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Revision 09-4; Effective December 1, 2009
Eligibility is determined for individuals and couples (in institutional living arrangements) who:
- apply for retroactive Medicaid coverage; or
- apply for or have eligibility redetermined under federally optional MEPD programs.
When a person not already eligible for Medicaid moves to an institutional setting, the income standard used and the income counted depend on whether the budget is for an individual, companion or couple case. Income is tested against the special income limit. See Appendix XXXI, Budget Reference Chart.
G-6110 Individual Institutional Eligibility Budget
Revision 09-4; Effective December 1, 2009
When a person applies for Medicaid, an individual budget is prepared if a person in an institutional setting is:
- single;
- widowed; or
- divorced.
Note: An individual budget is also used when a person is married and has a community spouse, but the community spouse refuses to cooperate in providing information and circumstances indicate possible abuse or neglect by the community spouse.
The income of the person is considered against the special income limit standard for an individual.
G-6120 Couple Institutional Eligibility Budget
Revision 18-3; Effective September 1, 2018
A couple budget is prepared when a person is residing in the same institutional setting with an eligible spouse (i.e., a spouse who is aged or has a disability) and they are:
- presenting themselves to the community as a married couple;
- determined to be married for purposes of receiving Social Security benefits; or
- recognized as married under state law.
The incomes of both spouses are considered against the special income limit standard for a couple.
Prepare two individuals budgets when a married couple:
- resides in different institutional settings; or
- is ineligible as a couple.
G-6130 Companion Institutional Eligibility Budget
Revision 09-4; Effective December 1, 2009
An institutional companion budget is prepared for a person in an institutional setting if:
- the person has a community spouse; and
- the couple meets the definition of a couple in Section G-6120, Couple Institutional Eligibility Budget, except the criterion that the couple live together does not apply.
Note: If the institutional setting is a waiver, the couple could be living together. If the institutional setting is a Medicaid certified facility, then the couple will not be living together since the criterion for a companion budget is a community spouse.
In preparing a companion institutional budget for a person, spousal impoverishment treatment of income and resources applies. See Chapter J, Spousal Impoverishment.
For the eligibility budget, the income of the person in the institutional setting is considered against the special income limit standard for an individual.