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 $185. Rita states that she does not need any medical services at this time.

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. (1/1/2025) $2901 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 $185 Medical Expense is deducted from James’s (IS) income.

James Williams (IS) Income = $1500
Maintenance Standard = -$75
Medical Expense = -$185
Vendor Payment / Amount available to deem. = $1240

$1240 Nursing Facility (NF) vendor payment or amount available to deem to Rita (CS).

Second, determine how much of the available income ($1240) 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. $3948 in this example.

Maximum monthly income standard = $3948
Rita Williams (CS) Income = -$1400
Maximum amount that can be deemed. = $2548

Since there is only $1240 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 $1240 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 is interested in applying for ADvantage. Carol receives $2000 in RSDI income and a $1000 pension. She pays a $185 Medicare Premium and $150 Supplemental Health Insurance Premium. Brian receives retirement in the amount of $900 a month.

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 = $3000
Categorically Needy Standard (eff 1/1/2025) = $2901
Amount needed to fund MIPT (monthly) = $99

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) = $2901
Maintenance Standard = -$75
Medical Expense = -$335
Vendor Payment / Amount available to deem. = $2491

Second, determine how much of the available income ($2491) 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. (1/1/2025) $2901 in this example.

Categorically Needy Standard (eff 1/1/2025) = $2901
Brian Riley (CS) Income= -$900
Maximum amount that can be deemed.= $2001

$2001 maximum allowed to be deemed to Brian (CS) in order for him to remain income eligible for ADvantage Waiver.

Amount Available to Deem = $2491
Maximum allowed to be Deemed = $2001
NF Vendor Payment = $490

Carol (IS) will have a NF vendor payment of $490.

Brian (CS) will have an additional $2001 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 $1950 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 $185.

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. (1/1/2025) $2901 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 = – $185
Vendor Payment / Amount available to deem. = $1140

$1140 Nursing Facility (NF) vendor payment or amount available to deem to Kenny (CS).

Second, determine how much of the available income $1140 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. $3948 in this example.

Maximum monthly income standard = $3948
Kenny Parton (CS) Income = $4300
Maximum amount that can be deemed. = $0

Even though there is $1140 available to deem to Kenny (CS), the amount of his income $4300 already exceeds the Maximum monthly income standard ($3948) No income can be deemed to Kenny and Reba will have a vendor payment of $1140.