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Sometimes, when both spouses are institutionalized, the income of one is greater than his or her monthly need and the income of the other is less than his or her monthly need. When this occurs, calculate the couple’s combined monthly need and compare it with their combined income. If the total need is greater than the total income, and if the spouse with greater income is willing to combine it with his or her spouse’s lesser income, both spouses could be eligible. 27.5.3 Divestment See 17.1 DIVESTMENT INTRODUCTION for Divestment policies. 27.5.4 Instructions for Manual Eligibility Determinations Use the following to determine which financial worksheet to use: 1. Medical institution (27.1 INSTITUTIONS) residents with no community spouse. Use the Medicaid Institution Worksheet (WORKSHEET #4). 2. Medical institution residents who have a community spouse and who became institutionalized before 09-30-89: Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse Form and the Medicaid Institution Worksheet (WORKSHEET #4). 3. Medical institution residents who have a community spouse and who became institutionalized on or after 09-30-89: Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse form and the Spousal Impoverishment Income Allocation Worksheet (WORKSHEET #7). 4. Community waiver applicants with no community spouse: Use the F-20919 5. Community waiver applicants with a community spouse: Use the F-10095 Medicaid Asset Assessment Medical Institution/Community Waiver Resident and Community Spouse form the Medicaid Waiver Eligibility and Cost Sharing Worksheet, and the Spousal Impoverishment Income Allocation Worksheet (WORKSHEET #7). This page last updated in Release Number: 22-02 Release Date: 08/01/2022 Effective Date: 08/01/2022 27.6 ILTC Monthly Need 27.6.1 Intermediate and Long-Term Care Monthly Need Introduction Monthly need is the amount by which the institutionalized person’s expenses exceed his or her income. It is computed by adding together the following monthly costs: 1. Personal needs allowance (SECTION 39.4 EBD ASSETS AND INCOME TABLES). 2. Cost of institutional care (use the private care rate of the institution where the applicant or member resides). 3. Cost of health insurance (SECTION 27.6.4 HEALTH INSURANCE). 4. Support payments (SECTION 15.7.2.1 SUPPORT PAYMENTS). 5. Out-of-pocket medical costs. 6. Work related expenses (SECTION 15.7.4 IMPAIRMENT RELATED WORK EXPENSES (IRWE)). 7. Self-support plan (SECTION 15.7.2.2 SELF-SUPPORT PLAN).