Long-term services and supports (LTSS) manual

Family and dependent allocation

Revised Date: 
July 1, 2015

Purpose: Describes how the spousal and dependent allocation is determined in post-eligibility for institutional and HCB waiver programs.

WAC 182-513-1385 Determining the community spouse monthly maintenance needs allowance and dependent allowance in post-eligibility treatment of income for long-term care (LTC) programs.

Effective February 20, 2017

  1. This section describes how to calculate the monthly maintenance needs allowance (MMNA) in post-eligibility treatment of income for long-term care (LTC) programs for a community spouse or dependent of the institutionalized individual.
  2. The community spouse MMNA standards are found at http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/standards-ltc, unless a greater amount is calculated under subsection (5) of this section. The MMNA standards may change each January and July based on the consumer price index.
  3. The community spouse MMNA is allowed only to the extent that the institutionalized spouse's income is made available to the community spouse, and is calculated as follows:
    1. The minimum MMNA as calculated in subsection (4)(a) of this section plus excess shelter expenses as calculated in subsection (4)(b) of this section;
      1. The total under (a) of this subsection cannot be less than the minimum MMNA; and
      2. If the total under subsection (4)(a) of this section exceeds the maximum MMNA, the maximum MMNA is the result under subsection (4)(a) of this section; and(b) The total under subsection (4)(a) of this section is reduced by the community spouse's gross income. The result is the MMNA.
  4. The minimum MMNA and excess shelter expense values are calculated as follows:
    1. The minimum MMNA is one hundred fifty percent of the two-person federal poverty level (FPL); and
    2. If excess shelter expenses are less than zero, the result is zero. Excess shelter expenses are calculated as follows:
      1. Add:
        1. Mortgage or rent, which includes space rent for mobile homes;
        2. Real property taxes;
        3. Homeowner's insurance;
        4. Required maintenance fees for a condominium, cooperative, or homeowner's association that are recorded in a covenant; and
        5. The food assistance standard utility allowance (SUA) under WAC 388-450-0195 minus the cost of any utilities that are included in (b)(i)(D) of this subsection.
      2. Subtract the standard shelter allocation from the total in (b)(i) of this subsection. The standard shelter allocation is thirty percent of one hundred fifty percent of the two-person FPL. The result is the value of excess shelter expenses.
  5. The amount allocated to the community spouse may be greater than the amount determined in subsection (3) of this section, but only if:
    1. A court order has been entered against the institutionalized spouse approving a higher MMNA for the support of the community spouse; or
    2. A final order has been entered after an administrative hearing has been held under chapter 182-526 WAC ruling the institutionalized spouse or the community spouse established the community spouse needs income, above the level otherwise provided by the MMNA, due to exceptional circumstances causing significant financial duress.
  6. If a final order establishes that the conditions identified in subsection (5)(b) of this section have been met, then an amount of allocated resources under subsection (3) of this section will be substituted by an amount adequate to provide such an MMNA.
  7. The agency or its designee determines the dependent allowance for dependents of the institutionalized individual or the institutionalized individual's spouse. The amount the agency allows depends on whether the dependent resides with the community spouse.
    1. For each dependent who resides with the community spouse:
      1. Subtract the dependent's income from one hundred fifty percent of the two-person FPL;
      2. Divide the amount determined in (a)(i) of this subsection by three;
      3. The result is the dependent allowance for that dependent.
    2. For each dependent who does not reside with the community spouse:
      1. The agency determines the effective MNIL standard based on the number of dependent family members in the home;
      2. Subtracts each dependent's separate income;
      3. The result is the dependent allowance for the dependents.
    3. Child support received from a noncustodial parent is the child's income.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

The WACs used to determine post-eligibility treatment of income (PETI), also called participation calculation:

WAC 182-515-1509 for HCS CN Waiver programs (Commonly referred as the COPES WAC)
WAC 182-515-1514 for DDD CN Waiver programs
WAC 182-513-1380 Participation (residing in medical institutions)

In post-eligibility, the community spouse and family allocation is allowed as a deduction when determining participation. The basic community spouse maintenance and family allocation standard is 150% of the 2-person FPL increases annually on July 1.

We allow this deduction to the extent income of the institutionalized spouse is made available to, or for the benefit of, the community spouse or dependent. If the institutionalized spouse refuses or we have evidence the spousal maintenance or family allocation is not made available to the spouse or dependents, we do not give the allocation. Indicate "waive spousal allowance" on the LTCX screen.

If the community spouse or dependent does not provide verification of their gross income and shelter costs needed to determine the spousal and dependent allocation, do not deny or terminate the case. Do not allow the allowance and indicate in the notice that in order to allow the possible deduction, the agency needs verification of the spousal/dependent income. Once verification is provided, we would allow the deduction the first of the following month for HCB Waivers and in the month verification is provided for institutional programs.

The dependent rule states:

A monthly maintenance needs amount for each minor or dependent child, dependent parent, or dependent sibling of your community or institutional spouse. The amount the department allows is based on the living arrangement of the dependent. If the dependent:

  1. Resides with your community spouse, the amount is equal to one-third of the community spouse allocation as described in WAC 182-513-1380 (5)(b)(i)(A) that exceeds the dependent family member's income (child support received from a noncustodial parent is considered the child's income);
  2. Does not reside with the community spouse, the amount is equal to the Standards - LTSS based on the number of dependent family members in the home less their separate income (child support received from a noncustodial parent is considered the child's income).

What is a dependent?

A dependent for deeming purposes is the same as a dependent for Federal income tax purposes. If a dependent is claimed on the community spouse or institutional spouse's personal income tax return, a family allocation can be considered.
A dependent does not need to be living with the client or the community spouse to be considered for a family allocation.

Dependent residing with the community spouse

For each dependent we take the community spouse income and family allocation standard (150% of the 2 person FPL) minus that dependents income. Then we divide that figure by 3. The result is the dependent allocation allowed for that dependent.

For more than one dependent we do the same computation indicated above for each dependent.

Example #1

COPES client living with the community spouse and 3 minor children.

Child #1 has $300 Social Security and $300 child support

Child #2 has $300 Social Security

Child #3 has $300 Social Security

Computation for the dependent deeming based on the 7/1/2009 community spouse income and family allocation of $1822. (see LTC standard chart for current CS income and family allocation):

Child #1

$1,822 (7/1/2009 CS and family allocation standard)

-$600 child's income

= $1,222 divided by 3 = $407.33 available to deem to child #1

Child #2

$1,822

- $300 child's income

= $1,522 divided by 3 = $507.33 available to deem to child #2.

Child #3

$1,822

-$300

= $1,522 divided by 3 = $507.33 available to deem to child #3

Example #2

Nursing Home client. Community spouse has a dependent sibling residing with her that is claimed on the income tax return. She also has a 19 year old and 14 year old child living with her.

Dependent #1 sibling has $100 per month gross earnings

Dependent #2 19 year old child has $500 per month gross earnings

Dependent #3 14 year old child has no income

Computation:

Dependent #1

$1,822 CS income and family allocation

- $100 income

= $1,722 divided by 3 = $574 available to deem to dependent #1

Dependent #2

$1,822

- $500 income

= $1,322 divided 3 = $440.47 available to deem to dependent #2

Dependent #3

$1,822 divided by 3 = $607.33 available to deem to dependent #3

Note: The dependent and their income is coded on the LTCX screen in ACES.

Dependent not residing with the community spouse

When the dependent does not reside with the community spouse the

calculation standard is the MNIL and based on the number of dependents minus the

dependents income.

Example #1

COPES client with 2 dependent children. Child #1 is 18 and has $100 income. Child #2 is 15 and has $300 child support income.

Calculation:

MNIL/$674.00 (Standard is based on 1/2009 standards, see LTC standard chart for current MNIL)

- both dependents total income of $400

= $274.00 available to deem to the 2 dependents

Why are the 2 calculations so different?

The calculation when the dependents are living with the community spouse are based on the spousal impoverishment act. When there is no community spouse as part of the household, the spousal impoverishment rules do not apply.

CMS standards including spousal impoverishment

Spousal Impoverishment

Things to remember about the dependent allocation

  1. If the dependent is applying for their own medical benefits, any actual income deemed from the institutional individual to the dependent is considered the dependent's income. Code the deemed income as OC under the income in ACES 3G or the UNER screen in ACES mainframe and document this deemed income from the institutional individual in the remarks.
  2. The dependent allocation follows the order of post eligibility deductions in WAC 182-513-1380 for institutional (residing in a medical institution) services, WAC 182-515-1509 for HCS CN Waiver programs, or WAC 182-515-1514 for DDD Waiver programs. The institutional individual may not have enough income to deem the maximum amount available for the family allocation based on the amount of income and the deductions allowed. For cases with a community spouse, the community spouse (CS) is allowed up to the CS income and family allocation minus the CS income before the dependent deduction. In addition the CS may get additional deeming up to the CS maintenance standard due to excess shelter.

Child Support received by the institutionalized individual

WAC 182-513-1340 (10) states child support payments received from an absent parent for a child living in the home is income of the child.

Back child support received for a child no longer living in the home is considered income.