Revision 20-2; Effective June 1, 2020

HHSC allows a deduction from a co-payment if a person intends to return home within six months of admission to an institutional setting and needs to meet expenses in maintaining the home. The deduction is based on the person's mortgage or rent payment and average utility charges, excluding phone. The amount deducted cannot exceed the SSI income limit, not including the $20 disregard. The first month of the six-month period is the month of admission to the institution.

Note: A separate deduction for maintenance of the home is not allowable in companion cases. The spousal allowance provides for home maintenance in those cases.

The home maintenance deduction is allowable if:

• the person notifies the eligibility specialist that he expects to be in an institutional setting for at least 30 consecutive days, but no more than six months;
• the eligibility specialist receives a practitioner's certification within 90 days of admission. The practitioner certifies that the person is likely to leave the institution within six months of admission; and
• the eligibility specialist receives evidence within 90 days of admission that the person needs to maintain and provide for the expenses of the home to which he may return.
  
  Note: The day of admission to the institutional setting is day zero.
  • Example 1: A person entered a nursing facility on March 1. An application was received on May 30, which included a completed and signed Form H1280, Statement of Residence Maintenance Needs. The applicant signed the form on March 28 and the physician's signature was dated April 15. The day of entry to the nursing home on March 1 would be counted as day zero. The 90th day would be May 30. It is calculated by the following: 31 days in March (30 countable days, since March 1 would be counted as day zero), 30 days in April (30 countable days) and 31 days in May (30 countable days) for a total of 90 days. May 31 would be 91 days. Application was received on May 30; thus, Form H1280 was received by the 90th day.
  • Example 2: A person entered a nursing facility on April 1. An application was received on July 10, which included a completed and signed Form H1280. The applicant signed the form on April 29 and the physician's signature was dated May 15. The day of entry to the nursing home on April 1 would be counted as day zero. The 90th day would be June 30. It is calculated by the following: 30 days in April (29 countable days, since April 1 would be counted as day zero), 31 days in May (31 countable days) and 30 days in June (30 countable days) for a total of 90 days. Application was received on July 10; thus, Form H1280 was not received by the 90th day. The individual is not eligible for the home maintenance deduction.

Use Form H1280, Statement of Residence Maintenance Needs, to obtain the person's and practitioner's declaration. Use the amount reported on Form H1280 as the home maintenance deduction amount as long as it does not exceed the SSI income limit, not including the $20 disregard. No additional verification is needed.

To ensure the home maintenance allowance is included as a deduction in the recipient’s co-payment calculation, staff makes the following selections within the appropriate Logical Unit of Work (LUW):

• on the Shelter Expense LUW, select an expense type of “Rent” or “Mortgage”;
• on the Utility Expense LUW, select the expense type “gas/propane, water, electric”; and
• select Form H1280, Statement of Residence Maintenance Needs, as verification for both the Shelter and Utility Expense LUWs.

Note: If any other source of verification is selected, the home maintenance allowance will not be allowed in the co-payment.

The system will automatically end the home maintenance allowance in the sixth month after the month of admission and will:

• end date the appropriate shelter or utility records;
• adjust the ongoing co-payment; and
• generate Form TF0001, Notice of Case Action, and Form TF0001P, Provider Notice, to notify both the recipient and the facility of the ongoing co-payment.