Revision 17-3; Effective September 1, 2017

 

All Living Arrangements — Effective January 1, 2017

Special income exemption for student (regardless of living arrangement):

  • Monthly earnings — $1,790
  • Annual earnings — $7,200

For additional information, see Section E-2220, Student Earnings.

Note: The following information is effective January 1, 2017. These amounts do not include a $20 disregard.

 

Community Living Arrangement — Effective January 1, 2017

Income — Effective January 1, 2017, total countable income must be less than the Supplemental Security Income (SSI) federal benefit rate (FBR):

  • Individual — $735
  • Couple — $1,103
  • Deeming amount — $368

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000
  • Companion — $3,000

 

Community Living Arrangement In-Kind Support and Maintenance

Income — Effective January 1, 2017, total countable income must be less than the SSI FBR:

  • One-third of the SSI FBR:
    • Individual — $245.00
    • Couple — $367.66
  • One-third of the SSI FBR + 20:
    • Individual — $265.00
    • Couple — $387.66
  • One-half of the couple 1/3 SSI FBR:
    • Companion — $183.83
  • One-half of the couple 1/3 SSI FBR + 10:
    • Companion — $193.83

 

Medicare Savings Programs (MSP) — Effective March 1, 2017

Income — Effective March 1, 2017, total countable income must be:

  • QMB — Based on 100 percent of the federal poverty income limit (FPIL):
    • Individual — $1,005
    • Couple — $1,354
    • Deeming amount — $349
    • Medicaid benefits are:
      • Part A premiums
      • Part B premiums
      • Deductibles
      • Coinsurance
  • SLMB —Based on greater than 100 percent FPIL, but less than 120 percent FPIL:
    • Individual — $1,005.01 to < $1,206
    • Couple — $1,354.01 to < $1,624
    • Deeming amount — $418
    • Medicaid benefits are:
      • Part B premiums
  • QI-1 — Based on at least 120 percent FPIL, but less than 135 percent FPIL:
    • Individual — $1,206 to < $1,357
    • Couple — $1,624.01 to < $1,827
    • Deeming amount — $470
    • Medicaid benefits are:
      • Part B premiums
  • QDWI — No more than the limit based on 200 percent FPIL:
    • Individual — $2,010
    • Couple — $2,707
    • Deeming amount — $697
    • Medicaid benefits are:
      • Part A premiums

Note: These amounts do not include the $20 disregard for MSP.

Resources — Effective January 1, 2017, total countable resources must be:

  • QMB, SLMB, QI-1 — No more than the limit:
    • Individual — $7,390
    • Couple — $11,090
  • QDWI — No more than the limit:
    • Individual — $4,000
    • Couple — $6,000

 

Medicaid Buy-In (MBI) Program — Effective March 1, 2017

Income — MBI FPIL — Effective March 1, 2017:

  • Income eligibility is based on earnings.
  • Countable earned income must be less than the limit:
    • 250 percent of FPIL — $2,513

Resources — Total countable resources must be no more than the limit of $2,000.

MBI Monthly Premiums

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR of $735 Plus (+) Earned Income Premium

Countable Earned Income Based on FPIL Range
FPIL Dollar Range Earned Income Premium

 

Less than or equal to $1,508

$0

150%–185% of FPIL

Greater than $1,508 up to and including $1,860

$20

>185%–200% of FPIL

Greater than $1,860 up to and including $2,010

$25

>200%–250% of FPIL

Greater than $2,010 up to and including $2,513

$30

>250% of FPIL

Greater than $2,513

$40

If the unearned income premium amount plus the earned income premium amount equals or exceeds $500, then the total monthly premium remains at $500.

 

Medicaid Buy-In for Children (MBIC) Program Effective March 1, 2017

Resources — No resource test for MBIC.

Income

  • MBIC income exclusion — $85 plus one-half of the remaining income.
  • Eligibility — 150 percent FPIL based on family size — No more than the limit.
  • These amounts do not include the MBIC income exclusion.
FPIL Amounts for Income Eligibility
Family Size 150% FPIL
1 $1,508
2 $2,030
3 $2,553
4 $3,075
5 $3,598
6 $4,120
7 $4,643
8 $5,165

Ineligible sibling exclusion amount — $3,101

FPIL Amounts for Premium Determination
Family Size 150% FPIL 200% FPIL 300% FPIL
1 $1,508 $2,010 $3,015
2 $2,030 $2,707 $4,060
3 $2,553 $3,404 $5,105
4 $3,075 $4,100 $6,150
5 $3,598 $4,797 $7,195
6 $4,120 $5,494 $8,240
7 $4,643 $6,190 $9,285
8 $5,165 $6,887 $10,330
MBIC Premiums — No Employer-Sponsored Insurance (ESI)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount
At or below 150% FPIL $0 $0
151–200% FPIL

 

$90 $115
201–300% FPIL

 

$180 $230

 

MBIC Premiums — ESI with State-Paid Health Insurance Premium Program (HIPP)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount
At or below 150% FPIL $0 $0
151–200% FPIL

 

$25 $35
201–300% FPIL

 

$50 $70
 

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

Medicare for 2017

Part A Premium (Hospital Insurance):

  • $0 — Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
  • $413 — Standard Medicare Part A monthly premium cost — The monthly Part A premium for people who are not otherwise eligible for premium-free hospital insurance and who have less than 30 quarters of Medicare-covered employment.
  • $227 — Reduced Medicare Part A premium — The monthly Part A premium for people who have 30–39 quarters of Medicare-covered employment.

Part A Deductible and Coinsurance
Pays for inpatient hospital, skilled nursing facility (SNF) and some home health care. For each benefit period, Medicare pays all covered costs except the Medicare Part A deductible (2017 = $1,316) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period the Medicare recipient pays:

  • Part A deductible — A total of $1,316 for a hospital stay of 1–60 days.
  • Part A coinsurance:
    • $329 per day for days 61–90 of a hospital stay.
    • $658 per day for days 91–150 of a hospital stay (lifetime reserve days).
    • All costs for each day beyond 150 days.
  • Skilled nursing $164.50 per day for days 21–100 each benefit period in an SNF.

Part B Premium (Medical Insurance):

  • $134.00— 2017 standard Medicare Part B monthly premium.

Staff must use the Medicare Part B amount as verified in the State Online Query (SOLQ). For more information, see Section H-1800, Medicare Part B Premium.

Part B Deductible
Covers Medicare-eligible physician services, outpatient hospital services, certain home health services and durable medical equipment.

Medicare recipient pays:

  • Part B deductible:
    • The first $183 yearly for Part B-covered services or items.
    • 20 percent of the Medicare-approved amount for services, after the person meets the $183 deductible.

Community Attendant Services (CAS) — Effective January 1, 2017

The intent of the program is to delay or prevent the need for institutional care. Eligible individuals do not get regular Medicaid benefits; they get only Primary Home Care (PHC) services. This program historically was called Waiver Five, and later 1929(b).

Income — Effective January 1, 2017, total countable income must be no more than the special income limit:
  • Individual — $2,205
  • Couple — $4,410

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000


Institutional Living Arrangement — Effective January 1, 2017

Individual or Couple Budget

Nursing Facility Living Arrangement

Special income limit — The income limit used to test MEPD eligibility for an individual or a couple in an institutional setting per Texas Administrative Code, Title 1, Part 15, Chapter 358, §358.433, Special Income Limit. Formerly known as “institutional income limit.”

Section E-4311.2, $90 VA Pension and Institutional Setting — If a veteran without a spouse or child, or a surviving spouse without a child, is covered by Medicaid for services furnished by a nursing facility, the maximum pension that can be paid to or for the veteran or surviving spouse for any month after the month of admission to such nursing facility is $90. This reduced pension is an aid and attendance allowance in all cases, and not income. Do not consider the $90 in the eligibility or co-payment budget.

Income — Effective January 1, 2017, total countable income must be no more than the special income limit:

  • Individual — $2,205
  • Couple — $4,410

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000
  • Substantial home equity — $560,000
  • Transfer of assets (TOA) divisor — $172.65 daily rate (effective September 1, 2017)

Note: The daily rate is reviewed every biennium.

Co-Payment — Nursing Facility Living Arrangement

Individual or Couple Budget:


Institutional Living Arrangement — Effective January 1, 2017

Spousal Budget — Nursing Facility Living Arrangement

Income — Effective January 1, 2017, total countable income must be no more than the special income limit:

  • Individual — $2,205

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Substantial home equity — $560,000
  • TOA divisor — $172.65 daily rate (effective September 1, 2017)

Note: The daily rate is reviewed every biennium.

Calculation of the Spousal Protected Resource Amount (SPRA):

  • SPRA is the greater of:
    • one-half of the couple's combined countable resources; or
    • the minimum resource amount set by federal law (SPRA minimum — $24,180); but
    • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $120,900).
  • Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion — $3,022.50

Co-Payment — Spousal Budget

Nursing Facility Living Arrangement:

  • Section H-1500, Personal Needs Allowance (PNA) — $60
  • Section H-1550, Guardianship Fees — Varies
  • Community spouse's allowance — $3022.50
  • Section J-7400, Spousal Impoverishment Dependent Allowance — $2,030 (effective July 1, 2017)
  • Section H-2000, Incurred Medical Expenses — Varies


Institutional Living Arrangement — Effective January 1, 2017 — Individual or Couple Budget

Home and Community-Based Services Waiver Living Arrangement

Income — Effective January 1, 2017, total countable income must be no more than the special income limit:

  • Individual — $2,205
  • Couple — $4,410

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000
  • Substantial home equity — $560,000
  • TOA divisor — $172.65 daily rate (effective September 1, 2017)

Note: Check TOA policy for waivers. The daily rate is reviewed every biennium.

Co-Payment — Home and Community-Based Services Waiver Living Arrangement

Individual or Couple Budget:

  • Section H-1500, Personal Needs Allowance (PNA) — $2,205 (per eligible waiver recipient)
  • Section H-1550, Guardianship Fees — Varies
  • Dependent allowance — Varies
  • Section H-2000, Incurred Medical Expenses — See also Medicare page

Notes:

  • Because the institutional setting income limit is used as PNA, usually no co-payment allowances other than PNA will be available. When the recipient has excess income and uses a qualified income trust (QIT), more co-payment deductions can be allowed. Use the worksheets in Appendix XXII, Home and Community-Based Services Waiver Program Co-Payment Worksheets.
  • If the Home and Community-Based Services waiver recipient is living in foster care or an assisted living facility, use the worksheets in Appendix XXII.


Institutional Living Arrangement — Effective January 1, 2017

Spousal Budget — Home and Community-Based Services Waiver Living Arrangement

Income — Effective January 1, 2017, total countable income must be no more than the special income limit:

  • Individual — $2,205

Resources — Effective January 1, 2017, total countable resources must be no more than the limit:

  • Individual — $2,000
  • Substantial home equity — $560,000
  • TOA divisor — $172.65 daily rate (effective September 1, 2017)

Note: Check TOA policy for waivers. The daily rate is reviewed every biennium.

Calculation of SPRA:

  • SPRA is the greater of:
    • one-half of the couple's combined countable resources, or
    • the minimum resource amount set by federal law (SPRA minimum — $24,180), but
    • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $120,900).
  • Income-first MMMNA for SPRA expansion — $3,022.50

Co-Payment

Spousal Budget — Home and Community-Based Services Waiver Living Arrangement:

  • Section H-1500, Personal Needs Allowance (PNA) — $2,205
  • Section H-1550, Guardianship Fees — Varies
  • Community spouse's allowance — $3,022.50
  • Section J-7400, Spousal Impoverishment Dependent Allowance — $2,030 (effective July 1, 2017)
  • Section H-2000, Incurred Medical Expenses — Varies

Notes:

  • Because the institutional setting income limit is used as PNA, usually no co-payment allowances other than PNA will be available. When the recipient has excess income and uses a QIT, more co-payment deductions can be allowed. Use the worksheets in Appendix XXII, Home and Community-Based Services Waiver Program Co-Payment Worksheets.
  • If the Home and Community-Based Services waiver recipient is living in foster care or an assisted living facility, use the worksheets in Appendix XXII.