18-01 Version of 24.5 Calculating the Deductible

24.5.1 Fiscal Test Groups
24.5.2 Institution Cases

24.5.2.1 Backdating
24.5.2.2 Deductible

24.5.3 Deductible Examples

To calculate the dollar amount of the Medicaid deductible for a regular Medicaid fiscal test group:

24.5.1 Fiscal Test Groups

Determine the Medicaid deductible period (see Section 24.3 Deductible Period) for this fiscal test group.

Find the fiscal test group's total net income for each month in the deductible period.

For the months after the month of application, subtract the income deductions (see Section 15.7 Income Deductions), including any applicable special exempt income, IRWEImpairment-Related Work Expenses, the $65 and ½ earned income deduction, and the $20 disregard, from the applicant’s gross income to get the monthly countable net income. Some of the income deductions allowed in other forms of Medicaid, such as the COLA for Special Status Medicaid or medical/remedial expenses for MAPP, are not deducted when calculating a deductible.

Compare the total net income of each month with the group's medically needy income limit. If the group is an:

SSI-related fiscal test group, see Section 39.4 Elderly, Blind, Or Disabled Assets and Income Tables.

If a month's income is less than or equal to the medically needy limit, ignore it.

If a month's income is more than the medically needy limit, find the excess income by subtracting the income limit from the net in-come of that month.

Add together the excess income of the months in the deductible period. The result is the Medicaid deductible.

24.5.2 Institution Cases

24.5.2.1 Backdating

Institutionalized and non-institutionalized persons can be eligible back to the 1st of the month, 3 months prior to the month of application. Even if they are ineligible in the month of application, they may still be eligible for retroactive coverage. When an institutionalized person requests retroactive Medicaid, test him or her against the nonfinancial and financial standards that are appropriate to the month being tested. For the months he or she was not institutionalized, use the EBD asset and income limits (39.4 Elderly, Blind, or Disabled Assets and Income Tables). For the months he or she was institutionalized, use the institutional eligibility criteria found in 27.1 Institutions.

24.5.2.2 Deductible

For the months in which he or she was not institutionalized, he or she may be eligible in some, but ineligible in others, due to excess income. In this situation, he or she has two choices:

To be certified for the months he or she is eligible, and accept the ineligibility of the other months in which he or she has excess income, or
To meet a deductible. The deductible period begins in the backdate month that he or she chooses, and extends 6 months. Calculate the deductible for the full 6-month deductible period. Calculate the deductible by comparing his or her monthly income for each of the 6 months to the SSI-related medically needy income limit, not the institutional income limit.

Expenses which can be counted against the deductible are those listed in 24.7 Meeting the Deductible plus his or her cost of care (27.7 ILTC Cost of Care Calculation). Expenses that cannot be counted are listed in 24.7.2 Meeting the Deductible> Noncountable Costs.

When he or she meets the deductible, she can be certified to the end of the deductible period. At the end of the deductible period, redetermine his or her eligibility using the institutional financial tests.

24.5.3 Deductible Examples

Example 1:

Artie applies for Medicaid in July. He wants to backdate his Medicaid three months. His Medicaid deductible period is April through September. In April, May, June, and July his AGassistance group had excess income of $50 each month. His prospective excess income for August and September is $50 each month. 6 X $50 = $300. Artie's Medicaid deductible is $300.

Example 2:

Clarice applies for Medicaid in July. She wants to backdate her Medicaid to May 1. Her Medicaid deductible period is May 1 through October 31. In May and June her AG had excess income of $100 each month. In July it has excess income of $200. Its prospective excess income for August, September, and October is $200 a month. Clarice's Medicaid deductible is $1,000.

Example 3:

Myron applies for Medicaid in July. He wants to backdate Medicaid to June 1. His Medicaid deductible period is June 1 through November 30. In June his AG had excess income of $50. In July it has no excess income. Its prospective excess income for August, September, October, and November is $0. Myron's Medicaid deductible is $50.

Example 4:

Tyler applies for Medicaid in July. He wants his Medicaid to begin July 1. His Medicaid deductible period is July 1 through December 31. In July his AG has $100 excess income. Its prospective excess income for August, September, October, November, and December is $100 each month. Tyler's Medicaid deductible is $600.

This page last updated in Release Number: 18-01
Release Date: 04/13/2018
Effective Date: 04/13/2018