Ariz. Admin. Code § R9-28-408 - Income Criteria for Eligibility
A. The following Medicaid-eligible persons
shall be deemed to meet the income requirements for ALTCS eligibility unless
ineligible due to federal and state laws regarding trusts.
1. A person receiving Supplemental Security
Income (SSI);
2. A person receiving
Title IV-E Foster Care Maintenance Payments; or
3. A person receiving Title IV-E Adoption
Assistance.
B. If the
person is not included in subsection (A), the Administration shall count the
income described in
42
U.S.C. 1382a and 20 CFR 416 Subpart K to
determine eligibility with the following exceptions:
1. Income types excluded by
42
U.S.C. 1382a(b) for
determining net income are also excluded in determining gross income to
determine eligibility;
2. Income of
the parent or spouse of a minor child is counted as part of income under
42 CFR
435.602, except that the income of the parent
or spouse is disregarded for the month beginning when the person is
institutionalized;
3. In-kind
support and maintenance, under
42
U.S.C. 1382a(a)(2)(A), are
excluded for both net and gross income tests;
4. The income exceptions under A.A.C.
R9-22-1503(B)
apply to the net income test; and
5. Income described in subsection (C) is
excluded.
C. The
following are income exceptions:
1.
Disbursements from a trust are considered in accordance with federal and state
law; and
2. For an
institutionalized spouse, a person defined in
42
U.S.C. 1396r-5(h)(1), income
is calculated in accordance with
42
U.S.C. 1396r-5(b).
D. Income eligibility. Except as
provided in
R9-28-406(B)(2)(b), countable income shall not exceed 300 percent of the FBR.
E. The Administration shall determine the
amount a person shall pay for the cost of ALTCS services and the
post-eligibility treatment of income (share-of-cost) under A.R.S. §
36-2932(L) and
42
CFR 435.725 or 42 CFR 435.726. The
Administration shall consider the following in determining the share-of-cost:
1. Income types excluded by
42
U.S.C. 1382a(b) for
determining net income are excluded in determining share-of-cost.
2. SSI benefits paid under
42 U.S.C. 1382(e)(1)(E)
and (G) to a person who receives care in a
hospital or nursing facility are not included in calculating the
share-of-cost.
3. The share-of-cost
of a person with a spouse is calculated as follows:
a. If an institutionalized person has a
community spouse under
42
U.S.C. 1396r-5(h),
share-of-cost is calculated under R9-28-410 and
42
U.S.C. 1396r-5(b) and (d);
and
b. If an institutionalized
person does not have a community spouse, share of cost is calculated solely on
the income of the institutionalized person.
4. Income assigned to a trust is considered
in accordance with federal and state law.
5. The following expenses are deducted from
the share-of-cost of an eligible person to calculate the person's
share-of-cost:
a. A personal-needs allowance
(PNA) equal to 300 percent of the FBR for a person who receives or intends to
receive HCBS or who resides in a medical institution for less than the full
calendar month. A personal-needs allowance equal to 15 percent of the FBR for a
person residing in a medical institution for a full calendar month, except:
i. The PNA shall be increased above 15% of
the FBR by the amount of income garnished for child support under a court
order, including administrative fees garnished for collection efforts, but only
to the extent that the amount garnished is not deducted as a monthly allowance
for the dependent under any other provision of the post-eligibility process.
The increase to the PNA due to the garnishment shall not exceed the actual
garnishment paid in the month for which the PNA is calculated; and
ii. The PNA shall be increased above 15% of
the FBR by the amount of income garnished for spousal maintenance under a
judgment and decree for dissolution of marriage, including administrative fees
garnished for collection efforts, but only to the extent that the amount
garnished is not deducted as a monthly allowance for the spouse under any other
provision of the post-eligibility process. The increase to the PNA due to the
garnishment shall not exceed the actual garnishment paid in the month for which
the PNA is calculated.
b. A spousal allowance, equal to the FBR
minus the income of the spouse, if a spouse but no children remain at
home;
c. A household allowance
equal to the standard specified in Section 2 of the Aid for Families with
Dependent Children (AFDC) State Plan as it existed on July 16, 1996 for the
number of household members minus the income of the household members if a
spouse and children remain at home;
d. Expenses for medical and remedial care
services if the expenses were for services rendered to the applicant or
beneficiary and prescribed by a health care practitioner acting within the
scope of practice as defined by State law. The applicant or recipient must
have, or have had, a legal obligation to pay the medical or remedial expense.
Deductions do not include the cost of services to the extent a third party paid
for, or is liable for, the service. Deductions for expenses incurred prior to
application are limited to expenses incurred during the three months prior to
the filing of an application. Documents shall be submitted within a reasonable
time as determined by the Director.
i. The expense represents a
payment made and reported to the Admi nistration during the applic ation period
or a payment reported to the Administration no later than the end of the mon th
following the month in which the payment occurred and the expense has not
previously been allo wed a share-of-cost deduction; or
ii. he expense represents the unpa
id balance of an allowed, nonco vered medical or remedial expense, and the
expense has not been previously a share-of-cost deduction;
e. An amount deteted by the
Director for the maintenance of a single person's home for not longer than six
months if a physician certifies that the person is likely to return home within
that period; or
f. An amount for
Medicare and other health insurance premiums, deductibles, or coinsurance not
subject to third-party reimbursement; and
6. The deductible expense under subsection
(5)(d) shall not include any amount for a service covered under the Title XIX
State Plan.
a.
Nonemergency dental services for a person who is age
21 or olde r
b.
Hearing aids and heari ng aid batteries for a person
who is age 21 or older;
c.
Nonemergency eye care and prescr iptive lenses for a
person who is age 21 or older
d.
Chiropractic services, including treatment for
subluxation of t he spine, demonstrated by x-ray;
e. Orthognathic surgery for a per
son who is age 21 or older; or
f.
Co-payments for Medicare Part D prescriptions, if
not paid by t he State
g.
On a case by case basis, other noncovered medically
necessary s ervices that a person petitions the Administration for and the
Director approves
F. A person shall provide information and
verification of income under A.R.S. §
36-2934(G) and
20 CFR
416.203.
Notes
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