Income deductions

This section applies to an individual residing in the individual's own home or in a specialized facility, workers with disabilities coverage, children with disabilities coverage, and to the Medicare savings programs, but does not apply to an individual receiving nursing care services in a nursing facility, the state hospital, an institution for mental disease, a psychiatric residential treatment facility, an intermediate care facility for individuals with intellectual disabilities, or receiving swing-bed care in a hospital. No deduction not described in subsections 1 through 14 may be allowed in determining Medicaid eligibility. For individuals not subject to a MAGI-based methodology, the following deductions apply: 1. Except in determining eligibility for the Medicare savings programs, the cost of premiums for health insurance may be deducted from income in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage. In determining eligibility for the workers with disabilities coverage, the workers with disabilities enrollment fee and premiums are not deducted. In determining eligibility for the children with disabilities coverage, the children with disabilities premiums are not deducted. For purposes of this subsection, "premiums for health insurance" include payments made for insurance, health care plans, or nonprofit health service plan contracts which provide benefits for hospital, surgical, and medical care, but do not include payments made for coverage which is: a. Limited to disability or income protection coverage; b. Automobile medical payment coverage; c. Supplemental to liability insurance; d. Designed solely to provide payments on a per diem basis, daily indemnity, or nonexpense-incurred basis; or e. Credit accident and health insurance. 2. Except in determining eligibility for the Medicare savings programs, medical expenses for necessary medical or remedial care may be deducted only if each is: a. Documented in a manner which describes the service, the date of the service, the amount of the cost incurred, and the name of the service provider; b. Incurred by a member of a Medicaid unit in the month for which eligibility is being determined, or was incurred in a prior month but was actually paid in the month for which eligibility is being determined and was not previously allowed as a deduction or offset of recipient liability, and was not previously applied to recipient liability; c. Provided by a medical practitioner licensed to furnish the care; d. Not subject to payment by any third party, including Medicaid and Medicare; e. Not incurred for nursing facility services, swing-bed services, or home and community-based services during a period of ineligibility determined under section 75-02-02.1-33.1; and f. Claimed. 3. Reasonable expenses such as food and veterinarian expenses necessary to maintain a service animal that is trained to detect seizures for a member of the Medicaid unit. 4. Except for a support payment withheld from an extra check that is disregarded, nonvoluntary child and spousal support payments may be deducted if actually paid by a member of the Medicaid unit. 5. The cost of premiums for long-term care insurance carried by an individual or the individual's spouse may be deducted from income in the month the premium is paid or prorated and deducted from income the months for which the premium affords coverage. No premium deduction may be made in determining eligibility for the Medicare savings programs. 6. Reasonable child care expenses, not otherwise reimbursed, may be deducted to the extent necessary to permit a caretaker or a spouse to work or participate in training. Reasonable child care expenses do not include payments to parents to care for their own children. 7. With respect to each individual in the Medicaid unit who is employed or in training, but who is not aged, blind, or disabled, thirty dollars may be deducted as a work or training allowance, but only if the individual's income is counted in the eligibility determination. 8. Except in determining eligibility for the Medicare savings programs, transportation expenses may be deducted if necessary to secure medical care provided for a member of the Medicaid unit. 9. Except in determining eligibility for the Medicare savings programs, the cost of remedial care for an individual residing in a specialized facility, limited to the difference between the recipient's cost of care at the facility and the regular medically needy income level, may be deducted. 10. A disregard of twenty dollars per month is deducted from any income, except income based on need, such as supplemental security income and need-based veterans' pensions. This deduction applies to all aged, blind, and disabled applicants or recipients, provided that: a. When more than one aged, blind, or disabled person lives together, no more than a total of twenty dollars may be deducted; b. When both earned and unearned income is available, this deduction must be made from unearned income; and c. When only earned income is available, this deduction must be made before deduction of sixty-five dollars plus one-half of the remaining monthly gross income made under subdivision b of subsection 13. 11. Reasonable adult dependent care expenses for an incapacitated or disabled adult member of the Medicaid unit may be deducted to the extent necessary to permit a caretaker or a spouse to work or participate in training. 12. The cost to purchase or rent a car safety seat for a child through age ten is allowed as a deduction if a seat is not otherwise reasonably available. 13. The deductions described in this subsection may be allowed only on earned income. a. For all individuals except aged, blind, or disabled applicants or recipients, deduct: (1) Mandatory payroll deductions and union dues withheld, or ninety dollars, whichever is greater; (2) Mandatory retirement plan deductions; (3) Union dues actually paid; and (4) Expenses of a nondisabled blind person, reasonably attributable to earning income. b. For all aged, blind, or disabled applicants or recipients, deduct sixty-five dollars plus one-half of the remaining monthly gross earned income, provided that, when more than one aged, blind, or disabled person lives together, no more than sixty-five dollars, plus one-half of the remaining combined earned income, may be deducted. 14. A deduction may be made for the cost of services of an applicant's or recipient's guardian or conservator, up to a maximum equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments.