Note: The following selections apply for the time periods before January 1, 2014 or after December 31, 2018. c-1. Regular Post-Eligibility Treatment of Income: 209(B) State. Answers provided in Appendix B-4 indicate that you do not need to complete this section and therefore this section is not visible. Note: The following selections apply for the time periods before January 1, 2014 or after December 31, 2018. d. Post-Eligibility Treatment of Income Using Spousal Impoverishment Rules The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care if it determines the individual's eligibility under §1924 of the Act. There is deducted from the monthly income a personal needs allowance (as specified below), a community participant’s spouse's allowance and a family allowance as specified in the State Medicaid Plan. The State must also protect amounts for incurred expenses for medical or remedial care (as specified below). i. Allowance for the personal needs of the waiver participant (select one): SSI Standard Optional State supplement standard Medically needy income standard The special income level for institutionalized persons % Specify percentage: 300% of the SSI Federal Benefit Rate (FBR) The following dollar amount: $ If this amount changes, this item will be revised The following formula is used to determine the needs allowance: Specify formula: Other Specify: ii. If the allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the maintenance allowance under 42 CFR individual’s §435.726 or 42 CFR §435.735, explain why this amount is reasonable to meet the individual’s maintenance needs in the community. Select one: Allowance is the same Allowance is different. Explanation of difference:
Note: The following selections apply for the time periods before January 1, 2014 or after December 31, 2018. c-1. Regular Post-Eligibility Treatment of Income: 209(B) State. Answers provided in Appendix B-4 indicate that you do not need to complete this section and therefore this section is not visible. Note: The following selections apply for the time periods before January 1, 2014 or after December 31, 2018. d. Post-Eligibility Treatment of Income Using Spousal Impoverishment Rules The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care if it determines the individual's eligibility under §1924 of the Act. There is deducted from the participant’s monthly income a personal needs allowance (as specified below), a community spouse's allowance and a family allowance as specified in the State Medicaid Plan. The State must also protect amounts for incurred expenses for medical or remedial care (as specified below). i. Allowance for the personal needs of the waiver participant (select one): SSI Standard Optional State supplement standard Medically needy income standard The special income level for institutionalized persons % Specify percentage: 300% of the SSI Federal Benefit Rate (FBR) The following dollar amount: $ If this amount changes, this item will be revised The following formula is used to determine the needs allowance: Specify formula: Other Specify: ii. If the allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual’s maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735, explain why this amount is reasonable to meet the individual’s maintenance needs in the community. Select one: Allowance is the same Allowance is different. Explanation of difference:
ABI-RH%20Renewal%20Application-Clean%20draft-October%202017.docx