us-dc/manual/dhcf/medicaid/29-9804/block-1 — DCMR 29-9804 POST-ELIGIBILITY TREATMENT OF INCOME

(a)Income received on a yearly basis or less often than…#

(a) Income received on a yearly basis or less often than monthly shall be converted to a monthly amount or prorated;

(b)If the amount or frequency of regularly received income…#

(b) If the amount or frequency of regularly received income is known, the Department shall average the income over the period between payments; or

(c)If neither the amount nor the frequency of income is…#

(c) If neither the amount nor the frequency of income is predictable, the Department shall not average the income but count income only for the month in which it is received.

9804.4 The Department shall subtract the following types of deductions from the beneficiary’s gross countable monthly income:

A Personal Needs Allowance, the amount of which shall be annually posted by DHCF on its website at HYPERLINK "https://dhcf.dc.gov/page/general-information-0"https://dhcf.dc.gov/page/general-information-0, and shall be equal to:

One hundred and three dollars and twenty cents ($103.20) starting on January 1, 2024, and adjusted annually thereafter by the federal cost-of-living adjustment (COLA) for that year published by the Social Security Administration, for any beneficiary:

In a nursing facility;

(B) Who receives waiver-funded residential support through the District Department on Disability Services (DDS) and receives Social Security benefits;

(C) In an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) who receives supplemental security income (SSI); and

(D) In an ICF/IID who receives Social Security Disability Income (SSDI);

Two hundred and six dollars and forty cents ($206.40) starting on January 1, 2024, and adjusted annually thereafter by the federal COLA for that year published by the Social Security Administration, for a couple if each individual spouse is institutionalized in a nursing facility; or

One hundred and thirty-four dollars and sixteen cents ($134.16), and adjusted annually thereafter by the federal COLA for that year published by the Social Security Administration, for any beneficiary who is:

(A) Enrolled in the Home and Community Based Waiver for Persons who are Elderly and Individuals with Physical Disabilities (EPD) and receives Optional State Supplemental Payments (OSSP); or

(B) In a community residence facility or assisted living residence and receives SSI;

(b) A Community Maintenance Needs Allowance, for a beneficiary enrolled in an HCBS Waiver program only, equal to the Special Income Standard (SIS);

(c) A Community Spouse Allowance, for a beneficiary who has a community spouse only;

(d)A Dependent Family Allowance, equal to the annual MNIL,…#

(d) A Dependent Family Allowance, equal to the annual MNIL, for a beneficiary who has:

(1) Minor or dependent children, including disabled adult children of the beneficiary or community spouse, who reside in the personal home with the community spouse;

(2) Dependent parents of the beneficiary or community spouse who reside in the personal home with the community spouse; or

(3) Dependent siblings of the beneficiary or community spouse who reside in the personal home with the community spouse;

(e)Incurred Medical Expenses, if the expenses are not…#

(e) Incurred Medical Expenses, if the expenses are not subject to payment by a third party, including incurred medical expenses used to meet a spend down obligation;

(f)Incurred remedial expenses, if the expenses are not…#

(f) Incurred remedial expenses, if the expenses are not subject to payment by a third party, including incurred remedial expenses used to meet a spend down obligation;

(g)A Home Maintenance Deduction equal to the MNIL for a…#

(g) A Home Maintenance Deduction equal to the MNIL for a beneficiary residing in an institutional facility. A home maintenance deduction may be deducted only:

(1) For up to six (6) months;

(2) When a community spouse does not reside in the home; and

(3) If a physician certifies that the beneficiary is likely to return to the home within six (6) months; and

(h)The full amount of SSI or State Supplementary Payment…#

(h) The full amount of SSI or State Supplementary Payment Benefits for a beneficiary who resides in a long term care facility.

9804.5 The amount of the beneficiary’s gross countable income that remains after allowable deductions and spousal impoverishment protections for income and resources (if applicable) have been applied is the amount of the beneficiary’s contribution to the cost of care.

9804.6 The Department shall reduce its payment for LTCSS by the amount of the beneficiary’s contribution to the cost of care.

9804.7 The Department shall reconcile the beneficiary’s projected income with the beneficiary’s actual income at the end of every six (6) month period in which a beneficiary receives Medicaid coverage of LTCSS, or whenever any significant change in the beneficiary’s income or circumstances occurs.

9804.8 The reconciliation may include a period of up to six (6) months prior to the month in which the reconciliation is done.

9804.9 The Department may redetermine the beneficiary’s contribution to the cost of care:

After the reconciliation process;

At annual renewals; and

When a beneficiary reports a significant change of income or other circumstances.

9804.10 Any redetermination of or adjustment to the beneficiary’s contribution to the cost of care resulting from the reconciliation shall not be applied until timely and adequate notice of the redetermination or adjustment is provided to the beneficiary.

9804.11 The Department shall adjust the beneficiary’s contribution to the cost of care prospectively when the income actually received by the beneficiary during the six (6) month reconciliation period differs from the beneficiary’s projected income for that period.

9804.12 If the income actually received by the beneficiary during the six (6) month period exceeds the beneficiary’s projected income for that period, an adjustment shall be added to the beneficiary’s contribution to the cost of care in a future month or months to reflect the amount that should have been contributed during the six (6) month period.

9804.13 If an income change or change in circumstances renders a beneficiary ineligible for Medicaid coverage of LTCSS, a prospective adjustment cannot be added to the former beneficiary’s contribution to the cost of care. Under these circumstances, the Department may seek to recover the full amount of the adjustment by requesting voluntary repayment from the former beneficiary.

9804.14 The Department may pursue recovery by appropriate action, pursuant to District law, against the income or resources of the former beneficiary if the Department is unable to recover the full amount of the adjustment through voluntary repayment from the former beneficiary.

9804.15 If the income actually received by the beneficiary during the six (6) month period is less than the beneficiary’s projected income for that period, the beneficiary’s contribution to the cost of care shall be reduced in a future month or months to reflect the amount that should not have been contributed during the six (6) month period.

SOURCE: Final Rulemaking published at 63 DCR 1605 (February 12, 2016); as amended by Final Rulemaking published at 69 DCR 012069 (October 7, 2022); as amended by Final Rulemaking published at 72 DCR 010230 (September 19, 2025).

District of Columbia Municipal Regulations

Public Welfare 29 DCMR § 9804