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Excess Shelter Allowance = $514 BUDGETING FOR NURSING FACILITY COVERAGE A community spouse of a Medicaid eligible nursing facility resident may be entitled to a monthly income allowance (M.I.A.) depending on her monthly income. 42 U.S.C. 1396r-5(d). The community spouse will be entitled to the allowance if income is less than 150% of poverty level for a family of two, plus an additional excess shelter allowance to the extent the monthly cost of maintaining the home exceeds $514. The cost of maintaining the home includes mortgage payments or rent, taxes, insurance, condominium fees, maintenance fees and a standard utility allowance of $266 for one person ($292 for two) in a household (or higher with proof of higher utility expenses after an appeal). Without a court order or administrative appeal, the maximum MIA is currently $2,489. To exceed this amount, the community spouse must establish a need for more income “due to exceptional circumstances resulting in significant financial duress.” 42 U.S.C. 1396r-5(e)(2)(B). A dependent child, parent or sibling who will continue living with the community spouse, can claim an allowance calculated as one-third of the difference between each dependent’s income an the basic community spouse’s allowance of up to $571 per such person. Medicaid looks to the family’s tax returns to evaluate dependency for adults. If Medicaid does not pay for a type of medical treatment or if medical insurance will continue to be paid, an allowance to pay such costs may be available. An unmet medical need must be an allowable medical deduction for state and federal tax purposes. |
