N.H. Admin. Code § He-W 654.21

Current through Register No. 48, November 27, 2024

Section He-W 654.21 - Allocated Income

(a) Income of applicants and recipients of financial or medical assistance shall be allocated to provide for the unmet needs of a dependent, as described below, upon request of the client.

(b) For adult categories of financial and medical assistance other than medical assistance for institutionalized individuals who have a community spouse, an individual shall be considered a dependent, for purposes of allocating income, when the individual is:

(1) Financially dependent upon the individual from whom the income shall be allocated;

(2) Ineligible for any category of financial or medical assistance; and

(3) Either:

a. A parent;

b. A spouse who is separated due to institutionalization;

c. A child under the age of 18; or

d. A child age 18 or older who is unable to work due to a physical or mental disability.

(c) An individual shall be considered a dependent for purposes of allocation of income for the FANF category of assistance, when the individual is:

(1) Financially dependent upon the person from whom the income shall be allocated;

(2) Someone whom the FANF client is claiming or could claim for personal income tax purposes; or

(3) An individual whom the FANF client is legally obligated to support.

(d) Individuals who allocate income shall be:

(1) Age 18 or older; and

(2) The casehead, as defined in He-W 601.02(j).

(e) The amount of allocated income for a dependent who resides outside the FANF household shall be the amount the FANF client actually pays to support that dependent.

(f) The amount of allocated income for dependents residing in the FANF household and other dependents of a non-institutionalized individual shall be the difference between:

(1) The FANF standard of need for a group size equal to the number of legal dependents; and

(2) Any other gross income available to the dependents.

(g) When an individual in an adult category case with no spouse who lives in the community, enters or leaves a nursing facility, a portion of his or her income shall be allocated, at his or her request, for maintenance of the home in order to meet expenses incurred or to be incurred outside of the institution for that part of the month spent in the institution, as follows:

(1) If the stay of an institutionalized individual is to be 3 months or less, as certified by a physician, a portion of the client's income which represents the FANF shelter allowance shall be allocated, at the client's request, to the maintenance of the home to which the client is expected to return; or

(2) If the stay of an institutionalized individual is to be in excess of 3 months, the amount allowed as allocated income for maintenance of the home shall be the amount of the verified outside expenses for the first month of institutionalization and for the month the individual leaves the institution to return to the home.

(h) The department shall determine if the income of the community spouse as defined in 42 USC 1396r-5(d) is sufficient to have a maintenance needs allowance equal to the minimum percentage of the federal poverty income guidelines required under 42 USC 1396r-5.

(i) If the department determines that the income of the community spouse is insufficient to meet the minimum maintenance needs allowance in (h) above, the department shall determine an income allowance for the community spouse, pursuant to 42 USC 1396r-5(d).

(j) If either the institutionalized spouse or the community spouse is dissatisfied with the community spouse income allowance determination in (i) above, he/she shall be entitled to an administrative appeal pursuant to He-C 200 and with respect to such determination pursuant to the requirements specified in 42 USC 1396r-5(e).

(k) If either spouse verifies at the administrative appeal that the community spouse needs a higher income allowance than determined in (h) or (i) above due to exceptional circumstances resulting in significant financial duress, there shall be substituted for the minimum percentage an amount adequate to provide for such additional need.

(l) Exceptional circumstances resulting in significant financial duress shall be one or more of the following:

(1) Costs of medical, remedial, or other support services, including medical insurance, necessary for community spouses to maintain themselves in the community;

(2) Cost of repairs necessary to maintain the home in a livable condition;

(3) Cost of repairs to appliances within the home;

(4) Cost of repairs or maintenance of one vehicle, including insurance and registration;

(5) Costs associated with unforeseen circumstances such as fire or flood which result in loss of housing, clothing, household goods or other necessities; and

(6) Costs for items or services which have been certified in writing by a physician as being medically necessary to maintain the community spouse in the community.

(m) Acceptable documentation of the costs cited in (1) shall be a currently dated bill or written estimate from the provider which indicates the amount of the expense.

(n) When the administrative appeals unit determines that significant financial duress exists as a result of the costs described in (1) above, the community spouse's income allowance shall be adjusted as follows:

(1) If the cost is a one time expense and the institutionalized individual has sufficient monthly income to allocate to the community spouse to cover the cost, the allowance shall be adjusted only in the month that the expense is approved;

(2) If the cost is a one time expense and the institutionalized individual has insufficient monthly income to allocate to the community spouse to cover the cost, the cost shall be prorated and allowance shall be adjusted for the specific number of months required to accommodate the expense; and

(3) If the cost is an ongoing expense, the allowance shall be adjusted for the specific number of months for which the ongoing expense exists, if known, or until a change is reported or at the next regularly scheduled redetermination in accordance with He-W 684.02, whichever occurs first.

(o) The amount of allocated income for each legal dependent of the spouse who lives in the community or the institutionalized individual shall be one third of the difference between the dependent's gross income and the maintenance allowance, pursuant to 42 USC 1396r-5(d).

(p) For purposes of allocating income, individuals applying for or receiving home and community based care services pursuant to He-W 658.06 shall not be considered to be institutionalized individuals.

(q) There shall be no allocation of income to a legal dependent who would be categorically eligible for assistance but refuses to apply or cooperate in the application process.

N.H. Admin. Code § He-W 654.21

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss by #6614, eff 10-24-97; amd by #7086, eff 10-1-99; amd by #8452, eff 10-22-05; ss by #9980, eff 8-20-11

Amended by Volume XXXIX Number 37, Filed September 12, 2019, Proposed by #12851, Effective 8/20/2019, Expires 2/17/2020