Co-payment

Individual — Total gross income, less $75 for personal needs.

Individual with a spouse in the community — Total gross couple income, less:

$75 for personal needs;

amount up to $4,066.50 for community spouse; and

certain amount for dependents living with community spouse.

Couple — Total gross income, less $150 for personal needs.

Note: Certain other expenses may be deducted if the person meets program policy requirements. These expenses may include health insurance premiums, guardianship fees and incurred medical expenses if the Medicaid program does not cover direct payment for the services.