400.13 MIXED BUDGETING

Mixed budgeting methodologies are not allowed between Former SSI recipients budgeting and FPL budgeting. Any disregards allowed for former SSI recipients are not allowed in budgeting for a COE that uses the FPL as a need standard. The system will allow members of a couple to qualify in separate COE’s, but the budgeting rules for each COE apply to both members. The same rules apply when preparing manual budgets. For example: 1. Couple applies. The husband is determined to be a Disabled Adult Child (DAC) entitled to a DAC disregard of a portion of his income. His wife is disabled, with no Medicare, and is not a former SSI recipient. To determine income eligibility for both members of this couple, two couple budgets must be completed: o The DAC spouse is entitled to his DAC disregard while counting the full income of his wife. If the couple’s combined income, less his DAC disregard that is applied to his income, is less than the SSI FBR for a couple, the husband will qualify as a DAC. o The disabled wife’s budget must count her husband’s full income (no DAC disregard) as well as her full income, less all applicable income exclusions that apply to a Healthier MS Waiver (HMW) applicant. If countable income is equal to or less than 135% FPL for a couple, she will qualify in the Healthier MS waiver. 2. Couple applies. Husband has Medicare but disabled wife does not. Neither member of the couple is a former SSI recipient. Total countable income is less than 100% FPL and combined resources are less than $6,000. Only one income budget is needed but the husband with Medicare qualifies as QMB-only while the wife without Medicare will qualify in the Healthier MS waiver. 3. Couple applies. Husband is disabled, has Medicare and works over 40 hours per month. Wife is disabled and has Medicare. Countable resources are $23,000. Test the husband for Working Disabled eligibility by combining his and his wife’s unearned income and testing it against 135% FPL for a couple, then testing his earnings against 250% FPL for a couple. If he passes both income tests, he can qualify in the Working Disabled category. The wife will be tested for Medicare cost-sharing eligibility based on the couple’s combined unearned income and the husband’s earned income against the couple limit in the appropriate Medicare cost-sharing group.