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West Virginia Income Maintenance Manual Chapter 24
West Virginia Income Maintenance Manual Page 24 Chapter 24 Long Term Care
Step 1: Subtract the family member's total gross countable income from the minimum SMS. See Chapter 4, Appendix A. If the income is greater than the minimum SMS, no deduction is allowed for that member. Step 2: Divide the remaining amount by 3, and round the resulting amount up. This calculation ensures the FMA for each family member will not exceed one-third of the minimum SMS. See Chapter 4, Appendix A. Rounding Example: $201.07 = $202 Step 3: Add together the individual deductions for all family members to determine the total FMA which is deducted from the income of the institutionalized individual. 24.7.3.A.4 Outside Living Expenses (OLE) Single individuals and couples, when both spouses are institutionalized, receive a $175 deduction from income for maintenance of a home when a physician has certified in writing that the individual, or in the case of a couple, either individual, is likely to return to the home within six months. The amount may be deducted for up to six months. When both spouses are institutionalized, only one spouse may receive the OLE. They may choose which spouse receives the deduction. The OLE may be deducted during subsequent nursing facility admissions if the individual or couple meets the criteria listed above. OLE Example: Ms. Rose is admitted to a nursing facility for six months and then discharged to her home. Her condition worsens after four months and she is readmitted to the nursing facility again. She can receive the OLE again, if her physician certifies she is likely to return home again within six months. 24.7.3.A.5 Non-Reimbursable Medical Expenses (NRME) Certain non-reimbursable medical expenses for the eligible client only may be deducted in the post-eligibility process. These expenses are sometimes referred to as “remedial expenses.” Non-reimbursable means the expense will not be or has not been paid to the provider or reimbursed to the client by any third-party payer, such as, but not limited to, Medicare, Medicaid, private insurance or another individual.