Deeming of Income 510-05-85-50

(Revised 3/1/20 ML #3575)

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(N.D.A.C. Section 75-02-02.1-41)

 

This section applies to individuals who are subject to the Non-ACA Medicaid policies.

 

Excess income may be deemed to other members of the Medicaid unit as described in this section. Excess income is the amount of net income remaining after allowing the appropriate disregards, deductions and Medicaid income level.

  1. An ineligible Medicaid unit in the home is allowed a disregard of seventy-five percent of their excess income when determining client share (recipient liability) for an eligible recipient residing in a specialized facility. The excess income may be deemed to a non-SSI recipient in a specialized facility to bring the individual’s income up to the medically needy income level for one. Any remaining income becomes client share for the individual in the specialized facility. The 75% disregard applies during any full calendar month in which the recipient resides in a specialized facility.

Excess income of an eligible Medicaid unit in the home may be deemed to a non-SSI recipient in a specialized facility to bring the individual’s income up to the medically needy income level for one. Any remaining income becomes client share for the individual in the specialized facility and becomes client share for any other medically needy recipients in the Medicaid unit.

Refer to subsection 3 of 05-85-45 for instructions for the month the individual enters or leaves the facility.

  1. No income may be deemed to an SSI recipient in a specialized facility or receiving HCBS as such a recipient's maintenance needs are met by the SSI payment.
  2. The excess income of an individual in nursing care, an intermediate care facility for the intellectually disabled, the state hospital, the Anne Carlsen facility, or receiving swing bed care in a hospital or HCBS may be deemed to his or her legal dependents to bring their income up to the appropriate medically needy income level under the following conditions:
  1. The legal dependents who are also eligible for Medicaid do not receive a TANF payment or SSI. The maximum income that may be deemed is to the extent that it raises the legal dependent’s net income to the appropriate medically needy income level. Payments received specifically for increased medical costs are not income and cannot be deemed (e.g., Aid and Attendance, etc.).
  2. The legal dependents are ineligible or choose not to be covered by Medicaid. The maximum income that may be deemed is to the extent that it raises the legal dependents net income to the appropriate community spouse or family member income level. Payments received specifically for increased medical costs cannot be deemed (e.g., Aid and Attendance, etc.).
  1. Deeming to an ineligible community spouse is allowed only to the extent income of the institutionalized or HCBS spouse is made available to the community spouse.
  2. Excess income must be deemed to family members, in spousal impoverishment cases, up to the family member’s income level.
  1. The excess income of a spouse or parent(s) cannot be deemed to a recipient to meet medical expenses during any full calendar month in which the recipient receives psychiatric or nursing care services in a nursing facility, an intermediate care facility for the intellectually disabled (ICF-ID), the state hospital, the Anne Carlsen facility, the Prairie at St. John's center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), or receives swing bed care in a hospital or HCBS. Income of the eligible spouse or parent(s), however, may be deemed to bring the individual to the appropriate income level when the individual is ineligible for SSI.
  2. For purposes of determining eligibility for Workers with Disabilities coverage, income of a spouse or parent may be deemed to a non-SSI spouse or child, who is in the Medicaid unit, but who is not residing with the applicant or recipient, to bring their income up to the Workers with Disabilities income level.
  3. For purposes of determining eligibility for Children with Disabilities coverage, income of a spouse or parent may be deemed to a non-SSI spouse or child, who is in the Medicaid unit, but who is not residing with the applicant or recipient, to bring their income up to the Children with Disabilities income level.