Medicaid Policy
Medicaid Policy
Previous Policy (431-14 was previously found in section 409-16 until November 1, 2021)
Post-Eligibility Deductions for the New Choices Waiver
Members eligible for the New Choices Waiver receive certain deductions from income to decide what their cost of care will be. Deductions for post-eligibility are taken out of "Total Income." (463-1) Total income includes income that may be disregarded to determine eligibility for some individuals. See Sec. 417 for total income included in the post-eligibility process. (The MWI income category does not follow a Post Eligibility process, follow the rules found in 314-1 for the MWI premium). Use the following for all other income categories:
A. Community Groups and Spenddown Waiver Group
Members in the SSI Recipient, SSI Protected groups, 100% FPL Aged or Disabled groups, MWI group and Spenddown waiver income group do not have a post eligibility test.
B. Special Income Group
1. Deduct the following from the waiver member's total income in the following order.
a. Personal Needs Deduction: Deduct an amount equal to 100% of the federal poverty limit for one from the member's income. (See Table II)
b. Earned income deduction: Deduct $125 from earned income (431-4).
c. Shelter and Utility Cost Deductions: Members are allowed these income deductions so they can pay their shelter and utility costs.
i. Allow actual costs the member pays up to $300 for rent, or mortgage, property taxes, home-owner’s or renter’s insurance, etc.
ii. If the member has a heating or cooling expense, allow the Food Stamp program's Standard Utility Allowance. If the member does not have a heating or cooling expense, but has utility expenses other than just a phone, allow the Food Stamp WOHA (without heat) deduction. If the member only has a phone expense, allow the Food Stamp Phone Only allowance. (See Table II)
iii. If a member lives with a spouse, deduct only the amount of the rent/mortgage costs that the member is actually responsible to pay up to the $300. Only one utility allowance is allowed for the couple, so it can be deducted from the member's income, or it can be used to determine the amount of the spousal needs allowance deduction.
d. Spousal Needs Allowance: Deduct an amount for the waiver member's community spouse as described in Sec. 431-9.
e. Family Needs Allowance: Deduct an amount for the waiver member's dependent family members as described in Sec. 431-10.
f. Health Insurance Premiums: Deduct the amount of health insurance premiums the member pays for his or her own coverage as described in Sec. 431-1.
g. Medical Expenses: Deduct medical expenses the member pays or incurs for the member's medical services as described in Sec. 463-3.
h. Any remaining amount is the member's contribution to cost of care.
2. The member may not have enough income to cover the full amount of all the applicable deductions. However, the deductions are to be allowed in the order shown. This can mean there is too little income to provide the full deductions for a spouse or family member that could be allowed under policy.