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210-RICR-50-00-8 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 50 – MEDICAID LONG-TERM SERVICES AND SUPPORTS SUBCHAPTER 00 – LONG-TERM SERVICES PART 8 – Post-Eligibility Treatment of Income (PETI) 8.1 Overview A. Medicaid LTSS beneficiaries are required by Federal law and Regulations, the State Plan, and the Section 1115 waiver to contribute income toward the Medicaid cost of care, irrespective of whether LTSS is provided in a health care institution or a home or community living arrangement. Only persons eligible for Medicaid LTSS on the basis of MAGI – the ACA adult expansion – are not required to pay toward the cost of care under Federal Regulations in effect as of March 1, 2018. B. To ensure the beneficiary and/or spouse remaining at home (the “community” spouse) and the dependents of the LTSS beneficiary (the “institutionalized” spouse) have sufficient income and resources to thrive, Congress established a process to prevent spousal impoverishment. One important aspect of this process is a re-evaluation of the beneficiary’s income – known as the post- eligibility treatment of income or “PETI” – to determine what, if any, amount remains available to be applied to the LTSS cost of care after certain amounts are set aside or “protected” to meet the financial needs of the beneficiary, spouses and/or dependents. The amount a beneficiary must pay toward the cost of care for Medicaid LTSS coverage is referred to hereinafter as “beneficiary liability." This section pertains to the PETI process and the determination of beneficiary liability. 8.2 Legal Authority and Scope and Purpose A. Federal Authorities: 1. Federal Law: Title XIX, of the Federal Social Security Act at: 42 U.S.C. §§ 1396a, 1396b, and 1396k; 2. Federal Regulations: 42 C.F.R. §§ 435.700 – 435.735; 435.800 – 435.832; 460.184 Parts I through G, including §§ 435.733, 435.735 and 484.10(e). 3. The Rhode Island Medicaid State Plan and the Title XIX, Section 1115(a) Demonstration Waiver (11-W-00242/1), effective through December 31, 2018.