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Policy Clarifications - Medicaid - Long Term Care/SSI

Submitted: 3/10/07 Agency: CAOs
  Citations: LTCH 450.1; MEH 360.31
Subject: No Deduction to Receive Income for LTC and Waivers

OPS-04-09-01 allows the CAO to deduct certain bank fees as allowable deductions from unearned income. It refers to specific MEH chapters 318, 319, 360. & 361. It is correct that these deductions are not allowed for LTC Waiver cases?

Our client is over the income limit by $7.00 and is appealing our decision to close the case.

Response By: L Schmidt Date: 4/10/07

You are correct. The deductions outlined in OPS Memo 04-09-01 (bank fees and transportation costs) are not applied to unearned income in the eligibility computation for HCBS or payment toward the cost of LTC.

Please refer to MEH 389, Appendix B. To qualify for a waiver program, an individual's gross income may not exceed 300% of the Federal Benefit Rate.

Expenses paid to receive unearned income [55 Pa. Code 181.131(a), 140.281(a), 140.82(a), and 181.315(a)] are a deduction from income; they are not an exclusion. Deductions do not apply to the determination of gross income for Medicaid/LTC eligibility in NMP cases.