Current through Register Vol. 42, No. 11, August 30, 2024
(1) The income
limit for the institutional Medicaid program and certain home and
community-based waiver programs is determined by the Agency and published in
the State Plan for Medical Assistance. The income limit is equal to 300 percent
of the current SSI benefit amount payable to an individual in his own home who
has no income.
(2) The income limit
for certain recipients of home and community-based waiver services who are
eligible for Medicaid solely because they require and receive services under a
home and community-based services waiver is the SSI federal benefit rate plus
the $20.00 general disregard.
(3)
Rules in 20 C.F.R. 416 Subpart K govern types of countable income and income
exclusions except as further limited by §
36-27-21.1, Code of
Ala. 1975.
(4) In
determining the amount of income an individual has to apply to his cost of care
in an institution, the following are deducted:
(a) amounts of income protected for personal
needs subject to the limits as set forth in the Agency State Plan, Attachment
2.6-A.
(b) amounts of income
protected for the maintenance needs of the ineligible spouse and dependents
living outside the facility.
(c)
amounts of income protected for health insurance premiums that are paid by the
applicant/recipient.
(d) amounts of
income for incurred necessary medical or remedial care recognized under state
law but not covered under the State's Medicaid Plan, nor subject to payment by
Medicare or any other third-party health insurance including Medicare premiums,
deductibles and coinsurance.
1. The incurred
necessary medical or remedial care must be determined to be medically
necessary. All verification needed to make the determination of medical
necessity and to allow the deduction must be furnished to the agency within six
months of the date of the service.
2. A deduction for expenses incurred for
medically necessary non-covered medical or remedial care will be allowed based
on the lesser of the Medicaid rate, the Medicare rate, or reasonable and
customary charges.
3. A deduction
for incurred medically necessary non-covered medical or remedial care expenses
will be allowed when the bill is incurred during a period which is no more than
three months prior to the month of current application.
4. The deduction for medical and remedial
care expenses that were incurred as the result of imposition of a transfer of
assets penalty period is limited to zero.
5. A deduction for initial or replacement
dentures will be allowed for those meeting Agency established medical necessity
criteria.
6. A deduction for
hearing aids will be allowed for those meeting Agency established medical
necessity criteria.
7. A deduction
from the individual's income for incurred necessary medical or remedial care is
only applicable when the individual has available income to allow for an offset
(liability amount to the nursing home is greater than zero).
(5) The following are
more liberal income requirements than SSI for determining the eligibility of
individuals as Qualified Medicare Beneficiaries and Specified Low Income
Medicare Beneficiaries, and Qualifying Individuals-1:
(a) The consideration of in-kind income
support and maintenance in the income calculation is waived.
(b) Fluctuating income may be averaged for
the past six months and projected for twelve months.
(c) Interest and dividend income is
excluded.
Authors: Denise Banks, Associate Director,
Policy and Training, Beneficiary Services Division
Statutory Authority: State Plan; Social Security
Act, Titles XVI, XIX; 1902(r)(2); 42 C.F.R. §§ 401, et
seq.; Code of Ala.
1975, §
36-27-21 -.1;
42 C.F.R. §
435.725; 42 C.F.R. §§435.231,
1611(b)(1); §§1915(c),
§1902(a)(10)(A)(ii)(VI).
