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7. Allowance for minor dependents at home when there is no community spouse
a. When there are minor dependents at home and the a/b is not expected to return home within 6 months, subtract the dependents' gross monthly income from the full medically needy income limit for the number of dependents in the home. Deduct the resulting amount from the a/b’s monthly income in Step II (See VII., below).
b. When there are minor dependents at home and the a/b is expected to return home within 6 months, subtract the dependents' gross monthly income from the full medically needy income limit for the number of dependents in the home plus the a/b; e.g. if there are 2 dependents, use the income level for 3. Deduct the resulting amount from the a/b’s income in Step II (See VII., below).
8. Subtract Unmet Medical Needs (UMN) following policy in VIII., below.
9. Calculate the PML
Income remaining after making above deductions must be less than the facility's Medicaid reimbursement rate for 31 days.
Refer to MA-2240, Transfer of Assets, to calculate the PML for partial months of ineligibility due to transfers of resources.
a. If the remaining income is equal to or greater than the Medicaid reimbursement rate, the a/b is ineligible for help with cost of care. Go to XII., below to determine if the a/b could be eligible for other Medicaid services.
b. The income remaining is the pml. (Round to the nearest whole dollar. Round up for 50 cents or more.)
Send the DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability
10. Corrections or Changes to PML
It may happen that the a/b or facility reports a change (i.e. UMN, income, level of care) to the county. The a/b or representative should report any changes within ten (10) calendar days. This could result in adjustments to the PML. Follow procedures below when a change is reported.
a. Complete the reported change within 30 days.
b. If a client fails to report a change within ten days and the change results in:
(1) An overstated PML (PML should have been lower): Do not decrease PML for past months.
(2) An understated PML (PML should have been higher): Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493