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MEDICAL SERVICES POLICY MANUAL,SECTION M M-100 Overpayments M 130 Overpayment Evaluation Excess Income

Overpayments and potential overpayments due to excess income will be reported by the County Office on Form DHS-199. The report will identify each individual by name and Medicaid ID number, the total excess income for ineligible month(s), and each month/year of ineligibility. EXAMPLE 1: Excess Income – An individual was ineligible for nursing home care for 4 months due to income. The individual had unearned income of $1,150.00/month for the period. The facility had a private payment rate of $1,500.00/month for the period. Determine the amount of excess income for the period of ineligibility as follows: 1. Calculate net countable income. $1,150.00/month - $20.00 (general exclusion) = $1,130.00 x 4 months = $4,520.00 2. Calculate appropriate MNIL. $108.33 (1 person MNIL) x 4 months = $433.32 3. Calculate excess income. $4,520.00 (net income) - $433.32 (MNIL) = $4,086.68 4. Determine private payment rate for the facility as follows: $1,500.00/month x 4 months = $6,000.00 Since the private payment rate ($6,000) exceeds excess income ($4,086.68), the amount of overpayment claimed for repayment will be limited to the amount of the LTC vendor payment. EXAMPLE 2: Excess Income – An individual was ineligible for nursing home care for 4 months due to income. The individual had unearned income of $1,150.00/month for the period. The facility had a private payment rate of $900.00/month for the period. Determine the amount of excess income for the period of ineligibility as follows: 1. Calculate net countable income $1,150 - $20.00 (general exclusion) = $1,130 X 4 months = $4,520.00 2. Calculate appropriate MNIL. $108.33 (1 person MNIL) X 4 months = $433.32 3. Calculate excess income $4,520.00 - $433.32 (MNIL) = $4,086.68