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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 59 To be considered regularly employed or regularly attending, the recipient must be working or attending at least 3 1/2 hours per day and 4 days a week. 20610.4 Income Protection Nursing facility recipients who are eligible for Medicaid are entitled to retain some of their available income for personal needs. 20620 Patient Pay Amount Deductions 42 CFR §435.725; 42 CFR §435.733; 42 CFR §435.832 The total income to be used in the post-eligibility process will include all amounts that meet the definition of income. This includes income that is counted for eligibility, as well as income that is excluded for eligibility. The following amounts are deducted from the gross income when computing the application of an individual or couples income to the cost of institutionalized care: 20620.1 Personal Needs Allowance; 20620.2 Necessary Medical Care Expenses; 20620.3 Community Spouse Income Allowance/Home Maintenance Disregard (if applicable); and 20620.4 Family Allowance (if applicable). 19 DE Reg. 1095 (06/01/16) 20620.1 Personal Needs Allowance Statutory Authority 42 CFR 435.725 42 CFR 435.733 42 CFR 435.832 20620.1.1 $75 per month of available income is to be protected for the Medicaid recipient's direct personal needs; or 20620.1.2 If the recipient regularly attends a rehab/educational program off the grounds of the recipient’s long-term care facility, including employment for the purpose of rehabilitation in a sheltered workshop, $75 per month will be protected; or 20620.1.3 For long-term care facility residents who are participating in substantial gainful activity (SGA) (20 CFR 416.971), the following amounts, not to exceed the Adult Foster Care (AFC) rate will be deducted from gross earned income: 20620.1.3.1 Mandatory payroll deductions that are a condition of employment such as: • Federal, State and Local Taxes • FICA • Union Dues • Insurance premiums • Pension contributions • Transportation costs as paid to & from work • Clothing and personal needs allowance of $75/month. 20620.1.3.2 If monthly earnings average more than the current SGA amount in a calendar year, this is considered SGA and the Division of Medical Assistance (DMMA) can allow a personal needs allowance of up to the AFC rate. 20620.1.3.3 If earnings average less than $400 a month in a calendar year, this is not ordinarily considered SGA and DMMA can allow the $75 personal needs allowance. 20620.1.3.4 If average earnings are between $400 and the current SGA amount, DMMA must consider other factors to determine whether or not the work constitutes SGA. Other factors include considering if the work is comparable to persons without disabilities in the community performing similar jobs. 20620.1.4 For nursing facility residents requiring a court appointed guardian, the following amounts will be deducted from the gross income: i. Monthly guardianship fees not to exceed $100; ii. Initial establishment of a guardianship (to include attorney's fees) not to exceed $750. 19 DE Reg. 1095 (06/01/16) 26 DE Reg. 108 (08/01/22) 26 DE Reg. 694 (02/01/23) 28 DE Reg. 545 (01/01/25)