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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 8 3. CSIMA Example Casey Jones is approved for Institutional Medicaid. Shannon Jones, the community spouse, remains in the community and resides at home. Casey receives $800 per month in Social Security benefits, and $200 in monthly pension. Shannon receives $600 per month in Social Security benefits. Shannon Jones pays the mortgage of $400 per month, which includes taxes and insurance. She is responsible for all monthly heating and cooling costs. a. Determine ESA b. Determine Community Spouse Net Income Countable income is determined according to the ABD Earned Income policy and ABD Unearned Income policy. The community spouse’s net income is defined as income over which the community spouse has control and which is actually available to him or her. c. Calculate CSIMA

Casey’s monthly income is $1,000. Since the income is less than the calculated CSIMA, all of the income (less $70 PNA) will be allocated to Shannon. Note: In the event that the institutionalized spouse does not have enough income to provide the community spouse with the allowed CSIMA and income that may be generated from the Community Spouse Resource Maintenance Allowance (CSRMA) is inadequate to raise the community spouse’s available income to the Maintenance Needs Standard, there may be an allocation of additional resources to the community spouse to make up for the income shortfall if the couple has additional resources above the CSRMA. This must be done by appeal and a $400.00 Mortgage, taxes, insurance + $451.00 SUA – $811.50 SHA $ 39.50 ESA $2,705.00 SMA + $ 90.50 ESA – $ 600.00 Community Spouse Net Income = $2,195.50 CSIMA