Appendix 3 - Summary Chart for Institutional Income Eligibility Process
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Appendix 3 - Summary Chart for Institutional Income Eligibility Process


Revised October 28, 2007



Purpose:

SUMMARY CHART FOR INSTITUTIONAL INCOME ELIGIBILITY PROCESS

STEP

TANF/SSI Related

DETERMINE

COMPARE TO

IF BELOW

IF ABOVE

1

 

SSI related

Gross income

Medicaid SIL

Eligible for CN and institutional care. Go to Step 3.

Go to Step 2 ***

TANF related

Countable income *

TANF grant payment standard

Eligible for CN and institutional care. Go to Step 3.

Go to Step 2

2

SSI related and TANF related

Countable income *

Facility's private rate and client's recurring medical expenses

Eligible for institutional care. Go to Step 3 to determine if MN with or without spenddown.

Not eligible for institutional care. Determine MN eligibility as if living in own home.

3

SSI related and TANF related

Available income **

Facility's DSHS contracted rate

Eligible for CN or MN without spenddown

Must spenddown to be eligible for MN

The NF is "locked-in" and must accept the DSHS contracted rate, instead of private rate from the client.



* Determine countable income by subtracting exemptions and disregards from gross income.

** Determine available income by adding income disregarded in Steps 1 and 2 back in to countable income then deducting post-eligibility income allocations and exemptions].

*** If married with community spouse, redetermine income eligibility using "community income" rule.

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Modification Date: October 28, 2007
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