H5100, ICF/IID Individual and Couple Cases
Revision 123; Effective September 1, 2012
For individuals and couples, follow the steps in this section.
HHSC nets the person's and spouse's earned income each month by subtracting the following mandatory payroll deductions:
 income tax,
 Social Security tax,
 required retirement withholdings, and
 required uniform expenses.
H5110 ICF/IID Individual
Revision 241; Effective March 1, 2024
Determine the person’s monthly net earned and gross unearned income.
Determine the personal needs allowance (PNA) for a person as follows:
Person earns $30 or less.
Step  Description 

1.  Deduct the $75 PNA from the unearned income. 
2.  To the extent the unearned income is less than $75, deduct the difference from the net earned income. 
3.  Deduct all remaining net earned income up to $30. 
4.  Add the deductions from steps 1 through 3 to determine the total PNA/PEI allowance. 
Note: The total PNA/PEI must be at least $75.
Example: Person receives $300 RSDI and earns $30 per month.
Step  Description 

1.  $300 unearned – $75 PNA = $225 
2.  NA 
3.  $30 earned – $30 PEI = $0 
4.  $75 PNA + $30 PEI = $105 PNA/PEI 
Person's earnings exceed $30 but not $120.
Step  Description 

1.  Deduct the $75 PNA from the unearned income. 
2.  To the extent the unearned income is less than $75, deduct the difference from the earned income. 
3.  Deduct $30 from the remaining net earned income, plus onehalf of the remainder. 
4.  Add the deductions from steps 1 through 3 to determine the total PNA/PEI deduction. 
Example: Person earns $120 per month and receives $15.50 SSI.
Step  Description 

1.  $15.50 unearned – $75 PNA = –$59.50 
2.  $120 net earned – $59.50 = $60.50 
3.  $60.50 remaining net earned – $30 = $30.50 divided by 2 = $15.25 
4.  $12.50 + $59.50 + $30 + $15.25 = $117.25 PNA/PEI 
Person's earnings exceed $120.
Step  Description 

1.  Deduct the $75 PNA from the unearned income. 
2.  To the extent the unearned income is less than $75, deduct the difference from the first $120 of the net earned income. 
3.  Of the monies remaining from the first $120 of net earned income, deduct $30 and onehalf of the remainder. 
4.  Deduct 30 percent of the net earnings in excess of $120. 
5.  Add the deductions from Steps 1 through 4 to determine the total PNA/PEI allowance. 
Example 1: Person receives $300 RSDI and earns $250.
Step  Description 

1.  $300 unearned – $75 PNA = $225 
2.  NA 
3.  $120 earned – $30 = $90 divided by 2 = $45 
4.  $250 earned – $120 = $130 x .30 = $39 
5.  $75 PNA + $30 + $45 + $39 = $189 PNA/PEI 
Example 2: Person receives $7.50 SSI and earns $130.
Step  Description 

1.  $7.50 unearned – $75 = –$67.50 
2.  $120 earned – $67.50 = $52.50 
3.  $52.50 remaining earned – $30 = $22.50 divided by 2 = $11.25 
4.  $130 earned – $120 = $10 x .30 = $3 
5.  $7.50 + $67.50 + $30 + $11.25 + $3 = $119.25 PNA/PEI 
References
 Subtract the guardian fee allowance, if applicable.
 Subtract incurred medical expenses.
 Subtract the home maintenance allowance, if applicable.
 The total net earned income and gross unearned income minus the total personal needs allowance and other allowable deductions is the copayment.
H5120 ICF/IID Couple
Revision 241; Effective March 1, 2024
Determine the personal needs allowance for a couple as follows:
 If neither spouse has earned income, or if the only spouse with earned income does not have an ICF/IID level of care, the personal needs allowance for the couple is $75 for each spouse.
 If either spouse is an ICF/IID person who has monthly earned income, determine the personal needs allowance for each separately based on their individual monthly incomes.
Note: If one spouse has a level of care other than an ICF/IID level of care, the personal needs allowance for that individual is $75, even if the individual has earned income. Combine the individual personal needs allowance for the couple.
Subtract the total personal needs allowance from the total of net earned income and gross unearned income of the couple.
References
 Subtract guardian fee allowance, if applicable.
 Subtract incurred medical expenses.
 Subtract home maintenance allowance, if applicable.
 Divide the remainder by two to determine the copayment for each spouse.
H5130 ICF/IID Companion
Revision 241; Effective March 1, 2024
A separate deduction for maintenance of the home is not allowable in companion cases.
The spousal allowance provides for home maintenance in those cases.
Use the following steps to determine the copayment budget for a companion situation:
Step  Procedure 

1  Determine the countable net earned and gross unearned income of the person. 
2  Subtract the personal needs allowance, including the protected earned income allowance (if any) of the person based on his own net income. Subtract guardian fee allowance, if applicable. 
3  Add the spouse's countable net earned and gross unearned income to the remainder. 
4  Subtract the spousal allowance. 
5 

6  Subtract incurred medical expenses. 
The remainder is the copayment.
Example: The couple has the following income:
Person  Spouse  

$250  RSDI  $800  Net Earnings 
$130  Net Earnings 
Calculation for personal needs and protected earned income allowance:
Person  Spouse 

$250  RSDI unearned income 
− $75  PNA 
$175  remainder 
Calculation for protected earned income when earnings are greater than $120:
Person  Spouse 

$120  Deduct $30 from the first $120 of net earned income 
− $30  
$90  divided by 2 = $45 and get onehalf the remainder 
Calculation for 30% of earnings in excess of $120:
Person  Spouse 

$130  Net earnings 
− $120  First $120 of net earned income 
$10  x .3 = $3 (30% of earnings in excess of $120) 
Calculation for Total PNA/PEI:
Person  Spouse 

$75  PNA 
+ $30  $30 deduction 
+ $45  Onehalf the remainder deduction 
+ $3  (30% of earnings in excess of $120) 
$153  Total PNA/PEI 
Copayment calculation:
Step  Procedure  Amount 

RSDI  $250  
Net earnings  + $130  
Step 1:  Total  $380 
Step 2:  Total PNA/PEI  − $153 
Income available for diversion  $227  
Step 3:  Spouse's income  + $800 
Total  $1,027  
Step 4:  Spousal allowance  − $2,841 
Step 5:  NA  
Step 6:  NA  
Copayment  $0 