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Appendix F

Standards and Guidelines (Archive)

This appendix provides figures used to determine eligibility for a person, or in a specific calculation completed to determine eligibility.

Community Spouse Allowances

The Community Spouse Allowances are used when determining the long-term care (LTC) income calculation’s community spouse allocation.

Basic Shelter Allowance

The Basic Shelter Allowance is used to determine if the community spouse has any excess shelter expenses.

Effective Dates

Basic Shelter Allowance

July 1, 2016, to June 30, 2017

$602

July 1, 2015, to June 30, 2016

$598

Maximum Monthly Income Allowance

The Maximum Monthly Income Allowance, along with the Minimum Monthly Income Allowance, is used to determine the community spouse’s monthly maintenance needs amount.

Effective Dates

Maximum Monthly Income Allowance

January 1, 2016, to December 31, 2016

$2,980.50

January 1, 2015, to December 31, 2015

$2,980.50

Minimum Monthly Income Allowance

The Minimum Monthly Income Allowance, along with the Maximum Monthly Income Allowance, is used to determine the community spouse’s monthly maintenance needs amount.

Effective Dates

Minimum Monthly Income Allowance

July 1, 2016 – June 30, 2017

$2,005

July 1, 2015 – June 30, 2016

$1,992

Utility Allowance

The Utility Allowance is allowed as a shelter expense if the community spouse is responsible for heating or cooling costs.

Effective Dates

Utility Allowance

October 1, 2016 – September 30, 2017

$532

October 1, 2015 – September 30, 2016

$454

The Electricity and Telephone Allowances are allowed as shelter expenses if the community spouse is not responsible for heating or cooling expenses, but is responsible for electricity or telephone expenses.

Effective Dates

Electricity Allowance

October 1, 2016 – September 30, 2017

$141

October 1, 2015 – September 30, 2016

$141

 

Effective Dates

Telephone Allowance

October 1, 2016 – September 30, 2017

$38

October 1, 2015 – September 30, 2016

$38

Federal Poverty Guidelines

The federal poverty guidelines (FPG) are used to determine income eligibility for the Minnesota Health Care Programs (MHCP).

Refer to Insurance and Affordability Programs (IAPs) Income and Asset Guidelines (DHS-3461A) for the current FPG.

Home Equity Limit

The Home Equity Limit is applied only in specific situations and at certain times.

Effective Dates

Home Equity Limit

January 1, 2016, to December 31, 2016

$552,000

January 1, 2015, to December 31, 2015

$552,000

IRS Mileage Rate

The IRS mileage rate is used in many calculations to determine eligibility or reimbursement costs.

Effective Dates

IRS Mileage Rate

January 1, 2016, to December 31, 2016

54 cents

January 1, 2015, to December 31, 2015

57.5 cents

Long-Term Needs Allowances

The LTC needs allowances provide figures for needs allowances used in the LTC income calculation and for determining the community spouse or family allocation amounts.

Clothing and Personal Needs Allowance

The Clothing and Personal Needs Allowance is used when the enrollee is not eligible for any of the other LTC needs allowances.

Effective Dates

Clothing and Personal Needs Allowance

January 1, 2016, to December 31, 2016

$97

January 1, 2015, to December 31, 2015

$97

Home Maintenance Allowance

The Home Maintenance Allowance can be deducted from a person’s LTC income calculation if certain conditions are met.

Effective Dates

Home Maintenance Allowance

July 1, 2016, to June 30, 2017

$990

July 1, 2015, to June 30, 2016

$981

Special Income Standard for Elderly Waiver Maintenance Needs Allowance

The Special Income Standard for Elderly Waiver (SIS-EW) maintenance needs allowance is used in the LTC income calculation for persons who have income at or below the Special Income Standard (SIS).

Effective Dates

Maintenance Needs Allowance

July 1, 2016, to June 30, 2017

$988

July 1, 2015, to June 30, 2016

$988

Minimum and Maximum Asset Allowances

The Minimum and Maximum Asset Allowances are used to determine the community spouse asset allowance for an asset assessment.

Effective Dates

Minimum

Maximum

January 1, 2016, to December 31, 2016

$33,851

$119,220

January 1, 2015, to December 31, 2015

$33,851

$119,220

MinnesotaCare Premium Amounts

MinnesotaCare premiums are calculated using a sliding fee scale based on household size and annual income.

Refer to MinnesotaCare Premium Estimator Table (DHS-4139) for information about MinnesotaCare premiums. The table provides an estimate of the premium before receiving the actual bill. The premium calculated by the system and listed on the bill is the official calculation and the amount to be paid.

Pickle Disregard

The Pickle Disregard is a disregard of the Retirement, Survivors and Disability Insurance (RSDI) cost of living adjustment (COLA) amounts for Medical Assistance (MA) Method B and the Medicare Savings Programs (MSP).

Effective Date

Pickle Disregard

January 1, 2016, to December 31, 2016

1

January 1, 2015, to December 31, 2015

1.017

Remedial Care Expense

The Remedial Care Expense deduction amount can be used as a health care expense when meeting a spenddown or as an income deduction in an LTC income calculation.

Effective Dates

Remedial Care Expense

July 1, 2016 – December 31, 2016

$196

January 1, 2016 – June 30, 2016

$252

Roomer and Boarder Standard Amount

The Roomer and Boarder Standard income is used in calculating the amount of self-employment income a person who rents or boards another person has to add to the MA Method A income calculation.

Roomer and Boarder Standard

Amount

Roomer Amount

$71

Boarder Amount

$155

Roomer plus Boarder Amount

$226

Special Income Standard

The Special Income Standard (SIS) is used to determine certain criteria for the Elderly Waiver (EW) Program.

Effective Dates

SIS

January 1, 2015, to December 31, 2015

$2,199

January 1, 2014, to December 31, 2014

$2,163

Statewide Average Payment for Skilled Nursing Facility Care

The statewide average payment for skilled nursing facility (SAPSNF) care amount is used to determine a transfer penalty for MA. The SAPSNF is updated annually in July.

Effective Dates

SAPSNF

July 1, 2016, to June 30, 2017

$6,280

July 1, 2015, to June 30, 2016

$6,141

Student Earned Income Exclusion

The Student Earned Income Exclusion is a disregard of earned income for people who are under age 22 and regularly attending school. It is only available for MA Method B and MSP.

Effective Date

Monthly

Annual

January 1, 2016, to December 31, 2016

$1,780

$7,180

January 1, 2015, to December 31, 2015

$1,780

$7,180

Supplemental Security Income Maximum Payment Amount

These figures are the maximum benefit amounts for people eligible for Supplemental Security Income (SSI). A person’s SSI benefit amount is based on the income of the person and certain responsible household members.

SSI benefit payments may be deducted from the LTC income calculation if the person qualifies for the Special SSI Deduction.

Effective Date

Individual

January 1, 2016, to December 31, 2016

$733

January 1, 2015, to December 31, 2015

$733

 

Effective Date

Couple

January 1, 2016, to December 31, 2016

$1,100

January 1, 2015, to December 31, 2015

$1,100