Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.723 - PATIENT LIABILITY FOR PERSON WITH NO COMMUNITY SPOUSE

Current through August 31, 2023
For a participant with no community spouse, patient liability
				is computed as described in Subsections
				723.01 through
				723.03 of this rule.
				(3-17-22)
01.
Income of
			 Participants in Long-Term Care
. For a single participant, or participant
			 whose spouse is also in long-term care and chooses the SSI method of
			 calculating the amount of income and resources, the patient liability is his
			 total income less the deductions in Subsection
			 723.03 of this rule.
			 (3-17-22)
02.
Community
			 Property Income of Long-Term Care Participant with Long-Term Care
			 Spouse
. Patient liability income for a participant, whose spouse is also
			 in long-term care, choosing the community property method, is one-half (1/2)
			 his share of the couple's community income, plus his own separate income. The
			 deductions in Table 723.03 are subtracted from his income. (3-17-22)
03.
Income of Participant in
			 Facility
. A participant residing in the long-term care facility at least
			 one (1) full calendar month, beginning with his most recent admission, must
			 have the deductions in Subsection
			 723.03 subtracted from his
			 income, after the AABD exclusions are subtracted from the income. Total monthly
			 income includes income paid into an income (Miller) trust that month. The
			 income deductions must be subtracted in the order listed. Remaining income is
			 patient liability. (3-17-22)
a. AABD Income
			 Exclusions. Subtract income excluded in determining eligibility for AABD cash.
			 (3-17-22)
b. Aid and Attendance and
			 UME Allowances. Subtract a VA Aid and Attendance allowance and Unusual Medical
			 Expense (UME) allowance for a veteran or surviving spouse, unless the veteran
			 lives in a state operated veterans' home. (3-17-22)
c. SSI Payment Two (2) Months. Subtract the
			 SSI payment for a participant entitled to receive SSI at his at-home rate for
			 up to two (2) months, while temporarily in a long-term care facility.
			 (3-17-22)
d. AABD Payment. Subtract
			 the AABD payment, and income used to compute the AABD payment, for a
			 participant paid continued AABD payments up to three (3) months in long-term
			 care. (3-17-22)
e. First Ninety
			 ($90) Dollars of VA Pension. Subtract the first ninety ($90) dollars of a VA
			 pension for a veteran in a private long-term care facility or a State Veterans
			 Nursing Home. (3-17-22)
f. Personal
			 Needs. Subtract forty dollars ($40) for the participant's personal needs. For a
			 veteran or surviving spouse in a private long-term care facility or a State
			 Veterans Nursing Home the first ninety ($90) dollars of VA pension substitutes
			 for the forty dollar ($40) personal needs deduction. (3-17-22)
g. Employed and Sheltered Workshop Activity
			 Personal Needs. For an employed participant or participant engaged in sheltered
			 workshop or work activity center activities, subtract the lower of the personal
			 needs deduction of two hundred dollars ($200) or his gross earned income. The
			 participant's total personal needs allowance must not exceed two hundred and
			 thirty dollars ($230). For a veteran or surviving spouse with sheltered
			 workshop or earned income, and a protected VA pension, the total must not
			 exceed two hundred dollars ($200). This is a deduction only. No actual payment
			 can be made to provide for personal needs. (3-17-22)
h. Home Maintenance. Subtract two hundred and
			 twelve dollars ($212) for home maintenance cost if the participant had an
			 independent living situation, before his admission for long-term care. His
			 physician must certify in writing the participant is likely to return home
			 within six (6) months, after the month of admission to a long-term care
			 facility. This is a deduction only. No actual payment can be made to maintain
			 the participant's home. (3-17-22)
i. Maintenance Need. Subtract a maintenance
			 need deduction for a family member, living in the long-term care participant's
			 home. A family member is claimed, or could be claimed, as a dependent on the
			 Federal Income Tax return of the long-term care participant. The family member
			 must be a minor or dependent child, dependent parent, or dependent sibling of
			 the long-term care participant. The maintenance need deduction is the AFDC
			 payment standard for the dependents, computed according to the AFDC State Plan
			 in effect before July 16, 1996. (3-17-22)
j. Medicare and Health Insurance Premiums.
			 Subtract expenses for Medicare and other health insurance premiums, and
			 deductibles or coinsurance charges, not subject to payment by a third party.
			 Deduction of Medicare Part B premiums is limited to the first two (2) months of
			 Medicaid eligibility. Medicare Part B premiums must not be subtracted, if the
			 participant got SSI or AABD cash the month prior to the month for which patient
			 liability is being computed. (3-17-22)
k. Mandatory Income Taxes. Subtract taxes
			 mandatorily withheld from unearned income for income tax purposes. To qualify
			 for deduction of mandatory taxes, the tax must be withheld from income before
			 the participant receives the income. (3-17-22)
l. Guardian Fees. Subtract court-ordered
			 guardianship fees of the lesser of ten percent (10%) of the monthly benefit
			 handled by the guardian, or twenty-five dollars ($25). Where the guardian and
			 trustee is the same person, the total deduction for guardian and trust fees
			 must not exceed twenty-five dollars ($25) monthly. (3-17-22)
m. Trust Fees. Subtract up to twenty-five
			 dollars ($25) monthly paid to the trustee for administering the participant's
			 trust. (3-17-22)
n. Impairment
			 Related Work Expenses. Subtract impairment-related work expenses for an
			 employed participant who is blind or disabled under AABD criteria.
			 Impairment-related work expenses are purchased or rented items and services
			 that are purchased or rented to perform work. The items must be needed because
			 of the participant's impairment. The actual monthly expense of the
			 impairment-related items is subtracted. Expenses must not be averaged.
			 (3-17-22)
o. Income Garnished for
			 Child Support. Subtract income garnisheed for child support to the extent the
			 expense is not already accounted for in computing the maintenance need
			 standard. (3-17-22)
p. Incurred
			 Medical Expenses. Subtract amounts for certain limited medical or remedial care
			 expenses that have current balances owed and are deemed medically necessary as
			 defined in IDAPA 16.03.09, "Medicaid Basic Plan Benefits." Current medical
			 expenses that are not covered by the Idaho Medicaid Plan, or by a third party,
			 may be deducted from the base participation amount. (3-17-22)
q. Pre-existing Medical Expenses. Subtract
			 amounts for medical and remedial care expenses incurred within the three (3)
			 months prior to the month of application. The deductions for medical and
			 remedial care expenses are limited to those medically necessary expenses
			 incurred by the participant for the participant's care. The deduction for
			 medical and remedial care expenses is limited to the amount of liability owed
			 by the participant, and if applicable, after any third-party insurance has been
			 applied. The deduction for medical and remedial care expenses that were
			 incurred as the result of imposition of a transfer of assets penalty period is
			 limited to zero. (3-17-22)