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Aged, Blind and Disabled Manual Section: Institutional Medicaid Policy Manual Number: 125.020 Chapter: Post-Eligibility Treatment of Income

July 1, 2026 Division of TennCare 7 2. CSIMA Calculation The CSIMA is calculated using three steps: a. Determine Excess Shelter Allowance (ESA) An ESA is allowed when the total shelter costs for rent, mortgage, taxes and insurance, maintenance charges and utility costs exceed the SHA. The SHA is 30% of the SMA. The SUA is used when the community spouse is responsible for heating and/or cooling costs. If the SUA is used, it is considered to cover all utilities (no additional allowance for garbage, telephone, etc.) When there is no or reduced cost to the community spouse because the cost of a particular utility is paid by a third party (in cash or in kind), reduce the amount of the SUA by the third party payment. Determine ESA: Rent, mortgages, taxes, insurance, etc. + SUA – SHA ESA b. Determine Community Spouse Net Income Determine the Community Spouse’s total net income, including SSI and FF payments. The Community Spouse net income is defined as income over which the Community Spouse has control over and which is actually available. Income which is not considered available to the Community Spouse includes child support payments and other types of court-ordered payments made by the community spouse. c. Calculate CSIMA The CSIMA is calculated by adding the SMA and the ESA, and then subtracting the Community Spouse’s net income.

SMA ($2,705.00) + ESA (Amount determined in Step 1 of CSIMA budget) – Community Spouse Net Income (Amount determined in Step 2) = Community Spouse Maintenance Allowance