The following are instructions / examples on calculating a vendor payment. The basic equation for calculating the vendor payment is the total countable income minus the maintenance standard, minus any verified medical insurance expense, equals the vendor payment.

Countable Income (Review Quest article How to Round SSI and RSDI for Medical)

• Maintenance Standard
• Verified medical insurance expenses (add the exact amount of all insurance expenses, then round the total amount either up or down.)

= Vendor Payment

Use Appendix C-1, Schedule VIII.B.2 to determine the correct maintenance standard.

NOTE: Nursing care clients do not receive the $20 general income exclusion when determining the vendor payment.

Example 1: Single Individual

Mrs. Crawley entered the nursing home on October 3, 2020. She receives RSDI income in the amount of $1,200 and Retirement of $350. She pays $164.90 a month for Medicare.

$1,200 + $350 = $1550

• Maintenance Standard ($75)
• Verified medical expense ($165)

= Vendor Payment ($1310)

Example 2: Reduced VA Pension

If a client has a reduced VA Pension (they are allowed $90 + $75 for a total of $165 for the maintenance standard. Remember to add the VA pension in the initial calculation to determine if a MIPT is needed.

Mr. Evans entered the nursing home on December 24, 2020. He receives a reduced pension from the VA. He also receives $1300 in RSDI income and $420 pension. He pays $164.90 for Medicare and $118.50 for a Supplemental Health Insurance Plan.

Gross monthly income = $1810 ($90 + $1300 + 420)

• Maintenance Standard = $165 ($75+90)
• Verified medical expenses = $283 ($164.90 + $118.50 = $283.40)

= Vendor Payment $1362

Example 3: MIPT

If the client requires a Medicaid Income Pension Trust to be established, determine the monthly amount to remain in the MIPT before calculating the vendor payment by subtracting the current Categorically Needy Standard from the gross monthly income (*Appendix C-1 Schedule VIII B.1)

Mrs. Jasper entered the nursing home on February 3, 2021. She receives $1900 RSDI and a $1100 pension. She pays $164.90 for Medicare and $298.10 for a Supplemental Health Insurance Plan.

The amount needed to fund the MIPT is $3000 – $2742 = $258

Countable income after MIPT $2742

• Maintenance Standard = $75
• Verified medical expense = $463 ($164.90 + $298.10 = $463)

= Vendor Payment $2204

Example 4: Spousal Impoverishment

If the applicant is married, some of the income can be deemed over to the community spouse. The amount of income deemed to the community spouse affects the amount of the vendor payment.

Mr. Greely entered the nursing home on March 15, 2021. He receives $1800 RSDI and $300 pension. Mr. Greely has a Medicare Premium of $164.90 Mrs. Greely remains in the home and receives a pension of $1500. Mrs. Greely is applying for ADvantage Waiver (Refer to Step 2.2)

Step 1 – Determine how much income Mr. Greely has available to deem.

$1800 + $300 = $2100

• Maintenance Standard $75
• Verified medical expense $165 ($164.90)

= Vendor Payment or Available to Deem $1860

Step 2.1 Determine how much is allowed to deem to the community spouse without DHS benefits.

Community Spouse without DHS benefits:

$3716 – $1500 (CS income) = $2216 * Appendix C-1 Schedule X Maximum monthly income standard)

Determine the final amount deemed to the community spouse and calculate vendor payment for institutionalized spouse. In this example, we are only allowed to deem $2216 to the Community Spouse and the total amount available to deem is $1860.

$1860 (Amount Available to Deem)

• $2216 (Amount to Deem to Community Spouse)

= Vendor Payment $0

Step 2.2 Determine how much is allowed to deem to the community spouse (CS) with or applying for DHS benefits.

Mrs. Greely is applying for DHS benefits. If the community spouse is receiving a medical program or applying for benefits, we take the income standard of the medical program (QMB+, SLMB, QI1, ADvantage waiver) that is needed and subtract the income of the community spouse (CS).

Community Spouse applying for ADvantage waiver benefits:

$2742 – $1500 (CS income) = $1252*Appendix C-1 Schedule VIII B.1 Categorically Needy Standard)

Determine the final amount deemed to the community spouse and calculate vendor payment for institutionalized spouse. In this example, we are only allowed to deem to $1252 to the Community Spouse and the total amount available to deem is $1860.

$1860(Amount Available to Deem)

• $1252 (Amount allowed to Deem to Community Spouse)

= $608 (Vendor Payment)

Example 5: SSI Recipient

Mr. Nguyen enters the nursing home on January 5^th, 2020 and we received notification on February 8^th, 2020. He receives $749 of SSI and SSP of $41. SSP is being closed effective March 1^st, 2020.

$41 + $30 = $71 (SSP + $30 part of SSI that is considered)

• Maintenance Standard ($75)

= Vendor Payment ($0)

The vendor payment will be $0 for January 2020 (entered ICF after the 1^st day of the month) and $0 for February 2020. The vendor payment will continue to be $0 for March 2020 forward as the client is no longer receiving SSP and the SSI amount received ($30) is under the maintenance standard.

**NOTE: For individuals that reside in an ADvantage Assisted Living Center, use the Maintenance Standard – found on Appendix C-1. Schedule VIII B.2 for ADvantage assisted living facility residents.

The Medicaid Computation Worksheet 08MA008E, can be used to calculate the vendor payment as long as Spousal Impoverishment is NOT being considered. If there is a community spouse please use Title XIX Work Sheet 08MA012E.