The applicable income standard used in the determination of
a MAP category of institutional care eligibility for an applicant or recipient
who has not been institutionalized for a period of 30 consecutive days is the
SSI federal benefit rate (FBR) for a non-institutionalized individual.
Participation in the medicaid home and community based waiver program is
considered institutionalization and counts toward the calculation of the 30-day
period. All income, whether in cash or in-kind, shall be considered in the
eligibility determination, unless such income is specifically excluded or
disregarded.
A.
Institutionalization period of 30 consecutive days: After the
applicant or recipient has been institutionalized for 30 consecutive days, the
application can be approved as of the first day of the 30-day period. Once an
applicant or recipient has been institutionalized for 30 consecutive days, the
higher income maximum as specified in
8.200.520 NMAC is used.
B.
Institutionalization period less
than 30 consecutive days: If the applicant or recipient leaves the
facility before 30 consecutive days, the lower income standard (SSI FBR) is
used to establish eligibility.
C.
Transfer or death: If an applicant or recipient transfers to
another institution or dies prior to completing 30 consecutive days of
institutionalization, the higher income maximum is used. See
8.200.520 NMAC.
(1)
Income exclusions: Income
exclusions are applied before income disregards. Exclusions are applied in
determining eligibility whether the income belongs to the applicant or
recipient or to an individual from whom income is deemed.
(2)
Infrequent or irregular
income: Exclude the first $30 per calendar quarter of earned income; and
the first $60 per calendar quarter of unearned income. The following
definitions apply:
(a) "Irregular income" is
income received on an unscheduled or unpredictable basis.
(b) "Infrequent income" is income received
only once during a calendar quarter from a single source and includes:
(i) proceeds of life insurance
policies;
(ii) prizes and
awards;
(iii) gifts;
(iv) support and alimony;
(v) inheritances;
(vi) interest and royalties; and
(vii) one-time lump sum payments, such as
social security.
(c)
"Frequency" is evaluated for the calendar quarter (i.e. January - March, April
- June, July - September, October - December) but the dollar amount is
considered in the month received.
(3)
Foster care: Foster care
payments are totally excluded if:
(a) the
foster child is not eligible for SSI; and
(b) the child was placed in the applicant's
or recipient's home by a public or private nonprofit child placement or child
care agency.
(4)
Domestic volunteer services exclusions: Payments to volunteers
under domestic volunteer services (ACTION) programs are excluded from
consideration as income in the eligibility determination process. These
programs include the following:
(a) volunteers
in service to America (VISTA);
(b)
university year for action (UYA);
(c) special demonstration and volunteer
programs;
(d) retired senior
volunteer program (RSVP);
(e)
foster grandparent program; and
(f)
senior companion program.
(5)
Census bureau employment:
Wages paid by the census bureau for temporary employment related to the census
bureau are excluded from consideration as income in the eligibility
determination process.
