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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
4.1.3.1 Maintaining Home or Apartment
4.1.3.2.3 Fees to Guardians or Attorneys
4.1.3.3 Medical/Remedial Expenses ( MRE )
4.1.3.4 Impairment Related Work Expenses ( IRWE )
4.1.3.5 $90 Earned Income Disregard
4.1.3.6 $65 and ½ Earned Income Disregard
If an institutionalized person has a home or apartment, deduct an amount from his/her income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. to allow for maintaining the home or apartment.
Make the deduction only when the following conditions are met:
A physician certifies (verbally or in writing) that the person is likely to return to the home or apartment within six months, and
The person's spouse is not living in the home or apartment.
The amount is in addition to the personal needs allowance (8.1.5). It may not exceed the SSI payment level plus the E Supplement for one person (8.1.5). It should be enough for mortgage, rent, property taxes (including special assessments), home or renters insurance, utilities (heat, water, sewer, electricity, and other incidental costs.
Deduct it for no more than six months. If the person is re-admitted to the institution, grant a six month continuance. A physician must again certify that s/he is likely to return to the home or apartment within six months.
The home maintenance allowance can be granted at any time as long as the person is institutionalized. It is not limited to the first six months of institutionalization.
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Example: Bob was institutionalized in June 2003 as a private pay patient. In June 2004, he qualifies for Medicaid and is potentially eligible for the home maintenance allowance. Bob's doctor says he is expected to return home by November 2004. He is eligible for the deduction from his income when determining the amount of his income available for his cost of care starting in June 2004. |
Special exempt income includes:
Income used for supporting others (4.1.3.2.1).
Court-ordered attorney fees (4.1.3.2.3).
Court-ordered guardian and guardian ad litem fees (4.1.3.2.3).
Expenses associated with establishing and maintaining a guardianship. (4.1.3.2.3)
Expenses associated with a Self-Support Plan (4.1.3.2.2).
Impairment Related Work Expenses (IRWE) (4.1.3.4).
Maintaining a home or apartment (4.1.3.1)
Costs associated with real property listed for sale (4.5.2.1)
For specific exemptions see 4.1.2
Support payments are payments which an MA client makes to another person outside of the FTG for the purpose of supporting and maintaining that person. Support payments are either court-ordered or non-court-ordered.
Include the support payment amount as part of an institutionalized person's monthly need (5.8.6) and cost of care (5.8.7).
A person in the fiscal group who has legal responsibility for a person in a nursing home may be paying that person's patient liability. If so, deduct this amount from the group's income.
The income deduction for monthly court ordered support expenses is the amount that the client is "obligated" to pay as stipulated in the court order. Do not allow payments for arrearages and annual R & D expenses.
Actual payments may be deducted for court ordered lying in costs for the costs of the birth of the child. Unlike monthly court ordered expenses, actual payments for lying in costs are frequently paid at various times and are usually not tied to a regular payment schedule.
Note: If the court order stipulates that the individual must pay a monthly amount toward lying in costs, allow the court ordered amount (obligated amount) as an income deduction. If the member is required to pay lying in costs, but no specific monthly amount is ordered, allow actual payments for lying in costs as an income deduction.
4.1.3.2.1.2 Non-court-Ordered.
Include non-court-ordered support payments only if they are paid to the following:
Institutionalized spouse. The maximum amount that can be included is the AFDC Cat Needy income limit for a group size of one (8.1.4) minus the spouse's net income.
Minor child who is living with a non-legally responsible relative (NLRR). The maximum amount that can be included is the AFDC cat needy income limit for a group size of one plus the child's medical expenses minus the child's net income.
Do not include non-court-ordered payments if they are to:
A spouse or minor child who receives SSI, or
A spouse who is eligible for SSI but refuses to apply for it.
A client whose eligibility is based on blindness or disability may deduct income that is received under an approved self-support plan. This allows a handicapped person to receive income and accumulate resources for training or purchasing equipment necessary for self support. Where all requirements are met, income from any source, earned or unearned, is deducted and allowed to accumulate to the extent specified in the plan.
To qualify for this deduction, the client must perform in accordance with the plan. The plan must:
Be specific, current, and in writing.
Be approved by the county or tribal agency.
Specify the amount to be set aside, and the expected cost and time required to accomplish the objective.
Provide for identification and segregation of goods and money accumulated and conserved.
Count as available income any payments an institutionalized person makes to:
A legal guardian or attorney which are not court-ordered payments. Do not include such payments in the person's monthly need, and do not deduct them from his/her monthly income.
A third party to reimburse a prepayment the third party made of a guardianship fee. Count the payment even if the third party obtained a court order to recoup the pre-payment.
Exception: Deduct this third party prepayment if:
The third party was the county acting as guardian ad litem. A guardian ad litem is someone appointed by the court to represent the best interests of a juvenile or disabled person during a particular court proceeding.
The prepayment was to an attorney who was not a county employee at the time the services were delivered.
A court ordered the institutionalized person to reimburse the county's prepayment.
Do not count the following as available income:
Court-ordered guardian and/or attorney fees paid directly out of the person's monthly income.
Expenses paid by the person for establishing and maintaining a court-ordered guardianship or protective placement for him/herself.
Medical and Remedial Expenses ( MRE ) are used in waiver and Family Care Non-MA eligibility determinations, as well as in cost share and Medicaid Purchase Plan ( MAPP The Medicaid Purchase Plan (MAPP) offers people with disabilities who are working or interested in working the opportunity to obtain health care coverage through the Wisconsin Medicaid Program. ) premium calculations.
Medical expenses are anticipated incurred expenses for services or goods that have been prescribed or provided by a professional medical practitioner (licensed in Wisconsin or another state). The expense is for diagnosis, cure, treatment, or prevention of disease or for treatment affecting any part of the body. These are expenses that are the responsibility of the client, and cannot be reimbursable by any other source, such as MA, private insurance, or employer.
The following are examples of medical expenses:
Deductibles and co-payments for MA, Medicare, and private health insurances.
Health insurance premiums.
Bills for medical services which are not covered by the Wisconsin MA program.
For purposes of meeting a MA deductible, medical services received before the person became eligible for MA. (Past medical bills cannot be used for MAPP premium calculations.)
Remedial expenses are costs incurred for services or goods that are provided for the purpose of relieving, remedying, or reducing a medical or health condition. These are expenses that are the responsibility of the client and cannot be reimbursable by any other source, such as MA, private insurance, or employer.
Some examples of remedial expenses are:
Case management.
Day care.
Housing modifications for accessibility.
Respite care.
Supportive home care.
Transportation.
Services recognized under s.46.27, Wis. Stats.,
Community Options Program, that are included in the person's service plan.
Remedial expenses do not include housing or room and board services.
Impairment Related Work Expenses ( IRWE ) are expenses used to determine eligibility for EBD MA, MAPP eligibility and premium calculations. IRWEs are anticipated incurred expenses by the client related to the client’s impairment and employment. The expense cannot be one that a similar worker without a disability would have, such as uniforms. The expense cannot be reimbursable by a legally obligated third party such as MA, private insurance, or the client’s employer. If an anticipated IRWE is later paid by an unanticipated source it is still allowable for past months in which it was budgeted, but not for future months.
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Example: On March 25, Cecil was told by Harvey’s Auto Repair Shop that his wheelchair accessible van required repairs to fix the specialized door ramp. Cecil received an estimate of $2,000 for the repairs. The $2,000 estimate was determined to be a standard charge for this type of repair in the community.
On March 26, Cecil applied for MA in Milwaukee County. At this time the anticipated expense of the van repair was deducted from Cecil’s income.
Cecil delayed making the repairs until May 27, when the van’s wheelchair accessible door completely quit working. At that time Cecil’s friend Robin paid Harvey’s Auto Repair Shop for the repairs to Cecil’s van door. Cecil reported the repairs and the source of the money for the repairs to his IM worker.
Cecil’s IM worker should not deduct the anticipated cost of the van repairs for any subsequent eligibility and premium determinations.
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Deduct any EBD person’s expenses which:
Do not exceed his/her gross monthly earned income (plus room and board income, if any).
Are reasonably related to his/her earned in-come. Expenses which are reasonably related to earned income include those incurred in performing on the job and improving the person's ability to do the job.
Bills from months prior to months for which eligibility is being determined are not an allowable IRWE. This is true even if it is currently being paid.
Determine a standard charge for the item or service based on what is representative for the client’s community. If you count an expense as an IRWE, do not also use the expense as a Medical/Remedial Expense ( MRE ).
Some examples of IRWEs are: Modified audio/visual equipment, typing aides specialized keyboards, prostheses, reading aids, vehicle modification (plus installation, maintenance, and associated repair costs), and wheelchairs.
Do not allow the expense of getting to and from work as an IRWE, unless the expense is related to the client’s disability.
Exception: Always count the expense of getting to and from work as an IRWE for blind individuals.
When testing a MA client for Family MA, disregard $90 for each individual in the household that is employed.
The $65 and ½ earned income disregard is an EBD fiscal test group disregard.
To calculate the $65 and ½ earned income disregard, subtract $65 from the client’s monthly earned income. Divide the result by two, and add $65. This is the earned income disregard.
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Example: Michelle has monthly income of $1,240. Her $65 and ½ earned income disregard is
$1,240.00 – 65.00 $1,175.00
$1,175.00/2 = $587.50 Countable Income
$ 587.50 + 65.00 $ 652.50 Earned Income Disregard
Michelle’s earned income disregard amount is $652.50. |
This page last updated in Release Number: 08-01
Release Date: 01/07/08
Effective Date: 01/07/08
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