(A)
Consumer Payments. The
authorized agency will use a Department of Health and Human Services approved
form to determine income and liquid assets and calculate the monthly payment to
be made by the consumer. The agency may require the consumer and his or her
spouse to produce documentation of income and liquid assets. A consumer need
not complete a financial assessment if he or she pays the full cost of services
received. His or her payments, as determined by an annual financial assessment
may not exceed the total cost of services provided.
(B)
Definitions. The following
definitions apply to this Section.
(1)
Dependent Allowances. Dependents and dependent allowances are
defined and determined in agreement with the method used in the MaineCare
program. The allowances are changed periodically and cited in the MaineCare
Eligibility Manual, Chart II, AFDC Related Income Limits. Dependents are
defined as individuals who may be claimed for tax purposes under the Internal
Revenue Code and may include a minor or dependent child, dependent parents, or
dependent siblings of the consumer or consumer's spouse. A spouse may not be
included.
(2)
Disability-related expenses: Disability-related expenses are
out-of-pocket costs incurred by the consumer's for their disability, which are
not reimbursed by any third-party sources. They include:
(a)Home access modifications: ramps,
tub/shower modifications and accessories, power door openers, shower
seat/chair, grab bars, door widening, environmental controls;
(b)Communication devices: adaptations to
computers, speaker telephone, TTY, Personal Emergency Response
Systems;
(c)Wheelchair (manual or
power) accessories: lab tray, seats and back supports;
(d)Vehicle adaptations: adapted carrier and
loading devices, one communication device for emergencies (limited to purchase
and installation), adapted equipment for driving;
(e)Hearing Aids, glasses, adapted visual
aids;
(f)Assistive animals
(purchase only);
(g)Physician
ordered medical services and supplies;
(h)Physician-ordered prescription and over
the counter drugs;
(i)Medical insurance premiums, co-pays and
deductibles-.; and
(j)Unemployment
and workers compensation expenses related to employing the PA.
(3)
Household
members: means the consumer and the spouse.
(4)
Household members income
includes:
(a) Wages from work,
excluding state and Federal taxes and employer mandated or court ordered
withholdings of the consumer and the spouse;
(b) Benefits from Social Security,
Supplemental Security Income, pensions, insurance, independent retirement
plans, annuities, and Aid and Attendance;
(c) Adjusted gross income from property
and/or business, based on the consumer's most recent Federal income
tax;
(d) Interest and
dividends.
(e) Regularly occurring
payments received from a home equity conversion mortgage.
Not included are benefits from: the Home Energy Assistance
Program, Food Stamps, General Assistance, Property Tax and Rent Refund,
emergency assistance programs, or their successors.
(5)
A liquid asset is
something of value available to the consumer that can be converted to cash in
three months or less and includes:
(a) Bank
accounts;
(b) Certificates of
deposit
(c) Money market and mutual
funds;
(d) Life insurance
policies;
(e) Stocks and
bonds;
(f) Lump sum payments and
inheritances; and
(g) Funds from a
home equity conversion mortgage that are in the consumer's possession whether
they are cash or have been converted to another form.
Funds which are available to the consumer but which carry a
penalty for early withdrawal will be counted minus the penalty. Exempt from
this category are mortuary trusts and lump sum payments received from insurance
settlements or annuities or other such assets named specifically to provide
income as a replacement for earned income. The income from these payments will
be counted as income.
(C)
Consumer Payment Formula.
The Authorized Agent will use the following formula to determine the amount of
each consumer's payment.
Step (1) Calculate the Monthly Contribution from
the Household Income
(a) Total the
monthly income of household members.
(b) Deduct monthly allowable disability
related expenses.
(c) Deduct
monthly allowable dependent allowances.
(d) Multiply the net income by 4%.
Step (2) - Calculate the Monthly Contribution
from Liquid Assets.
(a) Total the
liquid assets of household members.
(b) Deduct annual interest and annual
dividends counted toward income for the household.
(c) Subtract $30,000 from the amount of
liquid assets calculated in Step (2)(a&b).
(d) Multiply the sum calculated in Step
(2)(c) by 3%. The result is the Monthly Contribution from Liquid Assets. If the
result is less than zero use zero.
Step (3) - Add the result of the calculation in
Step (1)(d), to the result of the calculation in Step (2)(d).
Step (4) - The consumer's monthly payment is the
lesser of the sum calculated in Step (3) or the actual cost of services
provided during the month.
Step (5) - When two persons in a household are
both receiving home based care services under this program, collect the
required information for each person. Calculate the co-pay for each consumer
and combine the total. Divide the amount by two to determine the household
monthly co-payment.
(D)
Waiver of Consumer Payment.
consumer's will be informed that they may apply for a waiver of all or part of
the assessed payment when:
(1) Monthly income
of household members is no more than 200% of the federal poverty level;
and
(2) Assets are less than
$30,000 for the household.
