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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
After the institutionalized person is found eligible, s/he may allocate
some of his/her income Income is anything you receive in cash or in kind that you can use to
meet your needs for food, clothing, and shelter.
to the community spouse and dependent family members living with the community
spouse.
Dependent family members include:
Dependent minor children (natural, adopted, step)
of either parent who live with the community spouse.
Children (natural, adopted, step), 18 years of
age or older, of either parent, who are claimed as dependents for
tax purposes under the Service Code Internal Revenue ( IRSC ) and who
live with the community spouse.
Siblings of either the institutionalized person
or the community spouse who are claimed as dependents and who live with
the community spouse.
Parents of either the institutionalized person or the community spouse who are claimed as dependents and who live with the community spouse.
The institutionalized person must decide how much income to allocate. S/he may allocate an amount that brings the community spouse's and family members' income up to the maximum allocation, or s/he may choose to allocate a lesser amount.
Since s/he may have medical costs that aren't covered by MA, s/he may wish to keep some income and not allocate it all.
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Example 1: Caroline has monthly income of $400. She transfers $310 to her community spouse, keeping only her personal needs allowance (8.1.5.1) and $45 to pay as her monthly patient liability. She incurs $80 in non-covered medical expenses each month. Those expenses will be charged first to her patient liability. But she must pay the remaining $35.00 out of her personal needs allowance. If the personal needs allowance does not cover her expenses, the provider will try to obtain the balance from the community spouse. |
Use the Spousal Impoverishment Income Allocation Worksheet (WKST 07) to determine how much of the institutionalized spouse's income:
May be allocated to his/her spouse ( Section A
).
Will be deducted, regardless of whether or not
s/he actually allocated it to other dependent family members ( Section
B ).
Will be paid toward his/her cost of care ( Section C ).
On the Spousal Impoverishment Income Allocation Worksheet (WKST 07), do the following:
Section A -- Community Spouse Income Allocation
Enter on Line 1 the
community spouse maximum income allocation. Unless
a larger amount is ordered by a fair hearing or court, the maximum allocation
is the lesser of:
$2,377.50, or
$2,138.33
plus excess
shelter allowance.
“Excess shelter allowance” means shelter expenses above $641.50.
Subtract
$641.50 from the community spouse’s shelter costs. If
there is a remainder, add the remainder to $2,138.33.
Community Waivers. Follow
these rules to determine when to add the excess shelter cost to the community
spouse income allocation:
If the waiver person's community spouse lives
with him/her, do not add the excess shelter cost to the income allocation.
If the waiver person's community spouse does
not live with him/her, add the excess shelter cost to the income allocation.
Community spouse shelter costs
include the community spouse’s expenses for:
Rent.
Mortgage principal and interest.
Taxes and insurance for principal place of residence. This includes renters insurance.
Any required maintenance fee if the community spouse lives in a condominium or cooperative.
The standard
utility allowance established under the Food Stamp program:
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If Community Spouse pays: |
Add |
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Heat and utilities |
$238 |
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Utilities only |
$135 |
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Telephone only |
$24 |
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If the community spouse lives in a condominium or cooperative where the maintenance fee includes utility expenses, reduce the standard utility allowance by the amount of utility expenses included in the maintenance fee. |
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A court or fair hearing can increase
the community spouse income allocation if it determines the spouse is
not able to provide for his/her necessary and basic maintenance needs
with the amount allocated.
If a court or a fair hearing decision orders a larger Community
Spouse Income Allocation, enter the court or fair hearing ordered amount
on Line 1.
Enter on Line 2 the community spouse's monthly
gross income.
Use the
EBD income rules, but do not give earned income, unearned income, and
work related deductions.
Do the math from Line 1 through Line 3. The result on Line 3 is the maximum amount of income the institutionalized spouse may allocate to his/her community spouse.
If the institutionalized spouse does not
allocate the maximum amount, the amount s/he retains counts as income
in determining the amount contributed to the patient liability.
Section B -- Family Member Income Allowance
Enter $534.58 on Line 1 under the name of each dependent family member who lives with the community spouse.
Enter the gross monthly income of each dependent
family member under his/her name. Use
the EBD income rules, but do not give earned income, unearned income,
and work related deductions.
Do the math from Line 1 through Line 3.
Add the Line 3 amounts together and enter the total on Line 4. Deduct the amount on Line 4 from the institutionalized spouse's income.
Section C -- Cost of Care
Enter the institutionalized person's gross monthly
income on Line 1. Use
the EBD income rules, but do not give earned income, unearned income,
and work related deductions.
Enter
his/her personal allowance on Line 2:
Personal Needs Allowance (8.1.5.1) for a person in
a medical institution, or
Personal Maintenance Allowance for a person in community waivers. This is the Community Waivers Basic Needs Allowance (8.1.5.1) plus other applicable deductions (5.9.9.2.1) up to the EBD Maximum Personal Maintenance Allowance amount (8.1.5.1).
Enter on Line 4 the income allocation amount (Section
A, Line 3) that is actually allocated to the community spouse.
Enter on Line 6 the dependent family member allowance
from Section B, Line 4.
Enter on Line 8 any court-ordered guardian or
attorney fees (5.8.6.5).
Community waivers only. Enter
on Line 10 the community waiver person's medical/remedial expenses and
the cost of his/her health insurance premiums.
Nursing home cases only. Enter
on Line 10 the cost of the nursing home person's health insurance premiums.
Do the math from Line 1 through Line 11. The result on Line 11 is the amount the institutionalized spouse must pay toward cost of care.
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Example 2: Harry, a MA recipient, resides in a nursing home. He has unearned income of $3,600 a month. His wife, Edith, gets $200 a month from Social Security. Her sisters, Mabel and Maxine, whom she claims as dependents on her IRS tax forms, live with her. Mabel has no income. Maxine receives $20 a month from her son. Community Spouse Income Allocation
Harry's community spouse, Edith, has shelter costs of $756.00 a month. Her excess shelter costs are $756.00 minus $641.50 = $114.50. $114.50 plus $2,138.33 = $2,252.83. $2,252.83 is less than $2,377.50, so the maximum allocation amount to Harry's spouse is $2,252.83.
$ 2,252.83 (maximum income allocation) -200.00 (Edith's monthly income) $ 2,052.83(spousal income allocation)
Family Member Income Allowance
$ 534.58 (maximum income allowance) -0.00 (Mabel's income) $ 534.58 (Mabel's income allowance)
$ 534.58 (maximum income allowance) -20.00 (Maxine's income) $ 514.58 (Maxine's income allowance)
$534.58 (Mabel's income allowance) +$514.58 (Maxine's income allowance) $1049.16 (total family member income allowance)
Payment Toward Cost of Care
$ 3600.00 (Harry's income) -45.00 (personal needs allowance) - 2,052.83(spousal income allocation) -$1049.16 (family member income allowance) $ 453.01 (nursing home liability amount)
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This page last updated in Release Number : 05-03
Release Date: 08/29/05
Effective Date: 07/01/05