Long Term Care (LTC): Spousal Impoverishment Examples – Income

Income is determined separately for an individual and his/her spouse for ADvantage, Nursing Home Care and Home Community Base Waiver / Intellectually Disabled (HCBW/ID) services. If the Community Spouse (CS’s) monthly gross income is less than the Maximum monthly income standard as shown on Appendix C-1, Schedule XI, the Institutionalized Spouse (IS) may deem a portion of his/her income sufficient to raise the CS’s income to the Maximum monthly income standard.

If the community spouse (CS) receives ADvantage Waiver or Home Community Based Waiver services, the deemed income amount must not cause the CS to exceed the categorically needy standard on Appendix C-1, Schedule VIII B.1.

Example 1:

James Williams is applying for nursing care. His spouse Rita plans to remain in the home and is concerned about having enough income to cover household expenses. James receives a monthly gross income of $1200 in RSDI benefits and a $300 pension. Rita receives RSDI income in the gross amount of $1,400 a month. James has a monthly Medicare Premium of $164.90. Rita states that she does not need any medical services at this time.

James Williams (Institutionalized Spouse) Income Rita Williams (Community Spouse) Income Total Medical Expense
$1,500 $1,400 $164.90

A Medicaid Income Pension Trust (MIPT) is not needed for James (IS) as his income is less than the Categorically Needy Standard for LTC according to Appendix C-1, Schedule VIII B.1. (4/1/2023) $2742 in this example.

First, determine how much of James’s (IS) income is available to deem to Rita (CS). The $75 maintenance standard for individuals residing in a nursing facility and the $170 Medical Expense is deducted from James’s (IS) income.

James Williams (IS) Income = $1500
Maintenance Standard = -$75
Medical Expense = -$165
Vendor Payment / Amount available to deem. = $1260

$1260 Nursing Facility (NF) vendor payment or amount available to deem to Rita (CS).

Second, determine how much of the available income ($1260) can be deemed to Rita (CS). Rita is not applying for any DHS medical services. If the community spouse is not applying for / or receiving DHS medical benefits, subtract the community’s spouse income from the Maximum monthly income standard found on Appendix C-1, Schedule XI. $3716 in this example.

Maximum monthly income standard = $3716
Rita Williams (CS) Income = -$1400
Maximum amount that can be deemed. = $2316

Since there is only $1260 available to deem to Rita (CS), all of it can be deemed and James (IS) will have a $0 vendor payment. Rita now has an additional $1260 per month to go towards her expenses.

Example 2:

Carol Riley is applying for nursing care as she has several medical issues that require services outside of the home. Her spouse Brian plans to remain in the home, but it interested in applying for ADvantage. Carol receives $2000 in RSDI income and a $805 pension. She pays a $164.90 Medicare Premium and $150 Supplemental Health Insurance Premium. Brian receives retirement in the amount of $900 a month.

Carol Riley (IS) Income Brian Riley (CS) Income Total Medical Expense
$2805 $900 $314.90

An MIPT is needed for Carol (IS) as her countable income is above the Categorically Needy Standard for LTC but less than the maximum monthly countable income for a MIPT. Subtract the Categorically Needy Standard (according to Appendix C-1 Schedule VIII B.1) from the institutionalized spouse’s income.

Carol Riley (IS) Income = $2805
Categorically Needy Standard (eff 4/1/2023) = $2742
Amount needed to fund MIPT (monthly) = $63

First, determine how much of Carol’s (IS) income is available to deem to Brian (CS). The $75 maintenance standard for individuals residing in a nursing facility and the $315 Medical Expense is deducted from Carol’s (IS) income.

Carol Riley (IS) Income (After MIPT is funded) = $2742
Maintenance Standard = -$75
Medical Expense = -$315
Vendor Payment / Amount available to deem. = $2352

Second, determine how much of the available income ($2352) can be deemed to Brian (CS). Brian is applying for ADvantage. Subtract the community spouse’s income from the Categorically Needy Standard for LTC (according to Appendix C-1 Schedule VIII B.1. (4/1/2023) $2742 in this example.

Categorically Needy Standard (eff 4/1/2023) = $2742
Brian Riley (CS) Income= -$900
Maximum amount that can be deemed.= $1842

$1842 maximum allowed to be deemed to Brian (CS) in order for him to remain income eligible for ADvantage Waiver.

Amount Available to Deem = $2352
Maximum allowed to be Deemed = $1842
NF Vendor Payment = $510

Carol (IS) will have a NF vendor payment of $510.

Brian (CS) will have an additional $1842 to use towards his expenses and remain income eligible for ADvantage Waiver.

Example 3:

Reba Parton is applying for nursing care. Her spouse Kenny plans to remain in the home and is concerned about having enough income to cover household expenses as they still have a mortgage on the home. Kenny receives a monthly gross income of $1450 in RSDI benefits and a $2350 pension. Reba receives RSDI income in the gross amount of $1,400 a month. Reba has a monthly Medicare Premium of $164.90.

Reba Parton (Institutionalized Spouse) Income Kenny Parton (Community Spouse) Income Total Medical Expense
$1,400 $3800 $164.90

A Medicaid Income Pension Trust (MIPT) is not needed for Reba (IS) as her income is less than the Categorically Needy Standard for LTC according to Appendix C-1, Schedule VIII B.1. (4/1/2023) $2742 in this example.

First, determine how much of Reba’s (IS) income is available to deem to Kenny (CS). The $75 maintenance standard for individuals residing in a nursing facility and the $165 Medical Expense is deducted from Reba’s (IS) income.

Reba Parton (IS) Income = $1400
Maintenance Standard = -$75
Medical Expense = – $165
Vendor Payment / Amount available to deem. = $1160

$1160 Nursing Facility (NF) vendor payment or amount available to deem to Kenny (CS).

Second, determine how much of the available income $1160 can be deemed to Kenny (CS). Kenny is not applying for any DHS medical services. If the community spouse is not applying for / or receiving DHS medical benefits, subtract the community’s spouse income from the Maximum monthly income standard found on Appendix C-1, Schedule XI. $3716 in this example.

Maximum monthly income standard = $3716
Kenny Parton (CS) Income = $3800
Maximum amount that can be deemed. = $0

Even though there is $1160 available to deem to Kenny (CS), the amount of his income $3700 already exceeds the Maximum monthly income standard ($3742) No income can be deemed to Kenny and Reba will have a vendor payment of $1160.

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