Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM
Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL
Section 469-4-008 - COMPUTING A STATE DISABILITY MEDICAL BUDGET

Universal Citation: 469 NE Admin Rules and Regs ch 4 ยง 008

Current through September 17, 2024

When computing a State Disability Medical budget, the amount of income when compared to the Federal Poverty Level will determine the applicant or recipient's State Disability Medical eligibility for medical, medical with a share of cost, or ineligibility.

008.01 ENTERING LONG TERM CARE. When a recipient enters long term care, the standard is not reduced to the long term care level or Assisted Living Waiver level until the first full month that the recipient resides in long term care, or at a later month if certain other criteria is are met, such as home liquidation.

008.02 INCOME WHEN ONE RECIPIENT OF THE HOUSEHOLD IS IN A SPECIFIED LIVING ARRANGEMENT. The following definitions apply when the eligible spouse is in a specified living arrangement and the ineligible spouse or family member is in the community:

(A) COMMUNITY SPOUSE. A spouse who is:
(i) Not applying for or receiving assistance;

(ii) Not residing with the alternate care spouse unless the alternate care spouse is in the home and eligible for Home and Community-Based Waiver Services; and,

(iii) Not in a hospital, skilled nursing facility, intermediate care facility, or intermediate care facility for persons with developmental disabilities.

(B) FAMILY MEMBERS. Minor children residing with a community spouse, or dependent parents or siblings of the community spouse or alternate care spouse who reside with the community spouse and could be claimed as dependents for tax purposes.

(C) MAINTENANCE ALLOWANCE. The amount deducted from an alternate care spouse's income to meet the home maintenance needs of the community spouse and family members.

(D) MAINTENANCE NEED STANDARD. The income standard to which the community spouse's and other family members' income is compared for the purpose of determining the amount of allowance which may be made from the alternate care spouse's income.

008.03 ALLOCATION OF INCOME. When computing the State Disability Program medical assistance budget for an alternate care spouse in a specified living arrangement, only that individual's income is considered. Income of a community spouse is not considered available to the alternate care spouse. Some of the income of the alternate care spouse may be allocated to the community spouse or family members to bring their income up to a minimum monthly allowable amount.

(A) The alternate care spouse must be residing in one of the following living arrangements for these special budgeting procedures to apply:
(i) A long term care facility;

(ii) An adult family home;

(iii) A licensed assisted living facility;

(iv) A center for the developmentally disabled; or

(v) Receiving services in a Home and Community Based Service Waiver.

008.04 DETERMINING OWNERSHIP OF INCOME. All income must be verified and the amount of income received by each individual determined. If payment is made in the name of both spouses, half is considered available to each spouse. If the income received does not specify either spouse, one-half of the amount is considered available to each spouse. Ownership of income may be appealed by the recipient.

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