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200%, and 250%) depending on the coverage group.

a) Countable income can be equal to, but cannot exceed the appropriate FPL for Medicaid eligibility.

3. 300% of the SSI FBR is the formula required by federal regulation, 42 CFR 435.1005, to set the institutional need standard for all long term care coverage groups. This limit is subject to increase in January of each year when SSI FBRs increase.

a) Countable income cannot be equal to or exceed the institutional limit for Medicaid eligibility.

b) If income does equal or exceed the limit, ineligibility exists for that month unless an Income Trust is in effect.

Source: Social Security Act §1902 (r)(2); 42 CFR § 435.601(b) (Rev 1994); 42 CFR 435.1005.

Rule 10.3: Deemed Income.

A. Deeming is defined as follow:

1. The term “deeming” identifies the process of considering another person’s income and resources to be available for meeting a Medicaid client’s basic needs.

2. Deemed income and resources are attributed to an eligible individual whether or not they are actually made available, with the following restrictions:

a) Deeming only applies in household situations;

1) Deeming of income is not applied in the eligibility determination for either an institutional or community spouse and deemed income is never included in the Medicaid Income computation post-eligibility.

b) Income is only deemed from an ineligible spouse to an eligible spouse and from ineligible parent(s) to eligible child.

1) Deeming is based on the concept that a husband and wife (including “holding out” couples) and/or parents and child who live together have a responsibility for each other and share income and resources.

2) Both SSI and Medicaid regulations require deeming in household situations.

B. It would not be equitable to deem the entire amount of an ineligible parent’s or spouse’s income to the eligible individual without some provision to permit the deemor to meet his own needs and those of ineligible children in the household.