Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 13 - HOME AND COMMUNITY-BASED WAIVER › Section 144-332-13-6 - WAIVER COST OF CARE

Current through 2024-29, July 17, 2024
A cost of care is determined for any month in which
					 eligibility exists.
Cost of care is determined by the budgeting process for
					 that waiver and paid to the appropriate agency.
The cost of care is due for each month for which services
					 are provided even if services are not provided for a full calendar
					 month.
The cost of care may be adjusted without timely notice and
					 may be adjusted retroactively (See Part 14, Section 6.2 ).
Individuals who are Medicaid eligible under the following
					 coverage groups do not have a cost of care:
I. any MAGI-based group;
II. an SSI - Related group with an income
				  limit of 100% FPL.
Note
: If there is a partial month transfer of
					 asset penalty the individual may be responsible for an amount in addition to
					 their cost of care (See Part 15, section 1.8 ).
Section 6.1:
Budgeting
Note
: VA pensions that are Aid and Attendance
					 or based on unusual medical expenses are not used to determine the cost of care
					 in the Home and Community Based Waivers.
I. Determine the individual's gross monthly
				  income. If this figure is over the Categorical Nursing Care limit (see Chart
				  4.1), use the SSI-Related budget for an individual (Part 7) and the deductible
				  process (Part 10) to determine eligibility.
Once the individual is Medicaid eligible, use the following
					 steps to determine the individual's cost of care.
A. If the individual has elected an option
				  under his or her retirement plan that results in a reduced benefit to the
				  individual in exchange for a continued benefit to the spouse upon the
				  individual's death (e.g. a joint and survivor annuity option), then that
				  reduced amount will be considered to be gross income. However, the reduced
				  amount may be used only if the election is irreversible and the reduction
				  amount does not exceed $1,000 per month.
B. If income is garnished due to a court
				  order for child support the reduced amount of the income is used. The maximum
				  reduction allowed is up to and including $1,000 per month, per child.
C. An adjustment may be made if there are
				  current federal, state or local income tax deductions from the individual's
				  gross income. Usually the amount of taxes withheld will be based on the
				  previous year's income tax return. The adjustment for taxes cannot exceed the
				  current tax liability. A deduction for past due taxes is not allowed.
Examples
1. Last year $600 was the tax liability.
				  $80.00 per month is withheld for income tax. Only $50.00 per month can be
				  allowed as a deduction as this is the current tax liability ($600 ÷12 =
				  $50.00).
2. Last year $600 was the
				  tax liability. $25.00 per month is being withheld for income tax. A deduction
				  of $50.00 per month is allowed as a deduction as this is the current tax
				  liability ($600 ÷12 = $50.00).
Note
: If an individual is paying estimated
					 quarterly taxes, use these for an adjustment in the gross income. The procedure
					 is the same as if the taxes were being withheld.
D. When a husband and wife are living
				  together and are both covered by a Waiver, they each may have a cost of care.
				  However, they may allocate income to each other to reduce or eliminate the cost
				  of care.
Example
Husband and wife are both eligible for Waiver. The husband
					 has SSA of $1,400. The wife has SSA of $700. We allocate $350 to the wife so
					 each will have $1,050 used in the calculation of their individual costs of
					 care.