In Step 1, the CAO must determine if an individual can receive MA LTC payments. For individuals in the Nonmoney Payment (NMP) program, the CAO will not count the following as income in Step 1:
The CAO will not count money from any loan that has a repayment statement.
NOTE: Any interest received on the borrowed money will be counted as income.
2. Credit life or disability insurance payments
The CAO will not count payments made for a credit life or disability insurance policy issued to, or on behalf of, borrowers to cover payments on loans or installment purchases if the individual dies or becomes disabled. These payments are made directly to the loan or mortgage company and are not available to the individual.
The CAO will not count federal, state, or local tax refunds (excluding the EIC portion).
The CAO will not count money received from another individual to pay back a loan to an individual.
NOTE: Any interest received on the money loaned must be counted as income.
5. Medical Assistance copayment and Medicare premium refunds
The CAO will not count money that the Department of Human Services (DHS) gave back to the individual because the individual paid more than the maximum copayment for a six-month period.
The CAO will not count refunds from the Social Security Administration (SSA) for Medicare Part B premiums.
The CAO will not count the following:
Care or services that are free or that someone else pays for
Room and board received during a period of confinement
Cash or in-kind income (including food, clothing, and shelter) under a federal, state, or local program that provides medical care or services including vocational rehabilitation
Cash from a nongovernmental medical care or service program or under a health insurance policy if (1) it is a repayment for program-approved services already paid for by the individual or (2) it must go toward the future purchase of a program-approved service
Example: The CAO will not count money paid to an individual from an insurance company giving the individual money for payments for prescription drugs.
Medical insurance premiums for the individual that someone else pays for
The CAO will not count money that replaces lost, stolen, or destroyed income.
Example: An individual’s pension check is stolen before the individual cashes it, and the pension fund issues a replacement check. The CAO will count the original check as unearned income in the month it was received, but it will not count the replacement check.
9. Resource converted to income
The CAO will not count the sale, exchange, or replacement of a resource as income. This includes cash or in-kind items that an individual gets to replace or repair something that was lost, damaged, or stolen.
NOTE: Money from the conversion of a resource must be counted as a resource. See Chapter 440, Resources.
The CAO will not count money obtained from any of the following:
Cash or in-kind income given to an individual under a federal, state, or local government program whose purpose is to provide social services, including vocational rehabilitation.
In-kind assistance provided under a nongovernmental program whose purpose is to provide Social Services.
Money provided by a nongovernmental social services program to be used either (1) to repay services already paid by an individual or (2) to pay for such services in the future. Examples of these services include, but are not limited to, homemaker services, attendant care, and chore services.
The CAO will not count the payment on a individual’s bill that was made by someone else.
12. Veterans Aid and Attendance
The CAO will not count the portion of the VA benefit that is for Aid and Attendance benefits or the housebound allowance. See Appendix B.
Exception: If the U.S. Department of Veterans Affairs says that a recipient of Aid and Attendance benefits is incompetent, it may require the income to be used to pay for LTC facility services. The CAO will count Aid and Attendance in determining contribution towards cost of care in Step 2 only if the VA tells it to in writing. The CAO will add the notice from the VA to the individual’s case record.
13. Veterans Aid and Attendance pension benefit (for Veterans or surviving spouse)
The CAO will not count the $90 per month VA pension received by a veteran or a surviving spouse of a veteran who is receiving LTC facility payments and who does not have dependents living in the community.
The CAO will exclude the first payment after the month of admission to the nursing facility. This pension represents a reduction in VA pension benefits required by Section 8003 of the Omnibus Budget Reconciliation Act of 1990 and Section 601 of Public Law (P.L.) 102-568, the Veterans Benefit Act of 1992.
Section 8003 of OBRA ’90
38 U.S.C. 5503(f) P.L. 101-508
14. Vietnam Veterans' children with Spina Bifida
The CAO will not count money paid to children of Vietnam Veterans who are diagnosed with Spina Bifida.
15. Assistance for the homeless
17. Payments to victims of Nazi persecution Enacted August 1, 1994, the Nazi Persecution Victims Eligibility Act (P.L. 103-286) excludes from income and resources any payments made to persons because of their status as victims of Nazi persecution.
Updated February 3, 2022, Replacing April 11, 2017