Budgeting
This is the personal needs allowance for an individual.
$70.00
This resource is protected if the a/b has a spouse or a dependent at home.
Homesite
Within these months, the a/b is budgeted PLA with all persons financially responsible for them.
Months prior to CPI
To be considered a dependent of an institutionalized spouse, the individual must live with the client/ CUSP and must be legally dependent. Legally dependent would include....
Must live with the community spouse if under 18 or must be claimed as a dependent for income tax purposes by either the a/b or the CUSP if they are over age 18.
A/b has $2,500 gross income, no dependents or spouse, has Medicare. Determine the a/b's PML for the entire certification period.
$2,255 (first two months)
$2,430 (remaining c.p.)
This form is sent to a facility to report the amount of income an a/b must pay to the facility for cost of care.
DHB-5016
The process of determining the total countable reserve of the couple on the first day of the month that institutionalized spouse begins first CPI; and the amount of community spouse resource allowance.
Assessment
This is when only the a/b's income and resources are counted but the a/b is budgeted PLA.
CPI Month
An amount that is deducted for the a/b's PML when a dependent is within the a/b's household.
The dependent family member allowance
A/b receives RSDI of $1893.00 monthly and a VA pension of $120.00 with ($20.00 Aid & Attendance) monthly. A/b has Medicare, a life insurance premium of $216.00 monthly and a six month letter. Determine the PML for the entire certification period.
$1,506 (first two months)
$1,681 (remaining 4 months if client still goes home in 6 months)
$1,923 (if client does not go home in 6 months)
This amount is the Spouse Base Allowance.
$2555.00
In this period of time, assets are protected for the Community Spouse.
Protection period
The period of time in which the a/b is budgeted as a unit of 1.
LTC Budgeting Month
This standard is 150% of the federal poverty limit for 2 people.
Basic Allowance for Community Spouse
A/b has income of $2721, pension of $50/ month and a VA pension of $120 with $40 Aid and Attendance. Client has a 6 month letter, Hearing aid (does not have a physician note) $157.00, Medicare premium and physician charges total $307.00 balance after Medicaid and Medicare paid.
$2,057 (first two months)
$2,299 (remaining c.p.)
This is amount is granted to the a/b who does not have a spouse or a child and intends to return home.
$242.00
Up to this amount of otherwise countable liquid assets may be excluded for burial purposes.
$1,500
Mr. Jones enters Graham Hospital on 10/5 and is discharged to Lake George Nursing on 10/9. Mr. Jones found out that someone he does not like resides at the same facility. He decides he no longer wishes to stay at Lake George Nursing anymore and is discharged home on 11/3. Determine his CPI.
There is no CPI because the client was not within the facilities for longer than 30 days.
When determining the community spouse allowance, we can sometimes consider shelter costs.
Excess Shelter Costs
A/b has RSDI of $1920 and a pension of $35. The client has Medicare, a six month letter, a hearing aid (does have a physician note) $139.00 and physician charges total $377.00 balance after Medicaid and Medicare paid. Determine the PML.
$1,091 (first two months)
$1,333 (remainder of c.p.)
After Medicaid pays, the a/b is responsible for paying this to the facility.
Patient Monthly Liability
This is countable for all life insurance policies, regardless if the total face value is equal to or less than $10,000.
Dividends
Mr. Bob enters Wake Med on 3/18 and is discharged from the hospital on 3/27. He returns to Wake Med on 4/1. It is found that Mr. Bob will need longer care. He is discharged to Magnolia Nursing on 4/5. What is the CPI month?
March
The CUSP states the expenses do exceed $767.00. The CUSP's household includes her institutionalized husband, herself, her daughter Cady (17) and her son Jon (8). This amount will be used for the utilities.
Utilities: $289
$707.00
A/b is employed at Harris Teeter, working 40 hours a week, paid weekly and makes $16.00 an hour. Client is admitted to Wake Med on 5/2. Application date is 6/15 and determined to return home in 6 months. The client also has Medicare. Determine the PML.
$2,265 (first two months)
$2,507 (remaining c.p.)