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State of Maryland Medical Assistance Manual Revised April 2014

After an institutionalized spouse has been determined to be resource eligible, income must be evaluated and income eligibility determined. Income is evaluated in accordance with Section 700. The institutionalized person is considered separated from the non-institutionalized spouse or family and only the income of the institutionalized person is considered. When a husband and wife share the same room in a LTCF, their income is not considered available to one another and the income of each will be considered separately. The income evaluation must be made for all institutionalized persons, including SSI recipients. (Although the SSI benefit for an institutionalized person is reduced, it is still possible for the SSI recipient to have other income. Refer to the appropriate sections for treatment of an SSI recipient’s income.) Total monthly income, less the allowable deductions specified in this section, is the available income which is compared to the monthly cost of care (COC). If available income is less than the monthly COC, the person is eligible for MA and the Program will assist with payments towards COC. If available income is equal to COC, the person is eligible for MA, but the Program will not assist with COC. If available income is greater than monthly COC, the person may be eligible for MA under the spend-down provision, but the Program will not assist with COC. (h) Determining Total Monthly Income The income exclusions under COMAR 10.09.24.07(J) and (K) apply to the income of an institutionalized person. For current eligibility, income is considered for the current 6-month period under consideration, beginning with the month of application or the first month, in which the person is considered institutionalized, whichever is later. This is not true for an SSI recipient because an SSI recipient is categorically needy and, as such, does not contribute towards his/her COC, unless they have other income in addition to SSI. SSI offsets a recipient’s monthly income to allow the person’s income to meet the SSI standard. In the first month of institutionalization, the SSI recipient is given the Personal Needs Allowance and the Residential Maintenance Allowance. Since these two deductions are greater than the person’s monthly income, there is no remaining income in the month of admission. Consequently, the SSI recipient with no monthly income other than SSI has no income to contribute towards his/her COC. Beginning the second month of institutionalization, the SSI benefits are reduced to the SSI standard of $30, which is less than the MA Personal Needs Allowance. The person will continue to have nothing to contribute to his/her COC. Therefore, an SSI recipient in long-term care with no countable income is determined eligible in coverage group L01 with no contribution to COC. If an SSI recipient receives countable monthly income in addition to SSI benefits, the person’s other monthly income is considered in order to determine the recipient’s contribution to cost of care. Eligibility is determined in coverage group L98. The LDSS must require an