withholdings; and
  • required uniform expenses.

Note: Mandatory payroll deductions also apply to a dependent's earned income in spousal impoverishment cases.

Do not count in-kind support and maintenance income the spouse receives.

A separate deduction for maintenance of the home is not allowable in companion cases. The spousal allowance provides for home maintenance in those cases.

How to Determine Co-Payment for a Spousal Companion Case

Step Procedure
1 Determine the countable net earned and gross unearned income of the individual.
2 Subtract the individual needs allowance (PNA) of $60 for the person. Subtract the guardian fee allowance, if applicable.
3 Add the spouse's countable net earned and gross unearned income to the remainder. (If the spouse’s income is more than the minimum monthly maintenance needs allowance [MMMNA], count only the MMMNA.)
4 Subtract the spousal allowance.
5 a) If there are no dependents, go to step 6.
b) If there are dependents, determine the dependent allowance.
c) Subtract the dependent allowance.
6 Subtract incurred medical expenses. The remainder is the co-payment for the payment plan.

Reference: See Chapter H, Co-Payment, for the deduction of incurred medical expenses.

 

Notes:

  • Enter incurred medical expense deductions on the Medical Expense LUW in TIERS even if the payment plan is $0.
  • If the individual has signed a statement and is refusing to make the spousal allowance available and there are no dependents, follow procedures for an individual payment plan budget.
  • If the community spouse's countable income is greater than the MMMNA, count only the MMMNA in step 3 above.

The following examples are for demonstration purposes only. They may not reflect the current protected resource minimum and maximum amounts.

Examples

An individual and his spouse have the following income:

  • Individual
    • $265 RSDI
    • +$200 Private retirement
    • $465 Total
  • Spouse
    • $350 RSDI
    • + $285 Teacher's retirement
    • = $635 Total
  • Co-payment calculation:
    • $465 Individual's gross income
    • – $60 PNA
    • = $405 Income available for diversion
    • + $635 Spouse's income
    • = $1,040 Total
    • – $3,160.50 Spousal allowance
    • = $0 Co-payment

Another individual and his spouse have the following income:

  • Individual
    • $490 RSDI
    • + $509 Private retirement
    • = $999 Total
  • Spouse
    • $450 RSDI
    • + $300 Private retirement
    • + $750 Net earnings
    • = $1,500 Total
  • Co-payment calculation:
    • $999 Individual's gross income
    • – $60 PNA
    • = $939 Income available for diversion
    • + $1,500 Spouse's income
    • = $2,439 Total
    • – $3,160.50 Spousal allowance
    • = $0 Remainder
    • – $60 Incurred medical expenses
    • = $0 Co-payment
    • $1,250 RSDI
    • + $800 Private retirement
    • = $2,050 Total

A third individual and his spouse have the following income:

  • Individual
    • $1,250 RSDI
    • + $800 Private retirement
    • = $2,050 Total
  • Spouse
    • $1,590 Net earnings
    • Monthly incurred medical expenses are $16.

The individual's dependent brother lives with the community spouse. The brother’s only income is $500 per month in RSDI disability benefits.

  • The brother’s dependent allowance is:
    • $2,003 Base amount of dependent allowance
    • – $800 Dependent's gross income
    • = $1,203 Remainder
    • $1,203 divided by 3
    • = $401 Dependent allowance
  • Co-payment calculation:
    • $2,050 Individual's gross income
    • – $60 PNA
    • = $1,990 Income available for diversion
    • + $1,590 Spouse's income
    • = $3,580 Total
    • – $3,160.50 Spousal allowance
    • = $419.50 Remainder
    • – $401.00 Dependent allowance
    • = $18.50 Remainder
    • – $16 Incurred medical expenses
    • = $2.50 Co-payment

 

J-7300 ICF/IID Spousal Companion Cases

Revision 19-1; Effective March 1, 2019

 

A separate deduction for maintenance of the home is not allowable in companion cases. The spousal allowance provides for home maintenance in those cases.

To determine the co-payment for a spousal companion situation for an individual with earnings who is in an ICF/IID, use the following steps:

Step Procedure
1 Determine the countable net earned and gross unearned income of the individual.
2 Subtract the personal needs allowance, including the protected earned income allowance (if any) of the individual based on their own net income. Subtract the guardian fee allowance, if applicable.
3 Add the spouse's countable net earned and gross unearned income to the remainder.
4 Subtract the spousal allowance.
5 a) If there are no dependents, go to step 6.
b) If there are dependents, determine the dependent allowance.
c) Subtract the dependent allowance.
6 Subtract incurred medical expenses. The remainder is the co-payment for the payment plan.

Reference: See Chapter H, Co-Payment, for the deduction of incurred medical expenses.

Example:

The couple has the following income:

  • Individual
    • $250 RSDI
    • + $130 Net earnings
  • Spouse
    • $800 Net earnings
    • Personal needs and protected earned income allowance calculation:
    • $250 RSDI unearned income
    • – $60 PNA
    • = $190 Remainder

Calculation for PEI when earnings are greater than $120:

  • Deduct $30 from the first $120 of earned income:
    • $120
    • – $30
    • = $90 Remainder of first $120 of earned income
  • Deduct one-half the remainder of the first $120 of earned income:
    • $90 Remainder of first $120 of earned income
    • / 2
    • = $45 One-half the remainder of the first $120 of earned income
  • Deduct 30 percent of earnings in excess of $120:
    • $130 Earnings
    • – $120 First $120 of earned income
    • = $10 Earnings in excess of $120
    • x .3
    • = $3 30 percent of earnings in excess of $120
  • Calculation of total PNA/PEI:
    • $60 PNA
    • + $30 PEI deduction from the first $120 of earned income
    • + $45 PEI deduction of one-half the remainder of the first $120 of earned income
    • + $3 PEI deduction of 30 percent of earnings in excess of $120
    • = $138 Total PNA/PEI
  • Co-payment calculation:
    • $250 RSDI
    • + $130 Net earnings
  • Step 1
    • = $380 Total
  • Step 2
    • – $138 Total PNA/PEI
    • = $242 Income available for diversion
  • Step 3
    • + $800 Spouse's income
    • = $1,042 Total
  • Step 4
    • – $3,160.50 Spousal allowance
  • Step 5 N/A
  • Step 6 N/A
    • = $0 Co-payment for payment plan

 

J-7400 Spousal Impoverishment Dependent Allowance

Revision 19-3; Effective September 1, 2019

 

For spousal cases, calculate the dependent allowance by subtracting the dependent's income from 150 percent of the monthly federal poverty level (FPL) for a family of two, and dividing the remainder by three. Mandatory payroll deductions also apply to a dependent's earned income.

Dependent family members may be either spouse's minor or dependent children, dependent parents, or dependent siblings (including half-brothers, half-sisters and siblings gained through adoption) who were living in an institutionalized person’s home before the person’s institutionalization and who are unable to support themselves outside the person’s home because of medical, social or other reasons.

Note: College students capable of supporting themselves do not meet the definition of a dependent.

The base amounts (150 percent of the FPL for two) for calculating the dependent allowance are:

Time Period

Amount

July 1, 2019 to present $2,114
July 1, 2018 to June 30, 2019 $2,058
July 1, 2017 to June 30, 2018 $2,030
July 1, 2016 to June 30, 2017 $2,003
July 1, 2015 to June 30, 2016 $1,992
July 1, 2014 to June 30, 2015 $1,967
July 1, 2013 to June 30, 2014 $1,939
July 1, 2012 to June 30, 2013 $1,892
July 1, 2011 to June 30, 2012 $1,839
March 1, 2009 to June 30, 2011 $1,822
March 1, 2008 to Feb. 28, 2009 $1,750
April 1, 2007 to Feb. 29, 2008 $1,712
April 1, 2006 to March 31, 2007 $1,650
Jan. 1, 2006 to March 31, 2006 $1,603.75
April 1, 2005 to Dec. 31, 2005 $1,604
April 1, 2004 to March 31, 2005 $1,562
April 1, 2003 to March 31, 2004 $1,515
April 1, 2002 to March 31, 2003 $1,493
April 1, 2001 to March 31, 2002 $1,452
April 1, 2000 to March 31, 2001 $1,407

 

Deduct the entire dependent allowance whether or not it is being made available to the dependent.

The community spouse can appeal the dependent allowance amount based on undue hardship caused by financial duress. Only hearing officers can set higher diversion amounts for cases of undue hardship. HHSC reviews cases of undue hardship every six months to monitor changes in circumstances.

 

Related Policy

General Information for Co-Payment, Section H-1000
Dependent Allowance, Section H-1600