Revision 15-4; Effective December 1, 2015

 

G-3100 Noninstitutional Budgets

Revision 09-4; Effective December 1, 2009

 

Eligibility is determined for individuals and couples (in noninstitutional living arrangements) who:

  • apply for retroactive Medicaid coverage;
  • apply for or have eligibility redetermined under various federally-mandated MEPD programs; or
  • apply for or have eligibility redetermined under the Community Attendant Services (CAS) program formerly known as 1929(b).

The income standard used and the income counted depend on whether the budget is for an individual, companion or couple case.

 

G-3110 Individual Noninstitutional Budget

Revision 09-4; Effective December 1, 2009

 

The full SSI federal benefit rate for an individual is the income standard or limit used for a person. Only the person’s income is considered. An individual budget is prepared if the person is single, widowed or divorced, or a married person who is:

  • a person separated from his spouse at the time of application, or
  • a person separated from his spouse during the previous month.

If the person is an individual and the MEPD program is Community Attendant Services (CAS), the institutional special income limit for an individual is the income standard or limit used.

See Appendix XXXI, Budget Reference Chart

 

G-3120 Companion Noninstitutional Budget (Person with Ineligible Spouse)

Revision 09-4; Effective December 1, 2009

 

The full SSI federal benefit rate for an individual is the income standard or limit used for a person, if a person lives with his ineligible spouse during any part of a calendar month. The income of the ineligible spouse may be deemed available to the person. See Section E-7000, Deeming Income, and Section G-2311, Spouse-to-Spouse Noninstitutional Deeming.

The institutional special income limit for an individual is the income standard or limit used for a person, if a person lives with his ineligible spouse during any part of a calendar month and the MEPD program is Community Attendant Services (CAS).

 

G-3130 Couple Noninstitutional Budget

Revision 15-4; Effective December 1, 2015

 

The following applies to couple budgets:

MEPD programs consider the income of both spouses against the full SSI payment standard for a couple (or the appropriate income limit for a couple if both spouses are clients in the same coverage group). A couple budget is prepared if an individual is living 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 institutional special income limit for a couple is the income standard or limit used for a couple, if the person lives with the eligible spouse during any part of a calendar month and the MEPD program is CAS.

Note: A couple budget is not prepared when only one member of an eligible couple enters a Title XIX long-term care facility and is entitled to vendor payment.

 

G-3131 Couple Budget Policy

Revision 09-4; Effective December 1, 2009

 

If both spouses are ineligible as a couple, redetermine the eligibility for each person on an individual basis. Use deeming procedures if appropriate. See Section E-7000, Deeming Income, and Section G-2311, Spouse-to-Spouse Noninstitutional Deeming.

Prepare an individual deeming budget for each spouse.

Perform the deeming pre-test for each member of the couple. Allow the exclusions, including the $20 dollar general exclusion, for each member of the couple during the deeming pre-test.

If only one member of the couple is eligible based on the deeming pre-test, complete a special deeming eligibility test worksheet using the steps found in Appendix XXIX, Special Deeming Eligibility Test for Spouse to Spouse, for the member found eligible in the pre-test.

If both members of the couple are eligible based on the deeming pre-test, complete a special deeming eligibility test worksheet using the steps in Appendix XXIX. Complete a worksheet for each member of the couple and follow the steps for each member as if one member of the couple was ineligible.