Income Eligibility Requirements Income Goal To understand income

Income Eligibility Requirements

Income Goal: To understand income eligibility rules and processes as well as the laws and problems that guide them. Objectives After this module, participants will be able to: § Understand how income is considered for eligibility purposes § Review types of income § Identify program income limits § Determine the need of, gain approval for, and data enter an Income Trust § Calculate allowable deductions

Income § Eligibility looks at the individual’s income only § Spouse’s income is considered later § For children, parental income is not considered § No disregards at initial eligibility § Expenses are considered later

Income for Eligibility 8. 100. 7. P One spouse applying, other remains in the community. Applicant's Income only. Community Spouse's income does not impact eligibility. Both Spouses applying for HCBS Income of each spouse is used to determine eligibility individually One spouse Institutionalized, Community Spouse is now applying for HCBS Count Community Spouse's income AND count income received from Monthly Income Allowance (MIA) Children Do not count parent's income

Types of Income § Earned § Unearned § Exempt

Examples of Earned Income § § Any wages received from employment Net income from self-employment Honoraria In-Kind Income

Examples of Unearned Income § § § § Pensions, Social Security Workers comp/disability benefits Veterans benefits Alimony, maintenance In-kind support and maintenance Interest, dividend, royalties Gifts, prizes, inheritances Some Annuity payments

Examples of Exempt Income § SSI § Veteran’s Aid and Attendance (A&A) 8. 100. 5. K. § Veteran’s Unreimbursed Medical Expenses (UME) 8. 100. 5. K. § Reverse Mortgage payments are not income 8. 100. 5. L.

Regional Private Pay Limits 2019 Region I • $9, 516 Region II • $8, 567 Region III • $8, 253 Region IV • $8, 118

Income Limits § $0 -$2313 (300% SSI) § $2314 - Regional Private Pay rate if income trust is established

Income eligibility Income over regional average private pay rate Income ineligible Customer must private pay Income from $2314 to regional avg. private pay rate Income eligible if they set up an Income Trust Excess income is deposited into Income Trust Income from $0 to $2313 Income eligible No trust is needed

What is a Trust? § A trust is an arrangement in which a party is given property on the condition it is used to benefit someone else. § All trusts must be approved by HCPF!

Income Trust 8. 100. 7. E. 6. a § Establishes income eligibility for HCBS, PACE or NF § Cannot be used for initial hospital coverage (30 -day med)

Income Trust Roles § Settlor: Applicant makes the arrangement § Trustee: Hold and disburses income according to HCPF rules § Beneficiary: HCPF will recoup funds HCPF will NOT act as Trustee!

How Does it Work? § Individual income $2314 – Regional Rate § There are limits on how much income can be retained by an individual § Excess funds remain in the trust (as a patient payment) § HCPF is the beneficiary, the balance will be subject to Estate Recovery

Generate Income Trust packet

Pending for Income Trust

Trust Transmittal Form

Pending for HCPF approval

Approval of Income Trust

Retainable by Applicant $2313 for HCBS, PACE $86. 95 for NF (2019) (300% SSI) $90 for some VA veterans and widow(er)s

HCBS Cash Flow Income Trust (keeps excess) Disbursed Allowances

HCBS Cash Flow - Alternative Income Client (disburses allowances) Deposits Excess to Trust

Allowable Disbursements Personal Needs Allowance (PNA) Monthly Income Allowance (MIA) Dependent allowance Trust maintenance fees Mandatory tax withholdings Nursing Facility patient payments

Monthly Income Allowance (MIA) Designed to ensure that the Spouse’s basic needs are met Calculated using spouse’s income, shelter and medical expenses Allows access to institutionalized spouse income to meet needs Must be made available to spouse

Minimum Basic Allowance Minimum standard set for basic needs Also called Minimum Monthly Maintenance Needs Allowance (MMMNA) Updated every July Currently $2058

Maximum Allowance Takes into consideration actual shelter costs Cap on allowance May be called Maximum MMMNA, MMMNA maximum or also MMMNA! Updates every January

Dependent allowance For each additional tax dependent member of the household 1/3 of the minimum allowance ($677) Minus the dependent’s income

Other § Trust Maintenance Fees § Earned income while in an institution § Authorized Health Insurance and ‘Special Medical Services’

Calculation Sheets § One for NF, one for HCBS § Includes allowable disbursements

Trust Accounting § Eligibility Sites will keep track of how much should be in the Income Trust § Perform checks at Redeterminations

Income Trust Data Entry Name of Transfer Recipient: Applicant Amount Transferred: Enough to adjust income below $2250 Reason: Income Trust approved by HCPF Source: Trust Officer

Practice!

Income Wrap-up Goal: To understand income eligibility rules and processes as well as the laws and problems that guide them. Objectives After this module you can: Understand how income is considered for eligibility purposes Review types of income Identify program Income limits Identify the need of, gain approval for, and data enter an Income Trust Calculate allowable deductions

Questions?
- Slides: 35