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 16.03.05.725 - PATIENT LIABILITY FOR PARTICIPANT WITH COMMUNITY SPOUSE

Current through August 31, 2023
After income ownership is decided, patient liability is
				determined using steps in Table 725.
TABLE 725 - INCOME DEDUCTIONS FOR
						  PARTICIPANT IN FACILITY
Step
Procedure
01.
AABD Income Exclusions
Subtract income excluded in determining eligibility for
						  AABD cash.
02.
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.
03.
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.
04.
AABD Cash
Subtract the AABD cash payment and income used to
						  compute AABD cash, for a participant eligible to have his AABD cash continued
						  up to three (3) months, while he is in long-term care.
05.
VA Pension
Subtract the first ninety (90$) of the VA pension for a
						  veteran.
06.
Personal Needs
Subtract forty dollars ($40) for the participant's
						  personal needs. Do not allow this deduction for a veteran.
07.
Employed and Sheltered Workshop Activity
						  Needs
For an employed participant or participant engaged in
						  sheltered workshop or work activity center activities subtract the lower of two
						  hundred dollars ($200) or his earned income.
Compute the Community Spouse Allowance (CSA) using Step
						  a. through Step c.
Compute the Shelter Adjustment.
Add the current Food Stamp Program Standard Utility
						  Allowance to the community spouse's shelter costs.
08.
Community Spouse Allowance:
Step a.
Shelter costs include rent, mortgage principal and
						  interest, homeowner's taxes, insurance, and condominium or cooperative
						  maintenance charges. The Standard Utility Allowance must be reduced by the
						  value of any utilities included in maintenance charges for a condominium or
						  cooperative.
Subtract the Shelter Standard from the shelter and
						  utilities. The Shelter Standard is thirty percent (30%) of one hundred fifty
						  percent (150%) of one-twelfth (1/12) of the income official poverty line
						  defined by the Federal Office of Management and Budget (OMB) for a family of
						  two (2) persons.
The Shelter Adjustment is the positive balance
						  remaining.
09.
Community Spouse Allowance:
Step b.
Compute the Community Spouse Need Standard (CSNS). Add
						  the Shelter Adjustment to the minimum CSNS. The minimum CSNS equals one hundred
						  fifty percent (150%) of one-twelfth (1/12) of the income official poverty line
						  defined by the OMB for a family unit of two (2) members. The minimum CSNS is
						  revised annually in July. The total CSNS may not exceed the maximum CSNS. The
						  maximum CSNS is computed by multiplying one thousand five hundred dollars
						  ($1,500) by the percentage increase in the consumer price index for all urban
						  Consumers (all items; U.S. city average) between September 1988 and the
						  September before the current calendar year. The maximum CSNS is revised
						  annually in January.
10.
Community Spouse Allowance:
Step c.
Compute the Community Spouse Allowance.
Subtract the community spouse's gross income from the
						  CSNS. The community spouse's income includes income produced by his resources.
						  Round any remaining cents to the next higher dollar. Any positive balance
						  remaining is the CSA. The CSA is subtracted as actually paid to the community
						  spouse, up to the computed maximum.
A larger spouse support amount must be used as the CSA,
						  if court-ordered. The CSA ordered by a court is not subject to the CSA
						  limit.
Compute the family member's gross income.
Subtract the family member's gross income from the
						  minimum CSNS.
Divide the difference by three (3).
Round cents to the next higher dollar.
11.
Family Member Allowance (FMA)
Any remainder is the FMA for that family member. The
						  FMA is allowed, whether or not it is actually paid by the participant.
A family member is, or could be claimed, as a dependent
						  on the Federal income tax return of either spouse. The family member must be a
						  minor or dependent child, dependent parent or dependent sibling of either
						  spouse. The family member must live in the community spouse's home.
12.
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.
Do not subtract the Medicare Part B premiums if the
						  participant got SSI or AABD cash the month prior to the month for which patient
						  liability is being computed.
13.
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.
14.
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 are the same person, the
						  total deduction for guardian and trust fees must not exceed twenty-five dollars
						  ($25) monthly.
15.
Trust Fees
Subtract up to twenty-five dollars ($25) monthly paid
						  to the trustee for administering the participant's trust.
16.
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, 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.
17.
Income Garnisheed for Child Support
Subtract income garnisheed for child support to the
						  extent the expense is not already accounted for in computing the Family Member
						  Allowance.
18.
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.
19.
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)