(Revised 2/04 ML #2900)
(N.D.A.C. Section 75-02-02.1-39)
This section applies to individuals residing in their own home or in aspecialized facility, and to theMedicare Savings Programs, but does not apply to Transitional Medicaid Benefits. For individuals receiving nursing care services in a nursing facility, the state hospital, the Anne Carlsen facility, the Prairie at St. John's center, the Stadter Psychiatric Center, an intermediate care facility for the mentally retarded (ICF-MR), or receiving swing-bed care in a hospital, refer to the Post Eligibility Treatment of Income, Section05-85-25.
The following income deductions are allowed in determining Medicaid eligibility:
Except in determining eligibility for the Medicare Savings Programs, the cost of premiums for health insurance may be deducted from income in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage. For purposes of this deduction, premiums for health insurance include payments made for insurance, health care plans, or nonprofit health service plan contracts which provide benefits for hospital, surgical, and medical care, but do not include payments made for coverage which is:
Limited to disability or income protection coverage;
Automobile medical payment coverage;
Supplemental to liability insurance;
Designed solely to provide payments on a per diem basis, daily indemnity, or nonexpense-incurred basis; or
Credit accident and health insurance.
Except in determining eligibility for the Medicare Savings Programs, medical expenses for necessary medical or remedial care claimed for deduction must be documented in a manner which describes the service, the date of the service, the amount of cost incurred, and the name of the service provider. A medical expense may be deducted only if it is:
Incurred by a member of a Medicaid unit in the month for which eligibility is being determined;
Provided by a medical practitioner licensed to furnish the care;
Not subject to payment by any third party, including Medicaid and Medicare;
Not incurred for nursing facility services, swing bed services, or HCBS during a period of ineligibility because of a disqualifying transfer; and
Reasonable expenses, such as food and veterinarian expenses, necessary to maintain a dog that is trained to detect seizures for a member of the Medicaid unit.
Except in determining eligibility for the Medicare Savings programs, the cost of premiums for long term care insurance carried by an individual or the individual's spouse may be deducted from income in the month the premium is paid or prorated and deducted from income in the months for which the premium affords coverage.
Except in determining eligibility for the Medicare Savings Programs, the cost ofremedial care for an individual residing in a specialized facility limited to the difference between the recipientís cost of care at the facility (e.g. room and board in a basic care facility) and the regular medically needy income level may be deducted.
Recipientís cost of care at the facility
Less the medically needy income level for one
Remedial Care Deduction
Except in determining eligibility under the Medicare Savings Programs, transportation expense may be deducted if necessary to secure medical care provided for a member of theMedicaid unit. Transportation expenses are not allowed for recipients in a facility that provides nursing care services, or to the extent the transportation cost is paid by any third party.
Non-voluntary child and spousal support payments (including surcharges and arrearages) may be deducted if actually paid by a member of the Medicaid unit. If the support payment is withheld from an extra check that is disregarded, the support payment withheld from that check is not allowed as a deduction.
Reasonable child care expenses, not otherwise reimbursed, may be deducted if necessary to engage in employment or training. The child must be a member of the Medicaid unit for the deduction to be allowed.
Reasonable adult dependent care expenses may be deducted. These are costs for care of an incapacitated or disabled adult who is living in the home so a caretaker or a spouse can work or attend training. The incapacitated or disabled adult must be a member of the Medicaid unit for the deduction to be allowed.
The cost to purchase or rent a car safety seat for a child through age ten is allowed as a deduction if a seat is not otherwise reasonably available. This deduction is not allowed if any third party, including TANF, pays the cost.
A disregard of $20 per month is deducted from any income, except income which is based on need, such as SSI, and need-based veteransí pensions. This deduction applies to all aged, blind and disabled applicants or recipients provided that:
When more than one aged, blind, or disabled persons live together, no more than one $20 disregard may be deducted;
When both earned and unearned income is available, apply the $20 disregard to the unearned income; and
When only earned income is available, the $20 disregard must be applied before the deduction of sixty-five dollars plus one-half of the remaining monthly gross income.
A deduction may be made for the cost of services of an applicant's or recipient's guardian or conservator, up to a maximum equal to five percent of countable gross monthly income excluding nonrecurring lump sum payments.
With respect to each individual in the Medicaid unit who is employed or in training, but who is not aged, blind, or disabled, thirty dollars may be deducted as a work or training allowance, but only if the individualís income is counted in the eligibility determination.
The deductions described in this subsection may be allowed only on earned income.
For all individuals, except for aged, blind, or disabled applicants or recipients:
Mandatory payroll deductions and union dues withheld, or ninety dollars, whichever is greater;
Mandatory retirement plan deductions;
Union dues actually paid; and
Expenses of a non-disabled blind person, reasonably attributable to earning income. (This provision applies to individuals who are eligible for Medicaid under the children and family category.)
For all aged, blind, or disabled applicants or recipients, sixty-five dollars plus one-half of the remaining monthly gross earned income; provided that, when more than one aged, blind, or disabled person lives together, no more than sixty-five dollars, plus one-half of the remaining combined earned income, may be deducted. This provision applies separately to the coverage, medically needy or the Medicare Savings Programs, for which eligibility is being determined.