Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:040 - Relative responsibility requirements for Medicaid

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services has responsibility to administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes resource and income
				considerations regarding relatives by which Medicaid eligibility is determined,
				except for individuals whose eligibility is determined based on modified gross
				adjusted income or former foster care individuals between the ages of nineteen
				(19) and twenty-six (26) who aged out of foster care while receiving Medicaid
				benefits.
Section 1. Treatment of
			 Income and Resources for a Parent, Dependent Child, ABD Applicant, or
			 Recipient.
(1) A married individual shall be
			 considered responsible for that person's spouse.
(2) A parent shall be considered responsible
			 for a dependent minor child.
(3)
			 Excluding a child who is at least eighteen (18) years of age and who is blind
			 or disabled and for purposes of deeming income and resources, an individual
			 under age twenty-one (21) years living with a parent shall be considered a
			 dependent minor even if the individual is emancipated under state
			 law.
(4) Responsibility regarding
			 income and resources shall be determined as established in this subsection.
(a)
1. For
			 an ABD applicant or a recipient living with a spouse who is eligible for
			 Medicaid, total resources and adjusted income of the couple shall be considered
			 in relation to the resource and income limitations for a family size of two (2)
			 unless a dependent lives with the couple.
2. If any dependent lives with a couple, the
			 appropriate family size shall include any dependent living with the
			 couple.
(b) For an ABD
			 applicant or a recipient living with an ineligible spouse, income from the
			 ineligible spouse shall be deemed as available to the eligible spouse as
			 outlined in this paragraph.
1. Determine the
			 potential spend-down amount of the eligible individual by comparing the
			 countable income, as determined in accordance with
			 907
			 KAR 20:020, to the income level for one (1) as shown
			 in
			 907
			 KAR 20:020, Section 1(1).
2. Allocate to other dependents in the
			 household from the ineligible spouse's income an amount equal to one-half (1/2)
			 of the MNIL for a family size of one (1) for each dependent.
3.
a. If the
			 ineligible spouse's income is more than the difference between the MNIL for one
			 (1) and MNIL for two (2), combine the income of the ineligible spouse with that
			 of the eligible individual and compare that figure with the MNIL for one (1) to
			 determine continuing eligibility or the spend-down amount in accordance with
			 clause b. of this subparagraph.
b.
			 If the ineligible spouse's income is less than the difference between MNIL for
			 one (1) and MNIL for two (2), the income shall be disregarded and the income of
			 the eligible individual shall be compared with the MNIL for a family size of
			 one (1).
4. Compare the
			 amount resulting from subparagraph 1 of this paragraph with the result of
			 sub-paragraph 3 of this paragraph and determine eligibility using the
			 spend-down amount, if any, which is greater.
5. Resources shall be considered in the same
			 manner as for an eligible spouse.
(c)
1. For
			 an ABD couple living apart for any reason and both of whom are concurrently
			 applying for or receiving Medicaid only, income and resources shall be
			 considered in relation to resource and income limitations for a family size of
			 one (1) after the month of separation, or if any other dependent lives with
			 either spouse, the family size shall include any dependent in the month
			 following the month of separation.
2. Eligibility shall be determined on a
			 couple basis for the month of separation.
(d) For an ABD individual living apart from a
			 spouse who is not a recipient of Medicaid only, eligibility shall be determined
			 on a couple basis for the month of separation and on an individual basis after
			 the month of separation.
(e) The
			 following shall be considered a resource for an individual considered to be
			 single in accordance with paragraphs (c) or (d) of this section and who has a
			 jointly-held checking or savings account with his or her spouse:
1. The entire jointly-held checking or
			 savings account if it may be accessed independently of the spouse; or
2. One-half (1/2) of the jointly-held
			 checking or savings account if it shall not be accessed independently of the
			 spouse.
(f) Resources
			 and income of an SSI essential person, spouse or nonspouse, whose Medicaid
			 eligibility is not based on inclusion in the SSI case shall be
			 considered.
(g) For a child who is
			 blind or disabled and under eighteen (18) years of age living with a parent
			 (including a stepparent, if applicable), total resources and adjusted income of
			 the parent shall be related to limitations for family size, including the
			 applicant or recipient child and any other dependent child of the parent using
			 the adult scale.
(h)
1. For comparison with the resource and
			 income limitations, a child's individual resources and income shall be
			 considered in relation to a family size of one (1).
2. The following criteria shall be used to
			 determine whether an AFDC-related Medicaid child who has been living with a
			 parent and is institutionalized in a psychiatric facility (mental hospital or
			 psychiatric residential treatment facility) shall be considered as living apart
			 from his or her parents:
a. Unless he or she
			 has been in a psychiatric facility for thirty (30) or more days, a child shall
			 be considered as living with a parent. Beginning with the 31st day in a
			 facility, a child shall be considered living apart from his or her
			 parent.
b. A child who is
			 institutionalized in a psychiatric facility but is legally committed to or in
			 the custody of the Cabinet for Health and Family Services shall not be
			 considered as living with a parent.
(i) Excluding a child, if an AFDC-related
			 Medicaid recipient has income and resources considered in relation to family
			 size and enters a nursing facility, his or her income and resources shall be
			 considered in the case for up to one (1) year with the individual allowed the
			 basic maintenance standard as established in
			 907
			 KAR 20:035, Section 3(2).
(j)
1. If a
			 child in an AFDC-related Medicaid case is in a nursing facility, eligibility of
			 the child shall continue in the case for up to a year but his or her liability
			 for the cost of care shall be determined by:
a. Allowing to the child from his or her own
			 income the basic maintenance standard as established in
			 907
			 KAR 20:035, Section 3(2); and
b. Considering the remainder available for
			 the cost of care.
2. A
			 welfare payment made to a child under subparagraph 1 of this paragraph shall be
			 disregarded when determining liability for cost of care.
3. The eligibility of the child, with regard
			 to income and resources, shall be determined on the basis of living apart from
			 the other family members if it becomes apparent that the separation will last
			 for more than one (1) year.