J-7200, Spousal Co-Payment
Revision 24-1; Effective March 1, 2024
Budget Steps
To determine the co-payment for a spousal companion case, determine the person and their spouse's net monthly earned income. Do this by subtracting the following mandatory payroll deductions:
- income tax;
- Social Security tax;
- required retirement withholdings; and
- required uniform expenses.
Note: Mandatory payroll deductions also apply to a dependent's earned income in spousal impoverishment cases.
Do not count in-kind support and maintenance income the spouse receives.
Do not allow a separate deduction for maintenance of the home in companion cases. The spousal allowance provides for home maintenance in those cases.
How to Determine Co-Payment for a Spousal Companion Case
| Step | Procedure |
|---|---|
| 1 | Determine the countable net earned and gross unearned income of the person. |
| 2 | Subtract the personal needs allowance (PNA) of $75 for the person. Subtract the guardian fee allowance, if applicable. |
| 3 | Add the spouse's countable net earned and gross unearned income to the remainder. If the spouse’s income is more than the minimum monthly maintenance needs allowance (MMMNA), count only the MMMNA. |
| 4 | Subtract the spousal allowance. |
| 5 | a) If there are no dependents, go to step 6. b) If there are dependents, determine the dependent allowance. c) Subtract the dependent allowance for the payment plan. |
| 6 | Subtract the person’s incurred medical expenses, if applicable. The remainder is the person’s co-payment. Refer to co-payment policy for the deduction of incurred medical expenses. |
Notes:
- Enter incurred medical expense deductions on the Medical Expense LUW in TIERS even if the payment is $0.
- If the person has signed a statement and refuses to make the spousal allowance available and there are no dependents, follow procedures for an individual payment plan budget.
- If the community spouse's countable income is more than the MMMNA, count only the MMMNA in step 3 above.
Examples
The following examples are for demonstration purposes only. They may not reflect the most recent protected resource amounts or dependent allowance.
A person and their spouse have the following income:
- Person
- $265 RSDI
- +$200 Private retirement
- $465 Total
- Spouse
- $350 RSDI
- + $285 Teacher's retirement
- = $635 Total
- Co-payment calculation:
- $465 Person's gross income
- – $75 PNA
- = $390 Income available for diversion
- + $635 Spouse's income
- = $1,025 Total
- – $3,853.50 Spousal allowance
- = $0 Co-payment
Another person and their spouse have the following income:
- Person
- $490 RSDI
- + $509 Private retirement
- = $999 Total
- Community Spouse
- $450 RSDI
- + $300 Private retirement
- + $750 Net earnings
- = $1,500 Total
- Co-payment calculation:
- $999 Person's gross income
- – $75 PNA
- = $924 Income available for diversion
- + $1,500 Spouse's income
- = $2,424 Total
- – $3,853.50 Spousal allowance
- = $0 Remainder
- – $60 Incurred medical expenses
- = $0 Co-payment
A third person and their spouse have the following income:
- Person
- $1,250 RSDI
- + $800 Private retirement
- = $2,050 Total
- Spouse
- $1,590 Net earnings
- Monthly incurred medical expenses are $16.
The person's dependent brother lives with the community spouse. The brother’s only income is $500 per month in RSDI disability benefits.
- The brother’s dependent allowance is:
- $2,465 Base amount of dependent allowance
- – $500 Dependent's gross income
- = $1,965 Remainder
- $1,965 divided by 3
- = $655 Dependent allowance
- Co-payment calculation:
- $2,050 Person's gross income
- – $75 PNA
- = $1,975 Income available for diversion
- + $1,590 Spouse's income
- = $3,565 Total
- – $3,853.50 Spousal allowance
- = $0 Remainder
- – $655 Dependent allowance
- = $0.00 Remainder
- – $16 Incurred medical expenses
- = $0.00 Co-payment
Related Policy
Co-Payment, Chapter H