Necessary medical or remedial care recognized under state law but not covered by MA;
The actual amount paid by the institutionalized person for support of a person for whom the institutionalized person is legally responsible but not to exceed the appropriate AFDC assistance standard unless the institutionalized person is paying court-ordered support in an amount greater than the AFDC assistance standard in s. 49.19 (11) (a) 1.
, Stats.; and
The monthly cost of maintaining a home when the conditions of s. DHS 103.06 (1) (b) 3.
are met, but not to exceed the SSI payment level for one person living in that person's own household.
DHS 103.07(2)(a)(a) Farm and self-employment income.
Farm and self-employment income used in MA calculations shall be determined by adding back into the net earnings the following: depreciation, personal business and entertainment expenses, personal transportation, purchases of capital equipment, and payments on the principal of loans. The total shall be divided by 12 to get monthly earnings. If no tax return has been filed, the individual shall complete a 1040 form of the internal revenue service (IRS) to determine net earnings or loss, or to anticipate, in case of relatively new businesses, net earnings as required by the IRS. If the latest income tax return does not accurately reflect the household's actual circumstances because the household has experienced a substantial increase or decrease in business, the agency shall calculate the self-employment income based on anticipated earnings. Agencies shall determine whether it is necessary to use anticipated earnings on a case-by-case basis and shall document the reasons for the determination in the case record.
(b) Contractual employment income.
Income received on other than an hourly or piecework basis from employment performed under a contract which is renewable on an annual basis shall be averaged over a 12-month period. Persons receiving this income shall be considered to receive compensation for the entire 12-month period even though actual compensation may only be received for part of the year.
DHS 103.07 Note
Note: For example, if school teachers are paid 9 months a year, the wages they receive are to be averaged over a 12-month period.
(c) In-kind benefits.
Predictable in-kind benefits received regularly and in return for a service or product delivered shall be treated as earned income in MA calculations. The value of the in-kind income is determined by using the prevailing wage rate in the local community for the type of work performed, but not less than the minimum wage for that type of work.
(d) Income from providing room and board.
Net profit from room and board shall be treated as earned income in MA calculations. Net profit is determined by deducting the following expenses of providing room and board from the gross room and board income received:
Roomer and boarder - current food stamp allotment for one plus $15.00.
(e) Income from rentals.
When the owner reports rental income to the IRS as self-employment income, the procedures set forth in par. (a)
shall be followed in MA calculations. If the owner does not report rental income to the IRS as self-employment income, net rental income shall be determined as follows:
When the owner is not an occupant, net rental income is the rental income minus the mortgage payment and verifiable operational costs;
When the owner receives rental income from a duplex or multiple rental unit building and the owner resides in one of the units, net rental income shall be computed according to the following method:
Add the interest portion of the mortgage and other verifiable operational costs common to the entire operation;
Add the result in subd. 2. c.
to any operational costs paid by the owner that are unique to any rental unit; and
(f) Income of SSI child's parents.
Income of a disabled child's parents shall not be considered when determining the child's eligibility for MA if the child meets the conditions stated in 42 USC 1396a
(h) Income from land contracts.
Income received from a land contract shall be counted as unearned income. If the income is received on a monthly basis, it shall be included as monthly income. Payments received on less than a monthly basis shall be prorated to a monthly amount over the period between payments. Any expenses that the applicant or recipient is required to pay under the terms of the land contract shall be deducted from the gross income received from the land contract.
It exceeds $20.00 per month. Amounts of $20.00 or less are considered inconsequential income and are disregarded.
The interest shall be counted as income in the month in which it is received. Interest income that is received less often than monthly shall be prorated over the period the payment covers.
DHS 103.07(3)(a)(a) Work-related deduction.
If an individual is employed, $90 shall be deducted from the individual's earned income when determining MA eligibility.
(b) Dependent care deductions.
When employment cannot be maintained without dependent care for a child or incapacitated adult in the MA or fiscal test group, the following deductions shall be applied:
The actual cost of care but not more than $175 each month for each dependent child age 2 or over or incapacitated adult; and
The actual cost of care but not more than $200 each month for each dependent child under age 2.
(c) Special deductions for employed blind persons.
Transportation expenses incurred in getting to and from work, expenses related to job performance and expenses related to improving job ability such as training meant to improve employability and increase earning power shall be deducted from the earned income of blind persons.
DHS 103.07 Note
Note: Examples of expenses related to job performance are a reader, translation of material into braille, the cost and upkeep of a seeing eye dog for a blind person, and the cost of a prosthesis.
(4) Deduction from any income for support to an institutionalized person.
If a person in the MA group has legal responsibility for a person residing in an institution where the cost of care cannot be covered by MA, any income actually made available by the MA group toward the institutional cost of care shall be deducted from the MA group's income.
DHS 103.07 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86; cr. (2) (h), Register, July, 1989
. No. 403, eff. 8-1-89; emerg. r. and recr. (3) (a) and (b), eff. 10-2-89; r. and recr. (3) (a) and (b), Register, March, 1990, No. 411
, eff. 4-1-90; am. (1) (a) 3., (b) (intro.), (c) 3. and (d) (intro.), r. and recr. (1) (d) 1., cr. (2) (i), Register, March, 1993, No. 447
, eff. 4-1-93; correction in (1) (a) 3. and (2) (e) 2. made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520
DHS 103.075 Prevention of spousal impoverishment. DHS 103.075(1)(1)
For resource eligibility, this section applies to all institutionalized applicants for and recipients of MA who began a continuous period of institutionalization on or after September 30, 1989, and to their spouses. For purposes of computing income available towards the cost of an institutionalized individual's care, this section applies to all institutionalized applicants for and recipients of MA who were residing in an institution on October 1, 1989, or who entered an institution subsequent to that date, and to their spouses.
This section implements s. 49.455
, Stats., which provides for protection of a couple's income and resources when one spouse is institutionalized and the other spouse lives in the community.
“Community spouse" means an individual who is legally married as recognized under state law to an institutionalized spouse but is not himself or herself an institutionalized individual.
“Consumer price index" means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.
“Continuous period of institutionalization" means an individual has resided in or is likely to remain in an institution for at least 30 consecutive days.
“Family member" means a minor or dependent child, dependent parent or dependent sibling of an institutionalized or community spouse who resides with the community spouse.
“Institutionalized spouse" means either an individual who is in a medical institution or nursing facility and is legally married to an individual who is not in a medical institution or nursing facility or an individual who receives services under a waiver under 42 USC 1396n
(c) or (d) and is legally married to an individual who is not in a medical institution or nursing facility and does not receive services under a waiver under 42 USC 1396n
(c) or (d).
Is organized to provide medical care, including nursing and convalescent care;
Has the necessary professional personnel, equipment and facilities to manage the medical, nursing and other health care needs of patients on a continuing basis in accordance with accepted professional standards;
Is staffed by professional personnel who are responsible for professional medical and nursing services. The professional medical and nursing services shall include adequate and continual medical care and supervision by a physician, registered nurse or licensed practical nurse supervision and services and nurses' aide services sufficient to meet nursing care needs and a physician's guidance on the professional aspects of operating the institution.
“Resources" does not include items excluded under 42 USC 1382b
(a) or (d) or items that would be excluded under 42 USC 1382b
(a) (2) (A) but for the limitation on total value established under that provision.
An institutionalized spouse or the community spouse, or a representative acting on the behalf of either spouse, may request that an agency complete an assessment of the couple's assets for purposes of determining total countable assets of the couple and the community spouse resource allowance. If the request is not part of an application for medical assistance, the agency may charge a fee not exceeding the reasonable expenses of providing and documenting the assessment.
Both the institutionalized spouse and the community spouse shall verify the assets that they own, jointly or individually, and the value of those assets at the beginning of the most recent continuous period of institutionalization.
Complete the assessment within 30 days after the date of the request for an assessment;
Notify in writing the institutionalized spouse and the community spouse, or a representative acting on the behalf of either spouse, of the couple's total countable assets, the community spouse resource allowance and the amount of assets that the couple may retain so that the institutionalized spouse may be asset-eligible for MA and of the right of either spouse to a fair hearing under sub. (8)
after an application for medical assistance is filed.
DHS 103.075(5)(a)(a) Applicability.
This subsection applies only to individuals who began their most recent continuous period of institutionalization after September 29, 1989. Those individuals who began their most recent continuous period of institutionalization before September 30, 1989, shall have their eligibility determined using asset eligibility criteria under s. DHS 103.06 (1)
unless the individual left the institution or lost eligibility for a community-based services waiver program under 42 USC 1396n
(c) or (d) for a period of at least 30 days and subsequently began a new continuous period of institutionalization after September 29, 1989.
Initial determination. The agency shall consider the total countable assets of the institutionalized spouse and his or her community spouse in determining initial MA eligibility for the institutionalized spouse.
2. Total countable assets.
The agency shall count all available assets belonging to either spouse in the month for which eligibility is being determined except for the following:
Burial assets and funds set aside for the purpose of meeting burial expenses, regardless of value. This includes burial trusts, burial funds, burial plots, burial insurance and other property or funds expressly set aside for burial expenses; and
Any other assets that would otherwise be excluded for purposes of SSI-related MA eligibility determination as provided under s. DHS 103.06
3. Asset limit.
The agency shall compare the value of the couple's assets to the amount obtained by adding the SSI-related one person asset limit under s. 49.47 (4) (b) 3g.
, Stats., to the community spouse resource allowance under s. 49.455 (6) (b)
, Stats. If the couple's available assets are equal to or less than the asset limit, the institutionalized spouse is asset eligible for MA.
(c) Consideration of community spouse's assets.
During a continuous period of institutionalization after an institutionalized spouse is determined to be eligible for MA, no assets of the community spouse may be considered available to the institutionalized spouse.
For the 12 months after an institutionalized spouse has been initially determined eligible for MA, an amount equal to the amount of assets comprising the community spouse resource allowance for which an institutionalized spouse has title interest that does not exceed the limits described in s. 49.455 (6) (b)
, Stats., shall be exempt from consideration;
After 12 months, the exemption of the protected spousal asset share ceases to exist;
In subsequent redeterminations of eligibility after 12 months, the agency shall compare the assets of an institutionalized spouse to the SSI-related MA asset limit provided under s. 49.47 (4) (b) 3g.
, Stats. If the institutionalized spouse's assets exceed those limits, he or she is ineligible for MA.
Limits on countable assets shall be determined as provided in par. (b) 2.
as long as there is a community spouse.
(e) Exceptions to resource ineligibility.
The agency may not determine an institutionalized spouse ineligible if one or more of the following conditions exists:
The institutionalized spouse has assigned to the state any rights to support from the community spouse;
The institutionalized spouse lacks the ability to execute an assignment under subd. 1.
due to a physical or mental impairment but the agency has the right to bring a support proceeding against the community spouse without an assignment; or
The agency determines and documents in the case record that denial of eligibility would work an undue hardship for the institutionalized spouse. In this subdivision, “undue hardship" means that a serious impairment to the institutionalized individual's immediate health status exists.
No income of a community spouse may be deemed available to an institutionalized spouse applying for MA, except if a court order is in effect.
The agency shall count voluntary contributions of a community spouse towards the cost of his or her institutionalized spouse's care as income in determining an institutionalized spouse's eligibility and the amount that an institutionalized spouse is required to contribute towards the cost of his or her care. An agency may not request or suggest that a community spouse make a voluntary contribution toward the institutionalized spouse's cost of care.
Unless an institutionalized spouse establishes by a preponderance of evidence through a fair hearing that ownership interest is other than as provided under s. 49.455 (3) (b)
, Stats., and this subdivision, non-trust income shall be considered the income of the person in whose name the payment is made or, if the income is paid in both spouses' names or is unspecified, half shall be considered as the income of each or, if the income is shared with others, amounts equal to each spouse's proportionate share shall be considered available.
The agency shall consider trust income as available based upon the specific terms of the trust. Income paid to a spouse from the trust belongs to that spouse alone. If trust income is paid to both spouses or if the percentage is unspecified, half of the income shall be considered to belong to each spouse.
The income eligibility standards against which an institutionalized spouse's income is tested shall be the same as those under s. DHS 103.04 (4)