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State of Wisconsin |
Release 24-03 |
Monthly need is the amount by which the institutionalized person’s expenses exceed his or her income. It is computed by adding together the following monthly costs:
When you determine a hospitalized person’s monthly need use the average daily charge for the hospital the person is in. See Section 39.7 Hospital Daily Rates. If his or her hospital is not on the list, enter $2,318.08 on Long Term Care Gatepost/ Institutions screen.
If both spouses are institutionalized and one has income greater than his or her monthly need, calculate the couple’s combined monthly need and compare it to their monthly income. If their combined monthly need exceeds their combined monthly income, both spouses may become eligible.
Allow health insurance costs only if the primary person is the owner of the policy and is billed for the premium.
Do not deduct health insurance premiums for health insurance that pays for more than the cost of medical care. An insurance policy which pays for accidental injuries, does not qualify as a health insurance premium and cannot be deducted.
When a person pays premiums less often than once a month, prorate the premium to find the monthly amount. Deduct the monthly amount from the monthly income.
The accumulation of these premium amounts is an exempt asset. Exempt them for a period over which they have been prorated.
| Example 1: | Mr. W. pays a health insurance premium of $600 every quarter. The monthly amount, prorated over three months, is $200. Deduct $200 from Mr. W’s monthly income. Each quarter, exempt $600 of Mr. W’s assets until that quarter’s premium due date. |
Nursing home and hospital insurance policies are indemnification policies. Indemnification policies provide benefits in a fixed amount for a confinement, such as a hospitalization, regardless of the expenses actually incurred by the insured.
Nursing home and hospital insurance policies pay a flat rate to the policy holder for each day that he or she resides in the nursing home or hospital, respectively.
Consider nursing home and hospital insurance as a type of medical insurance. Allow the premiums as a deduction in the eligibility test and post-eligibility calculation.
All members must cooperate in providing Third Party Liability (TPL) coverage and access information (see Section 9.2 Nursing Home and Hospital Insurance). All members must sign over to the State of Wisconsin all their rights to payments from hospital or nursing home insurance (see Section 9.2.2 Assignment). Terminate eligibility for any individual that will not cooperate in:
Support payments are payments which an institutionalized Medicaid member makes to another person for the purpose of supporting and maintaining that person. See Section 15.7.2.1 Support Payments.
See Section 15.7.2.3 Fees to Guardians or Attorneys.
This page last updated in Release Number: 24-03
Release Date: 12/18/2024
Effective Date: 12/18/2024
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