Gross Income Test

Married Couple where Both Individuals Institutionalized

If both spouses are institutionalized, apply the following rules:

• Calculate the individual's countable gross unearned income
• Calculate the spouse's countable gross unearned income
• Combine the countable gross unearned income of the couple
• Calculate the individual's countable gross earned income from all sources (including self employment income)
• Calculate the spouse's countable gross earned income from all sources (including self employment income)
• Combine the countable gross earned income of the couple
• Add the countable gross unearned income and the countable gross earned income to determine the total gross countable income for the eligible couple
• Determine the facility's monthly LTC Reimbursement Rate
• Compare gross amount to monthly LTC Reimbursement Rate

Exception: If spouses are both institutionalized but ineligible when treated as a couple, treat each spouse as an single institutionalized individual

Single Institutionalized Individual

• Calculate the individual's countable gross unearned income
• Calculate the individual's countable gross earned income from all sources (including self employment income)
• Add the individual's countable gross earned and unearned income to give total gross income.
• Determine the facility's monthly LTC Reimbursement Rate
• Compare gross amount to monthly LTC Reimbursement Rate

Married Couple where One is Institutionalized and Other is Community Spouse

• Calculate the individual's countable gross unearned income
• Calculate the individual's countable gross earned income from all sources (including self employment income)
• Add the countable gross unearned income and the countable gross earned income to determine the total gross countable income
• Determine the facility's monthly LTC Reimbursement Rate
• Compare gross amount to monthly LTC Reimbursement Rate

Eligible before Deductions (cost of care to be determined at post eligibility)

• If the client's gross income is less than or equal to the LTC Reimbursement Rate then the client is eligible
• If the client's gross income is more than the LTC

Reimbursement Rate apply the Deductions as follows:

1. Determine the individual's gross unearned income AND
2. Determine the individual's gross earned income AND
3. If the individual's earned income is greater than zero, apply the Earned Income Deduction to earned income AND
4. Total the individual's unearned income and earned income to give gross income for the individual AND
5. Apply the Personal Needs Allowance (see the Personal Needs Allowance section in this chapter) AND Apply the Community Spouse Needs Allowance (see the Community Spouse Needs Allowance section in this chapter) AND
6. Apply the Family Dependent Allowance (see the Family Dependent Allowance section in this chapter) AND
7. Apply the Medical Expense Deduction (see the Medical Expense Deduction section in this chapter) AND
8. Apply the Home Maintenance Allowance (see the Home Maintenance Allowance section in this chapter) AND
9. Apply the Legal Guardian Expense Deduction (see the Legal Guardian Expense Deduction section in this chapter)

• If the remaining amount after deductions have been applied is less than or equal to the LTC Reimbursement Rate (monthly) then the client is eligible
• If the remaining amount after the deductions have been applied is more the projected LTC Reimbursement Rate (monthly) then the client is medically needy ineligible.
• The remaining amount after deductions have been applied is the individual's contribution towards cost of care for the month.