Aged, Blind, Disabled (ABD): UpdatedDetermining Eligibility of Eligible Individual with an Ineligible Spouse

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 $570 a month. He is applying for the SSP and medical. His wife Claire and three minor children are not disabled. Claire works and earns a monthly gross salary of $2900 a month. Claire and the children each get a spousal/dependent benefit of $71. The children have no other income. 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.

Income Eligibility

Step 1:The eligible individual’s countable income.

Cliff’s countable income as an individual: $570

Step 2:Ineligible Child Allocation: $472 (Allocation) – $71 (child’s income) = $401 x 3 children = $1,203.

$1,203 (allocation) – $71 (Claire’s unearned income) = $1,132

$2900 (Claire’s earned) – $1132 = $1768

The remainder is higher than a single ineligible child allocation ($472) so Claire’s income will be considered towards Cliff’s eligibility.

Step 3:Couple’s countable income

$1768 (from Step 2) – $20 (GIE) = $1748 (Because we are looking at an SSP Benefit we give the GIE to the earned income)

Apply the earned income formula

1748 – $65 = $1683/2 = $841.50

$842 (Claire’s countable income) + $570 (Cliff’s countable income) = $1412

Step 1 income ($570) under the SSP standard ($984)

Step 3 income ($1412) is under the SSP standard ($1456)

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 $950 in RSDI. Her husband Philip is receiving $1150 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 $14,130.

Step 1: Vivian’s countable income: $950

Step 2: $472 (ineligible child allocation x 1 = $472.

$1150 (Philip’s VA) – $472 = $678

The remainder is more than the amount of a single ineligible child allocation ($472) so Philips’ will be considered towards Vivian’s eligibility.

Step 3: Couple’s countable income

$950 – $20 (GIE) = $930

$930 (Vivian’s countable income) + $678 (Philip’s countable income) = $1608

Step 4: Income from Step 1 ($950) is under the individual QMBP standard ($1255) and Income from Step 3 ($1608) is under the individual and spouse QMBP ($1704) so Vivian can be certified for QMBP.

Refer to article ABD: How to Code for Eligible Ineligible with Ineligible Spouse and view Example 2 for instructions on coding the case.

Resource Eligibility

Only countable resource is the checking account of $12.

Example 3

George is disabled. He receives $850 in RSDI and works part time earning $325 a month. He is applying for medical assistance. He is married to Anna and they have two minor children living in the home. Anna works and receives $2000 a month in earned income. Both children receive a portion of their fathers RSDI income in the amount of $212 each. They live in the home they own and they have two vehicles. George drives a 1990 Chevy Astro Van Extended with NADA value of $1475. Anna uses a 2020 Ford Fusion 4 door SE 14 Turbo with a value of $14,000 and she currently owes $4,000 on it. They also have a joint bank account with a carryover balance of $450. There are no other resources reported.

Step 1: Determining Countable Income for George as an individual

$850 RSDI

$325 earned income – 20 (GIE) = 305 (Because it appears his income may be eligible for SSP – We give the GIE off the earned income.)

Apply earned income formula:

$305 – 65 = 240/2 = 120

George Countable Income:

$850 (RSDI) + $120 countable earned = $970

Step 2: Ineligible Child Allocation

There are 2 ineligible children each receive $212.

Child 1 = 472 (Ineligible child allocation) – 212 (child’s income) = 260

Child 2 = 472 (Ineligible child allocation) – 212 (child’s income) = 260

260 + 260 = 520 (Total child allocation may deduct from ineligible spouse’s income)

2000 (Ineligible spouses, Anna’s income) – 520 (Total ineligible child allocation) = 1480

1480 is more than one child’s allocation of 472 therefore 1480 of ineligible spouse’s earned income is countable

Step 3: Couple’s countable income

Unearned income $850 since it appears couple income will exceed the SSP standard we will deduct the $20 GIE from the unearned income.

$850 – $20 (GIE) = $830 Countable unearned

Add earned income from George and Anna’s remaining income from Step 2.

$325 (George’s earned income) + $1480 Anna’s countable earned income from Step 2) = 1805

Apply the earned income formula:

1805 – 65 = 1740 / 2 half the remainder = $870 countable earned income

Total countable income is the countable earned $870 + the countable unearned $830 = $1700

Step 4: Compare the Income

In step 1 George’s countable income of $970 is under the SSP standard of $984.

However, in Step 3, the couple’s countable income of $1700 meets the income standards for QMBP ($1704).

George is eligible for QMBP based on income.

Resource Eligibility

  • Home is exempt
  • Two vehicles
    • 2020 Ford Fusion 4 door SE 14 Turbo with a value of $14,000 owes $4,000
    • 1990 Chevy Astro Van Extended with NADA value of $1475

Both vehicles are used for transportation exempt the Ford Fusion it has the higher value the $1475 value of the Astro Van is a countable resource.

  • Bank account with carryover balance of $450 month to month
  • Total resources if $450 (Bank account) and $1475 (Vehicle) total $1925.

Household is resource eligible for QMBP

Certify George for QMBP.

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