When one member of an eligible couple is in a medical facility where Medicaid is paying
more than 50 percent of the costs, and the other member of the couple is living in
their own household or the household of another throughout the entire quarter, compute
payments to each member of the couple as follows:
-
1.
Determine the applicable quarterly FBR for the member of the couple not institutionalized
(SI 02001.020). The quarterly FBR for the institutionalized member of the couple is $75. (See SI 02009.050 when there is an essential person(s)).
-
2.
Determine the quarterly countable income for each member of the eligible couple as
if each were an eligible individual without regard to any income of the spouse. Do
not combine the incomes. Do not attribute unused exclusions by one member of the couple
to the other member of the couple. (See SI 02009.050 when there is an essential person(s).)
-
3.
Subtract each member's countable income for the period from the appropriate FBR for
the same period. The results are the monthly payment amounts due each member of the
couple (or the monthly payment amounts for 2 months which must be divided by 2 to
find the amounts for each month).
-
4.
For the short quarter prior to the effective month for which one member of the couple
was institutionalized, re-compute the couples payment amounts as follows:
-
a.
Determine the applicable FBR for the couple (eligible individual with an eligible
spouse) for the short quarter.
-
b.
Subtract from the FBR the couple's total countable income for the period involved.
Determine the couple's countable income by combining the actual income received by
each member of the couple for the short quarter.
The result is the short quarter payment due the couple if the short quarter consists
of 2 months, divide the payment amount by 2 to find the monthly amount payable to
each member of the couple.
-
5.
If only the first month or first and second months of a quarter are months for which
one member of the couple was institutionalized in a medical facility, compute payments
by following steps 1 through 3 for the first month or first and second months of the
quarter and apply the rules in 4 for the remaining month(s). (See SI 02009.035C.6.
- examples 2 and 3.)
-
6.
If the second month of a quarter is the only effective month for which one member
of the couple is institutionalized, a determination of eligibility and calculation
of payment amount applies which depends on the circumstances existing each month of
the quarter. (In reality, three short quarters, see SI 02009.035C.6. - example 5.)
Example 1 -
Income the Same All Months; Live in Same Household
Richard. and Robin. Blue are an eligible and aged couple. Richard receives Title II
benefits of $130.60 a month and Robin receives spouse benefits of $65.30. On August
10, 1981, Richard enters a nursing home which reports it expects to receive Medicaid
payments for more than 50 percent of Richard's costs. Richard remains in the home
throughout the remainder of the quarter. Robin maintains their home. The original
and new computations for the quarter are shown below:
Original Computation Before Report of Change
|
|
$1191.00
|
Quarterly FBR
|
$ 527.70
|
Countable income (3x$130.60 + 3x$65.30 = $587.70-$60.00=$527.70)
|
$ 663.30
|
Quarterly payment amount
|
$ 221.10
|
Monthly payment amount to the couple
|
$ 110.55
|
Monthly payment amount to each member
|
New Computation: Richard and Robin Blue
|
|
$ 794.00
|
FBR short quarter of July/August 1981
|
$ 351.80
|
Countable income (2x130.60+(2x63.50)=$391.80-$40.00=$351.80)
|
$ 442.20
|
Short quarter payment amount
|
$ 221.10
|
Monthly payment amount to the couple
|
$ 110.55
|
Monthly payment amount to each member for July and August
|
Richard Blue
|
|
$ 25.00
|
FBR short quarter of September 1981
|
$ 110.60
|
Countable income ($130.60-$20.00=$110.60)
|
$ 0.00
|
Short quarter payment amount
|
Robin Blue
|
|
$ 264.70
|
FBR short quarter of September 1981
|
$ 45.30
|
Countable income ($65.30-$20.00=$45.30)
|
$ 219.40
|
Short quarter payment amount for September 1981
|
Example 2- Monthly Income Varies: Spouse Changes Living
Arrangement
Tyler and Jessica Green an eligible couple, have each been receiving monthly SSI
payments of $101.84. Tyler receives a pension payable the third month of each quarter
in the amount of $640. On November 3, 1981, Tyler enters a nursing home where Medicaid
pays for more than 50 percent of their costs. Several days later Jessica goes to stay
with their adult child while Tyler remains in the nursing home. Jessica contributes
nothing to the adult child's household expenses. Tyler stays in the nursing home throughout
the month of December. The original and new computations for the quarter are shown
below.
Original Computation Before Report of Change
|
|
$1191.00
|
Quarterly FBR (October through December 1981)
|
$ 580.00
|
Countable income ($640-$60=$580)
|
$ 610.00
|
Quarterly payment amount
|
$ 203.666
|
Monthly payment amount to the couple
|
$ 101.833
|
Monthly payment amount to each member (rounded to $101.84)
|
New Computation: Tyler Green
|
|
$ 25.00
|
FBR short quarter of December 1981
|
$ 620.00
|
Countable income ($640.00-$20.00=$620.00)
|
$ 0.00
|
Short quarter payment
|
New Computation: Jessica Green
|
|
$176.47
|
FBR Short quarter of December 1981
|
$ 0.00
|
Countable income
|
$176.47
|
Short quarter payment amount for December 1981
|
Tyler and Jessica Green
|
|
$794.00
|
FBR short quarter of October/November 1981
|
$ 36.16
|
Countable income (Presumed value of-income in-kind for November less unearned income
exclusion.) $76.16-$40.00 = $36.16.
|
$757.84
|
Short quarter payment amount
|
$378.092
|
Monthly payment amount to the couple
|
$189.46
|
Monthly payment amount to each member for October and November
|
Example 3- Member of Couple Leaves
Institution
On February 13, 1982, Tyler Green (from Example 2 above) leaves the nursing home.
Tyler and Jessica Green resume living together in their own household. Jessica stayed
with their adult child until Tyler left the nursing home. The original and new computations
for the March 1981 quarter are shown below:
Jessica Green
|
|
$ 75.00
|
Quarterly FBR
|
$580.00
|
Countable income ($640.00-$60.00=$580.00)
|
$ 0.00
|
Quarterly payment amount
|
Jessica Green
|
|
$529.00
|
Quarterly FBR
|
$ 0.00
|
Countable income
|
$529.40
|
Quarterly payment amount
|
$176.466
|
Monthly payment amount (rounded to $176.47)
|
New Computation: Tyler Green
|
|
$ 25.00
|
FBR short quarter of January 1982
|
$ 0.00
|
Countable income
|
$ 25.00
|
Monthly payment amount
|
New Computation: Jessica Green
|
|
$176.47
|
FBR short quarter of January 1982
|
$ 0.00
|
Countable income
|
$176.47
|
Monthly payment amount
|
Tyler and Jessica Green
|
|
$794.00
|
FBR short quarter of February/March 1982
|
$676.16
|
Countable income ($640.00+$76.16=$716.16-$40.00=$676.16)
|
$117.84
|
Short quarter payment amount
|
$ 58.92
|
Monthly payment amount to the couple
|
$ 29.46
|
Monthly payment amount to each member
|
Example 4 - Couple Lived in Household of
Another
William and Kristen White have been living with their adult child for over one year
and each has been receiving monthly SSI payments. William White receives unearned
income of $80.20 each month and during the second month of every quarter, William
receives additional unearned income of $96. Kristen White has no income. On November
2, 1981, William White enters a nursing home where Medicaid pays for more than 50
percent of William's costs. The original and new computations for the quarter are
shown below:
Original Computation Before Report of Change
|
|
$794.00
|
Quarterly FBR
|
$276.60
|
Countable income (3x$80.20=$240.60+$96=$336.60-$60=$276.60)
|
$517.40
|
Quarterly payment amount
|
$172.466
|
Monthly payment amount to the couple
|
$ 86.233
|
Monthly payment amount to each member (rounded to $86.24)
|
New, Computation-Short Quarter Computation (October-November 1981) Will \iam and
Kristen White (October)
|
|
$264.67
|
FBR
|
$110.70
|
Countable income (The countable income for the couple is computed by adding the income
actually received; 2x$80.20=$160.40+96.00=$256.40+$5.00 actual in-kind income received
by Mr. White for November. The presumed value of the in-kind income received during
November by Mr. White would have been $76.16 but this was rebutted. Mr. White's in-kind
income was actually established as $5.00 for the first 2 days of the month with no
in-kind income for the remainder of the month while in the nursing home. From this
total of $261.40 the $40.00 exclusion was subtracted resulting in $221.40 countable
income for the 2 months or $110.70 per month.)
|
$153.97
|
Monthly payment amount to the couple
|
$ 76.985
|
Monthly payment amount to each member (rounded to $76.99)
|
William and Kristen White (November)
|
|
$397.00
|
FBR
|
$110.70
|
Countable income
|
$286.30
|
Monthly payment amount to the couple
|
William White
|
|
$190.866
|
Two-thirds of $286.30, monthly payment amount rounded to $190.87)
|
Kristen White
|
|
$ 29.273
|
One third of $286.30=$95.433-$66.16 in kind income not rebutted, monthly payment rounded
to $29.28
|
Short Quarter Computation (December 1981): William White
|
|
$25.00
|
FBR
|
$60.20
|
Countable income ($80.20-$20.00=$60.20)
|
$ 0.00
|
SSI payment for the short quarter of December 1981
|
Kristen White
|
|
$176.47
|
Monthly FBR
|
$ 0.00
|
Countable income ($80.20-$20 = $60.20)
|
$176.47
|
SSI payment for the short quarter of December 1981
|
Example 5 - Institutionalization Second Month of the
Quarter
Connor and YvetteGray live in their own household. On October 15, 1981 Connor Gray
enters a medical facility which expects Medicaid to pay for all the costs. It is
expected that Connor will be in the facility indefinitely. Connor Gray normally receives
unearned income of $50 per month. Also, in the third month of each quarter, Connor
receives additional unearned income of $90. Yvette Gray receives unearned income
of $40 per month. Yvette remains in their home during Connor Gray's medical confinement.
The original and new computations for the quarter are shown below:
Original Computation Before Report of Change
|
|
$1191.00
|
Quarterly FBR
|
$ 300.00
|
Countable income (3x$90=$270+$90=$360-$60=$300)
|
$ 891.00
|
Quarterly payment amount
|
$ 297.00
|
Monthly payment to the couple
|
$ 148.50
|
Monthly payment amount to each member
|
New Computation: Connor and Yvette Gray
|
|
$ 397.00
|
FBR short quarter of October
|
$ 70.00
|
Countable income ($50+$40=$90-$20=$70)
|
$ 327.00
|
Short quarter amount
|
$163.50
|
Monthly payment amount to each member
|
Yvette Gray
|
|
$ 529.40
|
FBR for the short quarter of November/December
|
$ 40.00
|
Countable income (2x$40.00=$80.00-$40.00=$40.00)
|
$ 489.40
|
Short quarter payment amount
|
$ 244.70
|
Monthly payment amount
|
Connor Gray
|
|
$ 50.00
|
FBR for the short quarter of November/December
|
$ 150.00
|
Countable income (2x$50 =$100+$90=$190-$40=$150)
|
$ 0.00
|
Short quarter payment amount
|
On December 27, 1981, Yvette Gray reports that Connor Gray came home from the medical
facility on December 24th and is expected to stay at home. The new computation for
the quarter is:
Mr. and Mrs. Gray
Connor and Yvette Gray
|
|
$397.00
|
FBR for the short quarter of October
|
$ 70.00
|
Countable income ($50+$40=$90-$20=$70)
|
$327.00
|
Short quarter amount to the couple
|
$163.50
|
Monthly payment amount to each member
|
Yvette Gray
|
|
$264.70
|
FBR for the short quarter of December
|
$ 20.00
|
Countable income ($40.00-$20.00=$20.00)
|
$244.70
|
Short quarter payment amount for November
|
Yvette Gray
|
|
$ 25.00
|
FBR for the short quarter of November
|
$ 30.00
|
Countable income ($50.00-$20.00=$30.00)
|
$ 0.00
|
Short quarter payment amount for November
|
Connor and Yvette Gray
|
|
$397.00
|
FBR for the short quarter of December
|
$160.00
|
Countable income ($50.00+$40.00+$90.00=$180-$20.00=$160.00)
|
$237.00
|
Short quarter amount
|
$118.50
|
Monthly payment to each member
|