Obsolete 0620 - 416-1 Comparing Countable Income To The FPL

Effective Date: January 1, 2007 - May 31, 2020 (416-1 incorporated into 443 sections as of June 1, 2020)

Contact DWS Program Specialist for previous policy (305-1: Renumbered to 416-1 as of 11/1/17)

Married Couple: Both are Aged, Blind or Disabled

For AM, BM, and DM programs, compare the countable income to 100% FPL for a two person household.

If the income is equal to or less than 100% of the FPL, the couple is income eligible for Medicaid without a spenddown.

Use the BM program when both spouses are blind. If their income is under 100% FPL, they are eligible without paying a spenddown.

If the income is above 100% of the FPL, the couple may spenddown (415). (If one spouse will be on the New Choices waiver, see 386 for the NCW policy. Do not have the couple spenddown on a case together when one spouse will be on the NCW.)

For Medicare Cost-Sharing programs compare the countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.

One Spouse in a Married Couple

Compare the couple's countable income to 100% of the FPL for a household size of:

Two:

If the other spouse is also aged, blind or disabled and will not be covered by Medicaid (it doesn’t matter if the spouse has deemable income) or,

If the other spouse is not aged, blind or disabled but has deemable income.

One:

If the other spouse is not aged, blind or disabled and has no deemable income.

If the income is equal to or less than 100% of the FPL, the client is income eligible for Medicaid without a spenddown.

If the income is above 100% of the FPL, the client may spenddown (415). [If a client applying for the NCW fails the 100% poverty test, see Sec. 386 to determine how to count income and resources. Determine eligibility first for the Special Income group. The Spenddown Waiver group for NCW applies only after the client fails the Special Income test. For the NCW Spenddown group, do not use this method to calculate the NCW spenddown because you do not deem income from the spouse under the NCW spenddown group.]

Use 100% of the FPL for a household size of one to determine the spenddown if the other spouse has no deemable income.

Use 100% of the FPL for a household size of two to determine the spenddown if the other spouse has deemable income.

If one spouse is on a HCB waiver, do not use this income test to determine a spenddown for the non-waiver spouse. (See 'Single Adult' below.)

For Medicare Cost-Sharing programs compare the couple's countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.

Single Adults and Children

Compare the client's countable income to 100% of the FPL for a household size of one.

If the income is equal to or less than 100% of the FPL, the client is income eligible for Medicaid without a spenddown.

If the income is above 100% of the FPL, the client may spenddown (415).

For Medicare Cost-Sharing programs compare the client's countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.