## J-7000, Income for Eligibility and Co-Payment

Revision 21-3; Effective September 1, 2021

If the recipient does not make the entire spousal allowance available at certification and at each redetermination, obtain a written statement from the recipient or the recipient's authorized representative as to the amount that is being made available and deduct only that amount.

A written statement is not required at redetermination if:

- the community spouse is a Supplemental Security Income (SSI) recipient;
- zero ($0) amount is being diverted to the community spouse; or
- the amount of the spousal diversion at redetermination remains the same.

Diversion of VA income to the community-based spouse may affect the VA income amount. Inform the couple of this possibility and give them the option of not diverting VA income to the community-based spouse. Their decision should be documented in a signed statement.

Financial duress is defined as having insufficient funds to meet living expenses because of debts incurred for medical expenses for the institutionalized spouse, community-based spouse or dependent, or because of replacement of a resource lost through theft or acts of God.

## J-7100, Spousal Companion Budget

Revision 09-4; Effective December 1, 2009

Using the special income limit for an individual, HHSC considers only the person's income in determining eligibility. The ineligible spouse's income is considered in determining the amount of co-payment.

## 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

## J-7300, ICF/IID Spousal Companion Cases

Revision 24-1; Effective March 1, 2024

Do not allow a separate deduction for maintenance of the home in companion cases. The spousal allowance provides for home maintenance in those cases.

Use the following steps to determine the co-payment for a spousal companion situation for a person with earnings who is in an ICF/IID:

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 their own net income. Subtract the 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 | a) If there are no dependents, go to step 6. b) If there are dependents, determine the dependent allowance. c) Subtract the dependent allowance. |

6 | Subtract incurred medical expenses. The remainder is the co-payment for the payment plan.Reference: Refer to Chapter H, Co-Payment, for the deduction of incurred medical expenses. |

**Example:**

**The couple has the following income:**

- Individual
- $250 RSDI
- + $130 Net earnings

- Spouse
- $800 Net earnings
- Personal needs and protected earned income allowance calculation:
- $250 RSDI unearned income
- – $75 PNA
- = $175 Remainder

**Calculation for ****PEI**** when earnings are greater than $120:**

- Deduct $30 from the first $120 of earned income:
- $120
- – $30
- = $90 Remainder of first $120 of earned income

- Deduct one-half the remainder of the first $120 of earned income:
- $90 Remainder of first $120 of earned income
- / 2
- = $45 One-half the remainder of the first $120 of earned income

- Deduct 30 percent of earnings more than $120:
- $130 Earnings
- – $120 First $120 of earned income
- = $10 Earnings more than $120
- x .3
- = $3 30 percent of earnings more than $120

- Calculation of total PNA/PEI:
- $75 PNA
- + $30 PEI deduction from the first $120 of earned income
- + $45 PEI deduction of one-half the remainder of the first $120 of earned income
- + $3 PEI deduction of 30 percent of earnings more than $120
- = $153 Total PNA/PEI

- Co-payment calculation:
- $250 RSDI
- + $130 Net earnings

- Step 1
- = $380 Total

- Step 2
- – $153 Total PNA/PEI
- = $227 Income available for diversion

- Step 3
- + $800 Spouse's income
- = $1,027 Total

- Step 4
- – $3,853.50 Spousal allowance

- Step 5 N/A
- Step 6 N/A
- = $0 Co-payment for payment plan

## J-7400, Spousal Impoverishment Dependent Allowance

Revision 23-3; Effective Sept. 1, 2023

To calculate the dependent allowance for spousal cases, subtract the dependent's income from 150% of the monthly federal poverty level (FPL) for a family of two and divide the remainder by three. Mandatory payroll deductions also apply to a dependent's earned income.

Dependent family members were living in the institutionalized person’s home before the person entered a facility and are unable to support themselves outside the person’s home because of medical, social or other reasons. They may be either spouse's minor or dependent children, dependent parents or dependent siblings including half-brothers, half-sisters and siblings gained through adoption.

**Note:** College students capable of supporting themselves do not meet the definition of a dependent.

The base amount (150% of the FPL for two) for calculating the dependent allowance is:

Date Range | Amount |
---|---|

July 1, 2023 to Present | $2,465 |

July 1, 2022 to June 30, 2023 | $2,289 |

July 1, 2021 to June 30, 2022 | $2,178 |

July 1, 2020 to June 30, 2021 | $2,155 |

July 1, 2019 to June 30, 2020 | $2,114 |

July 1, 2018 to June 30, 2019 | $2,058 |

July 1, 2017 to June 30, 2018 | $2,030 |

July 1, 2016 to June 30, 2017 | $2,003 |

July 1, 2015 to June 30, 2016 | $1,992 |

July 1, 2014 to June 30, 2015 | $1,967 |

July 1, 2013 to June 30, 2014 | $1,939 |

July 1, 2012 to June 30, 2013 | $1,892 |

July 1, 2011 to June 30, 2012 | $1,839 |

Deduct the entire dependent allowance even if it is not made available to the dependent.

The community spouse can appeal the dependent allowance amount based on undue hardship caused by financial duress. Only hearing officers can set higher diversion amounts for cases of undue hardship. Review cases of undue hardship every six months to monitor for changes in circumstances.

### Related Policy

General Information for Co-Payment, H-1000

Dependent Allowance, H-1600

Spousal Co-Payment, J-7200