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
his/her 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
Mr. and Mrs. Blue are an eligible and aged couple. Mr. Blue receives Title II benefits
of $130.60 a month and Mrs. Blue receives wife's benefits of $65.30. On August 10,
1981, Mr. Blue enters a nursing home which reports it expects to receive Medicaid
payments for more than 50 percent of Mr. Blue's costs. He remains in the home throughout
the remainder of the quarter. Mrs. Blue 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
Mr. and Mrs. 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
|
Mr. 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
|
Mrs. 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
Mr. and Mrs. Green an eligible couple, have each been receiving monthly SSI payments
of $101.84. Mr. Green receives a pension payable the third month of each quarter
in the amount of $640. On November 3, 1981, Mr. Green enters a nursing home where
Medicaid pays for more than 50 percent of his costs. Several days later Mrs. Green
goes to stay with her daughter while Mr. Green remains in the nursing home. She contributes
nothing to the daughter's household expenses. Mr. Green 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
Mr. Green
$ 25.00
|
FBR short quarter of December 1981
|
$ 620.00
|
Countable income ($640.00-$20.00=$620.00)
|
$ 0.00
|
Short quarter payment
|
Mrs. Green
$176.47
|
FBR Short quarter of December 1981
|
$ 0.00
|
Countable income
|
$176.47
|
Short quarter payment amount for December 1981
|
Mr. and Mrs. 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, Mr. Green (from Example 2 above) leaves the nursing home. He
and Mrs. Green resume living together in their own household. Mrs. Green stayed with
her daughter until Mr. Green left the nursing home. The original and new computations
for the March 1981 quarter are shown below:
Mr. Green
$ 75.00
|
Quarterly FBR
|
$580.00
|
Countable income ($640.00-$60.00=$580.00)
|
$ 0.00
|
Quarterly payment amount
|
Mrs. 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
Mr. Green
$ 25.00
|
FBR short quarter of January 1982
|
$ 0.00
|
Countable income
|
$ 25.00
|
Monthly payment amount
|
Mrs. Green
$176.47
|
FBR short quarter of January 1982
|
$ 0.00
|
Countable income
|
$176.47
|
Monthly payment amount
|
Mr. and Mrs. 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
Mr. and Mrs. White have been living with their son for over one year and each has
been receiving monthly SSI payments. Mr. White receives unearned income of $80.20
each month and during the second month of every quarter, he receives additional unearned
income of $96. Mrs. White has no income. On November 2, 1981, Mr. White enters a nursing
home where Medicaid pays for more than 50 percent of his 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)
Mr. and Mrs. 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)
|
Mr. and Mrs. White (November)
$397.00
|
FBR
|
$110.70
|
Countable income
|
$286.30
|
Monthly payment amount to the couple
|
Mr. White
$190.866
|
Two-thirds of $286.30, monthly payment amount rounded to $190.87)
|
Mrs. 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)
Mr. 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
|
Mrs. 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
Mr. and Mrs. Gray live in their own household. On October 15, 1981 Mr. Gray enters
a medical facility which expects Medicaid to pay for all the costs. It is expected
that he will be in the facility indefinitely. Mr. Gray normally receives unearned
income of $50 per month. Also, in the third month of each quarter, he receives additional
unearned income of $90. Mrs. Gray receives unearned income of $40 per month. She
remains in their home during Mr. 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
Mr. and Mrs. 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
|
Mrs. 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
|
Mr. 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, Mrs. Gray reports that Mr. Gray came home from the medical facility
on December 24th and he is expected to stay at home. The new computation for the quarter
is:
Mr. and Mrs. 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
|
Mrs. 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
|
Mr. 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
|
Mr. and Mrs. 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
|