Revision 153; Effective September 1, 2015
To determine the copayment for a person living in an approved public or private ICF/IID facility, use the following budget steps. The difference in the copayment calculation for this group is that a person who has earned income in excess of $30 per month may receive an additional allowance. The purpose of the additional allowance is to provide the ICF/IID person who has a short or longterm objective of semiindependent or independent living the additional resources to make the transition possible.
H5100 ICF/IID Individual and Couple Cases
Revision 123; Effective September 1, 2012
For individuals and couples, follow the steps in this section.
HHSC nets the person'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.
H5110 ICF/IID Individual
Revision 153; Effective September 1, 2015
Determine the person’s monthly net earned and gross unearned income.
Determine the personal needs allowance (PNA) for a person as follows:
Person earns $30 or less.
Step  Description 

1: 
Deduct the $60 PNA from the unearned income. 
2: 
To the extent the unearned income is less than $60, deduct the difference from the earned income. 
3: 
Deduct all remaining earned income up to $30. 
4: 
Add the deductions from steps 1 through 3 to determine the total PNA/PEI allowance. 
Note: The total PNA/PEI must be at least $60.
Example: Person receives $300 RSDI and earns $30 per month.
Step  Description 

1:  $300 unearned – $60 PNA = $240 
2:  NA 
3:  $30 earned – $30 PEI = $0 
4:  $60 PNA + $30 PEI = $90 PNA/PEI 
Person's earnings exceed $30 but not $120.
Step  Description 

1:  Deduct the $60 PNA from the unearned income. 
2:  To the extent the unearned income is less than $60, deduct the difference from the earned income. 
3:  Deduct $30 from the remaining earned income, plus onehalf of the remainder. 
4:  Add the deductions from steps 1 through 3 to determine the total PNA/PEI deduction. 
Example: Person earns $120 per month and receives $12.50 SSI.
Step  Description 

1:  $12.50 unearned – $60 PNA = –$47.50 
2:  $120 earned – $47.50 = $72.50 
3:  $72.50 remaining earned – $30 = $42.50 divided by 2 = $21.25 
4:  $12.50 + $47.50 + $30 + $21.25 = $111.25 PNA/PEI 
Person's earnings exceed $120.
Step  Description 

1: 
Deduct the $60 PNA from the unearned income. 
2: 
To the extent the unearned income is less than $60, deduct the difference from the first $120 of the earned income. 
3: 
Of the monies remaining from the first $120 of earned income, deduct $30 and onehalf of the remainder. 
4: 
Deduct 30 percent of the earnings in excess of $120. 
5: 
Add the deductions from Steps 1 through 4 to determine the total PNA/PEI allowance. 
Example 1: Person receives $300 RSDI and earns $250.
Step  Description 

1: 
$300 unearned – $60 PNA = $240 
2: 
NA 
3: 
$120 earned – $30 = $90 divided by 2 = $45 
4: 
$250 earned – $120 = $130 x .30 = $39 
5: 
$60 PNA + $30 + $45 + $39 = $174 PNA/PEI 
Example 2: Person receives $7.50 SSI and earns $130.
Step  Description 

1: 
$7.50 unearned – $60 = –$52.50 
2: 
$120 earned – $52.50 = $67.50 
3: 
$67.50 remaining earned – $30 = $37.50 divided by 2 = $18.75 
4: 
$130 earned – $120 = $10 x .30 = $3 
5: 
$7.50 + $52.50 + $30 + $18.75 + $3 = $111.75 PNA/PEI 
References:
 Subtract the guardian fee allowance, if applicable.
 Subtract incurred medical expenses.
 Subtract the home maintenance allowance, if applicable.
 The total net earned income and gross unearned income minus the total personal needs allowance and other allowable deductions is the copayment.
H5120 ICF/IID Couple
Revision 123; Effective September 1, 2012
Determine the personal needs allowance for a couple as follows:
 If neither spouse has earned income, or if the only spouse with earned income does not have an ICF/IID level of care, the personal needs allowance for the couple is $60 for each spouse.
 If either spouse is an ICF/IID person who has monthly earned income, determine the personal needs allowance for each separately based on their individual monthly incomes.
Note: If one spouse has a level of care other than an ICF/IID level of care, the personal needs allowance for that individual is $60, regardless of whether the individual has earned income. Combine the individual personal needs allowance for the couple.
Subtract the total personal needs allowance from the total of net earned income and gross unearned income of the couple.
References
 Subtract guardian fee allowance, if applicable.
 Subtract incurred medical expenses.
 Subtract home maintenance allowance, if applicable.
 Divide the remainder by two to determine the copayment for each spouse.
H5130 ICF/IID Companion
Revision 123; Effective September 1, 2012
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 copayment budget for a companion situation, use the following steps:
Step  Procedure 

1 
Determine the countable net earned and gross unearned income of the person. 
2 
Subtract the personal needs allowance, including the protected earned income allowance (if any) of the person based on his own net income. Subtract 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 

6 
Subtract incurred medical expenses. 
The remainder is the copayment.
Example: The couple has the following income:
Person 
Spouse 

$250 
$800 
Net Earnings 

$130 
Net Earnings 
Calculation for personal needs and protected earned income allowance:
$250 
RSDI unearned income 
− 60 
PNA 
$190 
remainder 
Calculation for protected earned income when earnings are greater than $120:
$120 
Deduct $30 from the first $120 of earned income 
− 30 

$ 90 
divided by 2 = $45 and get onehalf the remainder 
Calculation for 30% of earnings in excess of $120:
$130 
Earnings 
−120 
First $120 of earned income 
$ 10 
x .3 = $3 (30% of earnings in excess of $120) 
Calculation for Total PNA/PEI:
$ 60 
PNA 
30 
$30 deduction 
45 
Onehalf the remainder deduction 
+ 3 
(30% of earnings in excess of $120) 
$138 
Total PNA/PEI 
Copayment 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: 
−2,841 
Spousal allowance 
Step 5: 
NA 

Step 6: 
NA 

$ 0 
Copayment 