360-4.9 Post-eligibility utilization of income. For a person in permanent absence
status in a medical facility, after MA eligibility is established the person is subject to
chronic care budgeting. Under chronic care budgeting, all income must be applied toward
the cost of care in the facility, including income disregarded or considered unavailable
for the purpose of determining MA eligibility. However, before any income is required to
be applied to the person's cost of care, deductions will be made in the following order:
(a) For an institutionalized person without a community spouse:
(1) A personal needs allowance of $50 will be
allotted to an applicant/recipient who is a resident of a residential health care
facility, as defined by Article 28 of the Public Health Law, or who is in permanent
absence status in an acute care hospital certified under Article 28 of the Public Health
Law. A personal needs allowance of $33.50 will be allotted to an applicant/recipient who
is a resident of a psychiatric care facility, developmental center, or related
intermediate care facility regulated by Article 31 of the Mental Hygiene Law. A personal
needs allowance equal to the amount of a reduced veteran's pension pursuant to 38 U.S.C.
5503(f), but not to exceed $90, will be allocated to an applicant/recipient who receives
such pension or who has elected a greater compensation benefit under 38 CFR 3.701 in lieu
of such pension.
(2) An amount will be deducted to cover third
party health insurance premiums.
(3) An amount will be set aside to meet any
maintenance needs of dependent members of the applicant's/recipient's former family
household. The amount deducted will be the amount needed to bring the income of the family
up to the MA standard or the Public Assistance Standard of Need, whichever is higher.
(4) An amount will be deducted to cover any
expenses incurred for medical care, services, supplies, or remedial care for the
institutionalized individual not subject to payment under this Title or by a third party.
(5) The following income received by an
applicant/recipient in a residential health care facility is not required to be applied
toward the cost of medical care:
(i) money received as
the result of a legal action against the residential health care facility because of
improper and/or inadequate treatment;
(ii) income necessary
to achieve a plan of self-support, as described in section 360-4.6(a)(2)(xxi) of this
Subpart;
(iii) SSI benefits paid
under section 1611(e)(1)(E) of the Social Security Act;
(iv) reparation
payments received from the Federal Republic of Germany;
(v) benefits paid to
eligible Japanese-Americans and Aleuts under the federal Civil Liberties Act of 1988 and
the Aleutian and Pribilof Islands Restitution Act;
(vi) payments made from
the Agent Orange Settlement Fund or any other fund established pursuant to the settlement
in the In re Agent Orange product liability litigation, and payments received from court
proceedings brought for personal injuries sustained by veterans resulting from exposure to
dioxin or phenoxy herbicides in connection with the war in Indochina in the period of
January 1, 1962 through May 7, 1975;
(vii) payments made by
the Austrian government under paragraphs 500 to 506 of the Austrian General Social
Insurance Act provided that the payments remain identifiable as such; and
(viii) income equal to
the amount of a reduced pension pursuant to 38 U.S.C 5503(f), for a veteran's surviving
spouse who receives such a pension; such income will count toward the personal needs
allowance described in paragraph (1) of this subdivision.
(b) For an institutionalized spouse, as defined in section
360-4.10(a)(7) of this Subpart, the deductions set forth in section 360-4.10(b)(4) of this
Subpart and in paragraphs (a)(2) and (a)(5) of this section will be made.