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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
15.7.1 Maintaining Home or Apartment
15.7.2.3 Fees to Guardians or Attorneys
15.7.2.3.1 Disallowed Deductions
15.7.3 Medical/Remedial Expenses (MRE)
15.7.4 Impairment Related Work Expenses
15.7.5 $65 and ½ Earned Income Deduction
If a person residing in a medical institution has a home or apartment, deduct an amount from his or her income to allow for maintaining the home or apartment that does not exceed the SSI payment level plus the E supplement for one person (see Section 39.4.1 EBD Assets and Income Table). The amount is in addition to the personal needs allowance (see Section 39.4.2 EBD Deductions and Allowances). It should be enough for mortgage, rent, property taxes (including special assessments), home or renters insurance, utilities (heat, water, sewer, electricity), and other incidental costs.
Make the deduction only when the following conditions are met:
A physician certifies (verbally or in writing) that the person is likely to return to the home or apartment within six months, and
The person's spouse is not living in the home or apartment.
Deduct this amount for no more than six months. If the person is re-admitted to the institution, grant a six month continuance. A physician must again certify that he or she is likely to return to the home or apartment within six months.
The home maintenance allowance can be granted at any time. It is not limited to the first six months the person resides in the medical institution.
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Example 1: Bob entered the nursing home in June 2013 as a private pay patient. In June 2014, he qualifies for Medicaid and is potentially eligible for the home maintenance allowance. Bob's doctor says he is expected to return home by November 2014. He is eligible for a home maintenance deduction from his income, when determining the amount of his income available for his cost of care, starting in June 2014. |
Special exempt income includes:
Income used for supporting others (see Section 15.7.2.1 Support Payments).
Court-ordered attorney fees (see Section 15.7.2.3 Fees to Guardians or Attorneys).
Court-ordered guardian and guardian ad litem fees (see Section 15.7.2.3 Fees to Guardians or Attorneys).
Expenses associated with establishing and maintaining a guardianship (see Section 15.7.2.3 Fees to Guardians or Attorneys).
Expenses associated with a Self-Support Plan (see Section 15.7.2.2 Self-Support Plan).
IRWE (see Section 15.7.4 Impairment Related Work Expenses).
Maintaining a home or apartment (see Section 15.7.1 Maintaining Home or Apartment).
Costs associated with real property listed for sale (see Section 16.2 Assets Availability).
For specific exemptions, see Section 15.3 Exempt/Disregarded Income.
Support payments are payments which a Medicaid member makes to another person outside of the FTG for the purpose of supporting and maintaining that person. Support payments are either court-ordered (see Section 15.7.2.1.1 Court-Ordered or non-court-ordered (see Section 15.7.2.1.2 Non-court-Ordered).
Include the support payment amount as part of an institutionalized person's monthly need (see Section 27.6 ILTC Monthly Need) and cost of care (see Section 27.7 ILTC Cost of Care Calculation).
A person in the fiscal group who has legal responsibility for a person in a nursing home may be paying that person's patient liability. If so, deduct this amount from the group's income.
The income deduction for monthly court ordered support expenses is the amount that the member is "obligated" to pay as stipulated in the court order. Do not allow payments for arrearages and annual R & D expenses.
Actual payments may be deducted for court ordered lying in costs for the costs of the birth of the child. Unlike monthly court ordered expenses, actual payments for lying in costs are frequently paid at various times and are usually not tied to a regular payment schedule.
Note: If the court order stipulates that the individual must pay a monthly amount toward lying in costs, allow the court-ordered amount (obligated amount) as an income deduction. If the member is required to pay lying in costs, but no specific monthly amount is ordered, allow actual payments for lying in costs as an income deduction.
Include non-court-ordered support payments only if they are paid to the following:
Institutionalized spouse. The maximum amount that can be included is the AFDC Cat Needy income limit for a group size of one (see Section 39.3 AFDC Related Income Table) minus the spouse's net income.
Minor child who is living with a non-legally responsible relative (NLRR). The maximum amount that can be included is the AFDC cat needy income limit for a group size of one plus the child's medical expenses minus the child's net income.
Do not include non-court-ordered payments if they are to:
A spouse or minor child who receives SSI, or
A spouse who is eligible for SSI but refuses to apply for it.
A member whose eligibility is based on blindness or disability may deduct income that is received under an approved self-support plan. This allows a handicapped person to receive income and accumulate resources for training or purchasing equipment necessary for self support. Where all requirements are met, income from any source, earned or unearned, is deducted and allowed to accumulate to the extent specified in the plan.
To qualify for this deduction, the member must perform in accordance with the plan. The plan must:
Be specific, current, and in writing.
Be approved by the county or tribal agency.
Specify the amount to be set aside, and the expected cost and time required to accomplish the objective.
Provide for identification and segregation of goods and money accumulated and conserved.
The following fees to guardians or attorneys are not allowed income deductions:
Fees paid to a legal guardian or attorney, which are not court-ordered payments. Do not include such payments in the person's monthly need, and do not deduct them from his or her monthly income.
Fees paid to a third party to reimburse a prepayment the third party made of a guardianship fee. Do not allow the payment even if the third party obtained a court order to recoup the pre-payment.
Exception: Deduct this third party prepayment if:
The third party was the county acting as guardian ad litem. A guardian ad litem is someone appointed by the court to represent the best interests of a juvenile or disabled person during a particular court proceeding, and
The prepayment was to an attorney who was not a county employee at the time the services were delivered, and
A court ordered the institutionalized person to reimburse the county's prepayment.
The following fees to guardians or attorneys are allowable income deductions:
Court-ordered guardian and/or attorney fees paid directly out of the person's monthly income.
Expenses paid by the person for establishing and maintaining a court-ordered guardianship or protective placement for him or herself.
Medical/remedial expenses (MRE) are used in:
The home and community-based waiver programs,
Patient liability calculations for residents of a medical institution, and
Cost share and MAPP premium calculations.
Medical expenses are anticipated incurred expenses for services or goods that have been prescribed or provided by a professional medical practitioner (licensed in Wisconsin or another state). he expense is for diagnosis, cure, treatment, or prevention of disease or for treatment affecting any part of the body. These are expenses that are the responsibility of the member, and cannot be reimbursable by any other source, such as Medicaid, private insurance, or employer.
The following are examples of medical expenses:
Deductibles and copayments for Medicaid, Medicare, and private health insurances.
Health insurance premiums.
Bills for medical services that are not covered by the Wisconsin Medicaid program.
For purposes of meeting a Medicaid deductible, medical services received before the person became eligible for Medicaid. (Past medical bills cannot be used for MAPP premium calculations.)
Remedial expenses are costs incurred for services or goods that are provided for the purpose of relieving, remedying, or reducing a medical or health condition. These are expenses that are the responsibility of the member and cannot be reimbursable by any other source, such as Medicaid, private insurance, or employer.
Some examples of remedial expenses are:
Case management.
Day care.
Housing modifications for accessibility.
Respite care.
Supportive home care.
Transportation.
Services recognized under s.46.27, Wis. Stats.
Community Options Program, expenses that are included in the person's service plan.
Remedial expenses do not include housing or room and board services.
IRWE are expenses used to determine eligibility for Medicaid, MAPP eligibility and premium calculations. IRWE are anticipated incurred expenses by the member related to the member’s impairment and employment. The expense cannot be one that a similar worker without a disability would have, such as uniforms. The expense cannot be reimbursable by a legally obligated third party such as Medicaid, private insurance, or the member’s employer. If an anticipated IRWE is later paid by an unanticipated source, it is still allowable for past months in which it was budgeted but not for future months.
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Example 2: On March 25, Cecil was told by Harvey’s Auto Repair Shop that his wheelchair accessible van required repairs to fix the specialized door ramp. Cecil received an estimate of $2,000 for the repairs. The $2,000 estimate was determined to be a standard charge for this type of repair in the community.
On March 26, Cecil applied for MAPP in Milwaukee County. At this time the anticipated expense of the van repair was deducted from Cecil’s income.
Cecil delayed making the repairs until May 27, when the van’s wheelchair accessible door completely quit working. At that time Cecil’s friend Robin paid Harvey’s Auto Repair Shop for the repairs to Cecil’s van door. Cecil reported the repairs and the source of the money for the repairs to his IM worker.
Cecil’s IM worker should not deduct the anticipated cost of the van repairs for any subsequent eligibility and premium determinations. |
Deduct any MAPP member's expenses which:
Do not exceed his or her gross monthly earned income (plus room and board income, if any).
Are reasonably related to his or her earned income. Expenses which are reasonably related to earned income include those incurred in performing on the job and improving the person's ability to do the job.
Bills from months prior to the months for which eligibility is being determined are not an allowable IRWE. This is true even if it is currently being paid.
Determine a standard charge for the item or service based on what is representative for the member’s community. If you count an expense as an IRWE, do not also use the expense as a MRE.
Some examples of IRWE are: Modified audio/visual equipment, typing aides specialized keyboards, prostheses, reading aids, vehicle modification (plus installation, maintenance, and associated repair costs), and wheelchairs.
Do not allow the expense of getting to and from work as an IRWE, unless the expense is related to the member’s disability.
Exceptions: Always count the expenses of getting to and from work and the child care expenses as an IRWE for blind individuals.
The $65 and ½ earned income deduction is an EBD fiscal test group deduction.
To calculate the $65 and ½ earned income deduction, subtract $65 from the member’s monthly earned income. Divide the result by two, and add $65. This is the earned income deduction.
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Example 3: Michelle has monthly income of $1,240. Her $65 and ½ earned income deduction is
$1,240.00 - 65.00 $1,175.00
$1,175.00/2 = $587.50 Countable Income
$ 587.50 + 65.00 $ 652.50 Earned Income Disregard
Michelle’s earned income deduction amount is $652.50. |
This page last updated in Release Number: 15-01
Release Date: 06/10/2015
Effective Date: 06/10/2015
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030