Facts:

Mr. Smith has been found eligible for OSIPM-OAA while receiving nursing facility services. Mr. and Mrs. Smith's countable income is as follows:

Mr. Smith

Social Security

$ 1000

Private pension

     700

Total

$1,700

Mrs. Smith

Social Security

$ 450

$ 400

What are Mr. Smith's income deductions? What is his adjusted income?

Follow the steps below (461-160-0620)

Step 1:

Deduct the standard earned income deduction. Because Mr. Smith has no earned income, he does not qualify for this deduction.

Step 2:

Allow deductions under the plan for self-support. Mr. Smith does not have a plan for self-support. Therefore, there are no deductions to allow for this.

Step 3:

Deduct one of the following needs allowances for Mr. Smith:

• $30 for residents of nursing facilities or state institutions.

• $90 for clients in long-term care who are single, have no dependents, and are eligible for VA aid and attendance benefits.

• The applicable OSIPM standard for one person, for clients receiving waivered services. This amount is found in 461-155-0250, section (3).

In Mr. Smith's case, the allowance is $30 for nursing facility care.

Mr. Smith's total income

$1,700

Minus needs allowance

 - 30

Mr. Smith's available income

$1,670

Step 4:

Deduct a community spouse income allowance for Mrs. Smith. Calculate the community spouse income allowance as follows:

First, calculate a maintenance needs standard for Mrs. Smith by adding the following amounts:

$1,839; PLUS

The amount over $552 that is needed to pay monthly shelter expenses for the Mr. and Mrs. Smith's principal residence. Monthly shelter expenses are rent or mortgage payments, taxes, insurance, required maintenance charge for a condominium or cooperative, plus the FS full standard utility allowance (FUA) for the spouse and eligible dependents.

Monthly mortgage, taxes, insurance

$ 400

FUA

+ 395

 - 552

$243

So Mrs. Smith's total maintenance needs standard is:

$1,839

+243

$2,082

Next, subtract Mrs. Smith's monthly income from the maintenance needs standard calculated above:

Maintenance needs standard

$2,082

Mrs. Smith's monthly income

- 450

$1,632

Mrs. Smith's monthly community spouse income allowance is $1,632.

Step 5:

Deduct an amount for each eligible dependent whose monthly income is under $1,839. Determine the amount as follows:

Subtract the eligible dependent's monthly income from $1,839; AND

Calculate one-third of the amount remaining.

The Smiths have no eligible dependents and therefore do not qualify for this allowance.

Step 6:

Deduct the cost of the following:

Health insurance premiums prorated on a monthly basis; AND

Other incurred medical expenses not covered by the State Plan, but recognized under state law code (e.g., dentures).

Mr. Smith does not have any of these medical expenses, so he does not qualify for this deduction.

Step 7:

Once Steps 1 through 6 are completed, code CMS with a need code of LDS, reflecting the calculated amount for the community spouse income allowance. See the Computer Guide III-D, on need codes for more information.

Mr. Smith's contribution toward the cost of care will be $38 ($1,700 - $30 - $1,632).

Mrs. Smith will have a total income of $2,082 ($450 + $1,632).