Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 7 - SSI - RELATED MEDICAID BUDGETING
Section 144-332-7-4 - BUDGET FOR A COUPLE OR FOR AN ELIGIBLE INDIVIDUAL WITH AN INELIGIBLE SPOUSE

Universal Citation: 10 ME Code Rules ยง 144-332-7-4

Current through 2024-38, September 18, 2024

The following describes budgeting for an eligible couple or eligible individual with an ineligible spouse:

* SSI or State Supplement

* Pickle, DAC, DWB

* Categorically Needy Medicaid

* SSI, State Supplement and Categorically Needy Medicaid

Note: If over income or assets under Categorically Needy, eligibility needs to be determined under Medically Needy criteria (See Part 10).

In SSI - Related coverage groups, when one spouse is receiving an SSI/State Supplement benefit, that spouse is included in the assistance unit. The SSI/State Supplement payment is excluded income. All other countable income of the SSI/State Supplement recipient is used to determine eligibility for the assistance unit.

Example

Barb Van Marpel receives SSDI of $600 and SSI of $57.00. Her husband Antonio, age 83, has retirement income of $300, monthly. Barb is eligible for Medicaid because she receives SSI. Eligibility needs to be determined for Antonio. The budget for his eligibility will use Barb's SSDI of $600 and his retirement of $300. The budgeting process used is for an eligible couple.

Section 4.1 : Budget for SSI or State Supplement Payment

I. Budget for an Eligible Couple

Follow the budgeting steps for an individual with the following exceptions:

A. the income of the couple is used

B. the State Disregard for two is used in Step IX ($80.00).

C. Net income is compared to the SSI Income Standard for two based on living arrangement.

D. If ineligible for SSI, countable income is compared to the State Supplement Income Standard for two based on living arrangement.

II. Budget for an Eligible Individual with an Ineligible Spouse
A. Pretest

The individual must have countable income less than the SSI or State Supplement Income Standard for one.

1 Determine the eligible individual's countable income, using steps I - IXin Section 3.1.

2 If this figure is equal to or greater than the SSI or State Supplement Income Standard for one the individual does not meet the pretest and is not eligible under this section.

3 If this figure is less than the SSI or State Supplement Income Standard for one, based on the living arrangements (see Chart 3.4), the individual is potentially eligible for SSI or State Supplement.

The SSI or State Supplement budgeting process continues with deeming income from the ineligible spouse.

B. Deeming of income from the ineligible spouse

Note: See Section 2.2.2 of this Part on Deeming of Income for special income exclusions allowed from the income of an ineligible spouse.

1. Combine all of the ineligible spouse's unearned income.

2. Subtract any allocation to an ineligible child. An ineligible child is one who is not receiving TANF, SSI or State Supplement. To determine the allocation, deduct each child's countable income from the maximum child allocation (see Chart 3.2).

The remainder for each child is combined to determine the total allocation.

Note: For SSI or State Supplement eligibility, only the ineligible spouse can allocate income to an ineligible child.

The remainder is the spouse's net unearned income.

3. Combine all of the ineligible spouse's earned income.

4. Subtract any remaining child allocation from the earned income.

The remainder is the spouse's net earned income.

C. Eligibility of the Eligible Spouse
1. Combine the individual's gross unearned income with the spouse's net unearned income (after the child allocation has been deducted).

2. Subtract the $20.00 Federal Disregard, where applicable.

3. Combine the individual's gross earned income with the spouse's net earned income (after any remaining child allocation is deducted).

4. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.

5. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.

6. Subtract the earned income disregard of $65.00.

7. Divide the remaining earned income by 2. The remainder is the net earned income.

8. Combine the net earned and unearned income. This is the total net income.

If total net income is below the SSI Income Standard for two, based on living arrangement, and the individual met the pretest, the eligible individual meets the income criteria for an SSI and State Supplement payment.

If over income for SSI, s/he may be eligible for just a State Supplement payment.

9. To determine if the eligible individual can receive just a State Supplement payment subtract the State Disregard for two ($80.00), except for those in living arrangement D, E, F, G (See Part 11). The remainder is the countable income.

If the countable income is below the State Supplement Income Standard for two, (See Chart 3.4) based on living arrangement, and the individual met the pretest, the eligible individual meets the income criteria for just a State Supplement payment

Part 11 has additional information on State Supplement.

If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.

Section 4.2 : Budget for Medicaid for Coverage Under Pickle Amendment or Disabled Adult Child (DAC) or Disabled Widow(er) (DWB) Disregards

Follow the budgeting process in section 4.1, steps A, B and C, except that the Pickle DAC, and/or DWB income disregard(s) are subtracted before the Federal Disregard.

If countable income is below the State Supplement Income Standard for two, the individual is Medicaid eligible.

Section 4.3 : Budget for Categorically Needy Medicaid Coverage

A couple or an eligible individual with an ineligible spouse who is not eligible under 4.1 or 4.2 or who chooses not to apply for SSI/State Supplement, may get Medicaid coverage (if otherwise eligible) by using the following budget process.

Note: See Section 2.2.2 of this Part on Deeming of Income for special income exclusions allowed from the income of an ineligible spouse.

Combine all gross unearned income of the couple.

I. Subtract the $20.00 Federal Disregard where applicable.

II. Subtract any allocation to an ineligible child. An ineligible child is one not receiving TANF, SSI or State Supplement. To determine the allocation, deduct each child's countable income from the maximum child allocation (See Chart 3.2).The remainder for each child is combined to determine the total allocation. The remainder is the net unearned income.

III. Combine all gross earned income of the couple.

IV. Subtract any remainder of the $20.00 Federal Disregard not deducted from unearned income.

V. Subtract any remainder of the ineligible child allocation.

VI. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.

VII. Subtract the earned income disregard of $65.00.

VIII. Divide the remaining earned income by two. The remainder is net earned income.

IX. Combine the net earned and net unearned income.

X. Subtract the State Disregard for two ($80.00). The remainder is countable income.

If countable income is equal to or below 100% of the Federal Poverty Level for two and eligibility is based on age or disability, the individual or couple is Medicaid eligible.

Note: The State Supplement budgeting criteria must be used for an individual or couple whose eligibility is based solely on blindness. However, if the individual or couple also meets the SSI criteria for disability use the budgeting criteria in this section.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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