Allowable Deductions from Income Used in the Medicaid Income Calculation

Allowable Deductions from Income Used in the Medicaid Income Calculation A. A Personal Needs Allowance (PNA) is deducted as appropriate to allow the individual in the nursing facility to keep funds on hand for their own needs on a monthly basis. 1. The basic PNA that each individual is entitled to receive is forty-four dollars ($44), unless the individual qualifies for a higher PNA. 2. Individuals enrolled in work therapy programs or otherwise engaged in paid activity while in a facility have a PNA applied to earnings that is equal to one-half (1/2) of the SSI federal benefit rate less forty-four dollars ($44). Remaining earned and unearned income is offset by the basic PNA of forty-four dollars ($44). 3. Veterans or their dependents whose reduced pension payment is ninety dollars ($90) have a PNA equal to ninety dollars ($90). B. A Community Spouse (CS) income allocation is allowed if the CS’s income allows and the institutionalized spouse (IS) will make the income allocation available to the CS. Calculation of the CS allocation is determined as follows: 1. Income of the CS is determined using total income of the CS. Income that is not countable to the IS that is made available to the CS is countable income to the CS. An example would be Veterans Affairs (VA) Aid & Attendance received by the IS but transferred to the CS. 2. The maximum CS allocation is based on the lesser of the following amounts: a) The federal Monthly Maintenance Needs Allowance, subject to annual adjustment, less the CS’s own income, or, b) The income of the IS after deducting the PNA. c) The CS may not qualify for a CS allocation based on his/her own income or the CS may refuse an income allocation. In either case, no CS allocation is allowed. 3. The CS may opt to reduce the calculated CS income allocation in order to establish or maintain his/her own Medicaid eligibility. C. An allowance for other family members is possible if income remains after allocating income to the CS, if applicable. Other family members include: 1. A child or children under age twenty-one (21) living with the CS or a child or children under age eighteen (18) not living with the CS, 2. A child or children age twenty-one (21) and over who depend on the IS or CS for meeting physical, medical or financial needs, 3. A dependent adult family member living with the CS that includes a mother, father, grandparent, sibling, aunt or uncle who depend on the IS or CS for meeting physical, medical or financial needs. 4. The allowance is determined for each dependent family member by subtracting the gross income of the individual from the federal Other Family Member Needs Allowance, subject to annual adjustment. Remaining income, if any, is reduced by one-third to calculate that family member’s maximum allowance that can be deducted from the income of the IS, provided the IS has sufficient remaining income to allow one or more deductions. D. Non-Covered Medical Expenses (NCME) include the following effective January 1, 2019. The institutionalized individual must have income available to allow the expense, the expense must not be subject to payment by Medicaid, Medicare or other third party insurance and the expense must have been incurred by the individual: 1. Health insurance premiums, including Medicare-related health plans, employer or union health plans, Tricare, Indian Health Service, Tribal and Urban Indian Health plans, and any other type of health insurance, including limited health policies that cover a specific health benefit. Medicare Part D plans are not allowable since premium free Part D plans are available to Medicaid recipients. Verification of the amount and frequency of premium(s) is required. 2. Deductions for medically necessary care, services and items incurred by the applicant or recipient, within specified limits, that are verified and timely submitted, are subject to the following Mississippi Medicaid State Plan limitations: a) Allowable NCME’s must have been incurred no earlier than three (3) months preceding the month of the current application. The individual must have resided in the nursing facility at the time the expense was incurred. b) NCME’s are reduced by the amount of any earmarked funds that a recipient elects to earmark at the time of application for payment of nursing facility expenses in order to receive the resource disregard relating to nursing facility services incurred in months prior to application. c) NCME’s cannot have been for cosmetic or elective purposes, except when medically necessary and prescribed by a medical professional. d) NCME’s cannot be accepted for a duplication of expenses previously authorized as a deduction. e) NCME’s are not allowed during the imposition of a transfer of assets or substantial home equity penalty period. f) NCME’s that are not paid for under the Medicaid State Plan are allowed as a deduction not to exceed the Mississippi Medicaid maximum payment or fee. g) Expenses for eyeglasses, dentures, denture repair and hearing aids are subject to maximum allowable limits. These limits are published by the Division of Medicaid as Fee Schedules entitled Post-Eligibility Treatment of Income Deductions by Institutionalized Individuals. Limits are subject to annual adjustment, as appropriate. 3. The current application date does not change if a case is closed and later reinstated under reinstatement requirements outlined in Miss. Admin. Code, Title 23, Part 101, Chapter 14,