Medicaid Policy
Medicaid Policy
Previous Policy (431-10 was previously found in section 409-12 until November 1, 2021)
A. Deductions for Family Members
Allow an income deduction for institutionalized or waiver individuals with dependent family members who are not living in a medical institution. This family allowance is deducted from the institutionalized or waiver member's income before deciding how much the member must pay for Medicaid institutional or waiver services. Refer to the specific waiver policy to decide when to allow this deduction.
1. Allow this deduction for each dependent family member.
2. The term ‘family member’ only includes minor or dependent children, dependent parents, or dependent siblings of the institutionalized or community spouse.
B. When is this Deduction Allowed?
1. When the member is in a medical institution or on a HCB waiver, deduct an allowance for dependent family members who are not in a medical institution for a stay that is expected to last more than 30 days and are not eligible for a HCB Medicaid waiver.
· If the member is a resident in a nursing home, the family member must live with the community spouse.
· For members on a HCB waiver, refer to the policy specific to that waiver to see when the deduction is allowed.
2. Deduct an allowance for a dependent family member only to the extent the money will be made available to the family member. The money may go directly to the family member or to a responsible person who will use it for the family member's care.
3. Deduct only the amount the member will actually give to or make available to the dependent family member, up to the maximum amount allowed.
4. Do not deduct an allowance if the institutional or waiver member says he or she will not give this money to the family member.
a. If the member is married, the deduction begins in the month of entry to a Nursing Home or the first month the member is determined eligible on a Waiver Program.
b. If the member is single, the family deduction begins the month after entry into a Nursing Home. If the member is approved for waiver services, the deduction is allowed the first month of waiver eligibility.
C. When the Deduction Stops
1. Stop deducting an allowance the month after the dependent family member no longer meets the criteria for being a dependent family member. For example, the family member's circumstances change so that the member would not be able to claim the family member as a dependent for tax purposes.
2. Stop the deduction if the member leaves the Nursing Home or is no longer receiving Waiver Services.
3. Stop the deduction the month after the family member enters a medical institution for a stay that lasts, or is expected to last, more than 30 days.
4. Stop the deduction from the waiver member's income the month after the family member becomes eligible for a HCB Medicaid waiver.
Family Members Who Qualify for a Family Allowance
1. The following family members may qualify for a family allowance:
a. A dependent son or daughter of the member or the member's spouse. This includes adoptive and stepchildren. It does not matter if the son or daughter is emancipated.
b. Dependent parents of either the member or the spouse including adoptive and stepparents.
c. Dependent siblings, step-siblings, half-siblings, and adoptive siblings of the member or the spouse.
2. Who is "Dependent?"
a. A family member is dependent if they are claimed as a dependent of the member or the member's spouse for income tax purposes, or could be claimed if the member or spouse were to file a tax form.
Family Member Deduction of a Nursing Home Member.
1. When the dependent family member lives with the community spouse, the allowance for a family member is equal to the minimum spousal income maintenance amount minus the family member's income and then divided by 3. Complete this calculation separately for each family member.
2. When the dependent family member does not live with the community spouse, the deduction is equal to the BMS Income Limit for a HH Size of one (Table VII) for each dependent minus their income.
Family Member Deduction of a Waiver Member
1. Not all waiver members will be eligible to receive this deduction. See the specific waiver policy to determine when to allow this deduction.
2. For a waiver member, it does not matter whether the dependent lives with the community spouse or not. The allowance for a dependent family member of a waiver eligible member is equal to the minimum spousal income maintenance amount minus the family member's income and then divided by 3. Complete this calculation separately for each family member.