Resources 317:35-5-41(a)(3)

For an “Eligible Individual with an Ineligible Spouse”, look at all the resources belonging to either spouse and determine what is countable. Compare the couple’s total countable resources to the appropriate couple resource standard.

Definition of an Eligible Individual

• For SSP and QMBP, an eligible individual is someone considered aged, blind, or disabled using Social Security’s criteria or someone who is on SSI.
• For SLMB and QI-1, an eligible individual is one who is enrolled or has been given a date by Medicare when s/he will be enrolled into Medicare.

Definition of an Ineligible Spouse

• For SSP or QMBP, an ineligible spouse is someone who is not considered age, blind or disabled using Social Security’s criteria or someone from whose income SSI subtracted the Ineligible Child Allocation.
• For SLMB and QI-1, an ineligible spouse is one who is not on Medicare or has not been given a date by Medicare when s/he will be enrolled in Medicare.

Use these steps to determine income eligibility for an Eligible Individual with an Ineligible Spouse 317:35-5-42(m):

Step 1: Eligible Spouse as an Individual

• Take the ABD individual’s gross income and subtract the applicable deductions from 317:35-5-42(d) from it.
• (The deductions used in this step will all be available to use in Step 3.)

Step 2: Ineligible Child Allocation

• If the couple do not have an ineligible child skip this step.
• If the couple have minor children who do not receive SSI, SSP, or TANF take the Ineligible Child Allocation [Appendix C-1 Schedule VIII.C] and deduct the child’s total gross income from it.
• One Ineligible Child Allocation is used for each ineligible minor biological, adopted, or step-child who lives in the home.
• The remainder for each child is added together. This amount is the total ineligible child allocation.
• Next, take the Ineligible Spouse’s unearned gross income and subtract the ineligible child allocation amount determined. If any of the ineligible child allocation remains, deduct it from the Ineligible Spouse’s earned income.
  • If the remainder of the Ineligible Spouse’s income is more than a single Ineligible Child Allocation [Appendix C-1 Schedule VIII.C], the income must be considered for the Eligible Individual
  • If the remainder of the Ineligible Spouse’s income is equal to or less than a single Ineligible Child Allocation [Appendix C-1 Schedule VIII.C], the income does not have to be considered for the Eligible Individual. Skip step 3.

Step 3: Couple’s Countable Income

The ineligible spouse’s income is used to determine eligibility. Use either the ineligible spouse’s gross income or the remaining income from Step 2 and add it to the Eligible individual’s gross income.

• Add unearned income to unearned income and earned income to earned income
• Apply all the applicable deductions from 317:35-5-42(d). Any deductions from Step 1 can be used again in this step.
• Add the unearned and earned incomes together to get the couple’s total, combined income.

Step 4: Compare the Income

• Compare the countable income from Step 1 to the Individual Standards on the Appendix C-1.
• Next, compare the countable income from Step 3 to the Eligible Individual with an Ineligible Spouse or Couple standards on the Appendix C-1.

To be eligible for a program, the client must meet the income standards as both an individual and as a couple.

Example 1

Cliff is disabled and receiving RSDI of $967 a month. He is applying for the SSP and medical. His wife Claire is not disabled. Claire works and earns a monthly gross salary of $999 a month. He has a bank account with a current balance of $25.37. She has a bank account with a current balance of $298.03. They own the home they live in as their primary residence. Claire has a 2010 Kia Sedona EX, which she uses for transportation to work.
Step 1: The eligible individual’s countable income.

Cliff’s countable income as an individual: $967

Step 2: Ineligible Child Allocation(step is skipped – no children in the home)

Step 3: Couple’s countable income

$999 (from Step 2) – $20 (GIE) = $972 (Because we are looking at an SSP Benefit we give the GIE to the earned income)

Apply the earned income formula

$979 – $65 = $914/2 = $457 Rounded to $874

$457 (Claire’s countable income) + $967 (Cliff’s countable income) = $1424

Step 4: Apply the standards to determine income eligibility

Step 1 income $967 under the SSP standard ($1007)

Step 3 income ($1424) is under the SSP eligible individual with ineligible spouse standard ($1491)

Cliff can be certified for the SSP

Resource Eligibility

• Exempt primary residence
• Exempt one vehicle per household
• Countable bank account balance: $25.37 (his account) + $298.03 (her account) = $323.40 rounded to $323.
• Total countable resources: $323 – under the SSP resource standard
• Financially eligible for SSP
• Refer to article ABD: How to Code for Eligible Individual with Ineligible Spouse and view Example 1 for instructions on coding the case.

Example 2

Vivian is applying for disability-related benefits. She is receiving $1040 in RSDI. Her husband Philip is receiving $1160 pension from the VA. They have one child, Charlton.  Their only resource is a checking account with a reported balance of $12. The bank account balance is under the QMBP standard of $14,470.

Step 1: The eligible individual’s countable income.

Vivian’s countable income: $1040 – $20 (GIE) = $1020

Step 2: Is the ineligible spouse’s income considered towards the disabled spouse’s eligibility?

$484 (ineligible child allocation x 1 = $484)

$1160 (Philip’s VA) – $484 = $676

The remainder is more than the amount of a single ineligible child allocation $484 so Philip’s income will be considered towards Vivian’s eligibility.

Step 3: Couple’s countable income

$1040 (Vivian’s countable income) + $676 (Philip’s income from Step 2) = $1696

Step 4: Income from Step 1 ($1020) is under the individual QMBP standard ($1255) and Income from Step 3 ($1696) is under the individual and spouse QMBP ($1704) so Vivian can be certified for QMBP.

Resource Eligibility

• Only countable resource is the checking account of $12.
• Refer to article ABD: How to Code for Eligible Ineligible with Ineligible Spouse and view Example 2 for instructions on coding the case.