BASIC (11-02)

SI 02009.055 Eligible Couple With Essential Person(s)

A. Policy -- general

There are several possible essential person situations when an eligible individual and an eligible spouse are liv­ing together. There may be one essential person, essential to either a specific member of the couple or to both mem­bers. There may be two or more essential persons, each individually essential to a separate member of the couple or to the couple in general.

B. Policy -- couple living together

When the couple lives together, the payment computa­tion steps are the same as those reflected in SI 02009.050 with the additional step of dividing the monthly amount due to the couple by 2 to obtain the amount due to each member of the couple.

NOTE: When the couple is living together with their essen­tial person(s): (a) the increment(s) for the essential person(s) is added to the couple's FBR, (b) all the income of the essen­tial person(s) is deemed, i.e., included in the couple's counta­ble income, and (c) the couple's monthly payment amount is evenly divided between each member of the couple regard­less of whether the essential person was designated essential to a specific member of the couple or both members of the couple.

Example 1:

Bill and Beth Geiger are an eligible couple living in their own household during the third quarter of 1981. They have three essential persons living with them, one of whom has earned income of $75 a month. Mr. and Mrs. Geiger each receive a title II benefit of $125 per month. The computation for the third quarter of 1981 is as follows:

$1191.00

Quarterly FBR for 3rd quarter 1981

$1193.40

Essential person increments (3x$397.80=$1193.40)

$2384.40

 

$ 915.00

Countable income (3x$250+$225=$975-$60=$915)

$1469.40

Quarterly payment amount

$ 480.80

Monthly payment amount to the couple

$ 244.90

Monthly payment amount to each member

Example 2:

Same situation as Example 1 except the essential person who was working died on August 2. He had no income in August. The computation for the third quarter of 1981 becomes:

$1191.00

Quarterly FBR

$1060.80

Essential person increment (2x$397.80+265.20=$1060.80)

$2251.80

 

$ 765.00

Countable income ($3x$250+$75=$825-$60=$765)

$1486.80

Quarterly payment amount

$ 495.60

Monthly payment amount to the couple

$ 247.80

Monthly payment amount to each member

Example 3:

Judy and Thomas Punker are an eligible couple living in their own household. They have an essential person living with them who has earned income of $90 per month. The essential person is designated as essential to Judy. The couple has no other income. On July 3, 1981, Thomas en­ters a title XIX facility and Medicaid immediately-begins to pay over 50 percent of the costs. This results in a permanent separation from Judy. The computation follows:

Couple Status Short Quarter of July

$397.00

FBR for the short quarter of couple status

$132.60

Essential person increment for the short quarter

$529.60

 

$ 70.00

Countable income ($90 deemed from the essential person less $20 general exclusion)

$459.60

Short quarter payment amount to the couple

$229.80

Monthly payment amount to each member

Individual Status Short Quarter of August/ September

Mr. Punker

$50.00

FBR for the short quarter of individual status

$ 0.00

Countable income

$50.00

Short quarter payment amount

$25.00

Monthly payment amount

Mrs. Punker

$ 529.40

FBR for the short quarter of individual status

$ 265.20

Essential person increment for the short quarter

$ 794.60

 

$ 140.00

Countable income ($90x2= $180-$40=$140)

$ 654.60

Short quarter payment amount

$ 327.30

Monthly payment amount

Example 4:

Same as above except that Thomas' hospitalization is a temporary absence and the essential person is designated as essential to Thomas. Thomas returns home on October 7, 1981. The computation for the period July through September is the same as in the prior example; i.e., the es­sential person increment is given to Judy, and the essen­tial person income is deemed to Judy. The computation for October through December is:

$1191.00

Quarterly FBR

$ 397.80

Essential person increment ($132.60x3)

$1588.80

 

$ 210.00

Countable income ($90x3=270-$60=$210)

$1378.80

Quarterly payment amount

$ 459.60

Monthly payment amount to the couple

$ 229.80

Monthly payment amount to each member

C. Policy -- couple living apart

There are several possible essential person situations when an eligible individual and an eligible spouse are liv­ing apart. There may be one or more essential persons liv­ing with each member of the couple, or there may be one or more essential persons living with one member of the couple, while the other member of the couple has no es­sential person. In either situation, add the increment for the essential person(s) only to the monthly payment amount of the member of the couple with whom the es­sential person resides and similarly only charge that member of the couple with any deemable income of the essential person. If the general exclusion ($60) was not fully used to re­duce the couple's countable income it may be used to pro­portionally reduce the essential person's deemable income.

NOTE: When an essential person or persons live with an eligible individual and eligible spouse at the time one mem­ber of the couple enters a medical treatment facility where Medicaid pays for more than 50 percent of the costs, and the separation is expected to be temporary see SI 02001.015B.4. The computation to perform in all such cases is to deem the income of the essential person(s), if any, to the non-institu­tionalized member of the couple and add the essential per­son(s) increment(s) to the benefit rate for the non institutionalized member of the couple in computing the benefits according to SI 02009.035 . This rule applies during the period of temporary absence even though the member of the couple in the medical treatment facility is the sole quali­fied individual. In this latter situation, (the institutionalized member is the sole qualified individual) there is permanent loss of the essential person(s) increment(s), when or if it is determined the absence is not temporary.


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SI 02009.055 - Eligible Couple With Essential Person(s) - 11/18/2014
Batch run: 11/18/2014
Rev:11/18/2014