Clarifying Information
Income that remains after allowable deductions is the amount the client must pay toward the cost of care in the medical institution. The order and description of deductions follows WAC 182-513-1380. The combination of 1 - 4 can't exceed the medically needy income level (MNIL).
- Personal Needs Allowance (PNA)
- Mandatory taxes
- Wage deduction from department approved employment
- Guardianship fees and related attorney costs
- Court ordered child support
- Spousal maintenance allowance
- Dependent maintenance allowance
- Allowable medical expenses
- Home Maintenance Allowance (HMA)
Note: The 65 and 1/2 deduction is not allowed for earnings in a medical institution; however, a wage deduction is allowed, dollar for dollar, up to the MNIL after allowing the PNA and mandatory tax deduction. Approved wages are coded as RH ACES on the income screen.
SSI Income:
When an individual enters a medical institution, the Social Security Administration (SSA) reduces the SSI cash payment to $30 per month. The full SSI benefit is continued, if SSA determines the individual's stay in the institution is not likely to exceed three months and the individual has expenses for maintaining a home. When SSA makes this determination, the full SSI benefit/State supplementary payment (SSP) is continued and is excluded in the post-eligibility process.
Personal Needs Allowance (PNA):
Client's are allowed the highest PNA in a given month based on living arrangement, authorized service and marital status. If a client resides at home at least one moment in the month and admits into a nursing facility (NF) we would allow the in home PNA.
Dependent and Family Allocation Calculation:
Family and dependent allocation
Home Maintenance Allowance (HMA):
The HMA is income that the client can keep to maintain their residence during their NF stay. The HMA is approved by the social worker/case manager.
HMA can be approved for up to 6 months when it is determined the client is likely to return home within 6 months.
The monthly HMA amount is the current Federal Poverty Level (FPL).
There is no limit to HMA for multiple admissions and discharges to a NF. It is not allowed for more than 6 consecutive months.
Hospice:
Hospice index
Participation in the cost of care for hospice services received in a medical facility is determined according to WAC 182-513-1380. The client pays their participation amount to the hospice agency.
Changes in income and deductions using Method 1 and 2 for institutional cases.
For further information see LTC change of circumstance.