H-1200, Income That Is Not Used in the Co-Payment

Revision 18-1; Effective March 1, 2018

Determine the copayment for a Medicaid eligible individual or couple residing in an institution, receiving services under the Program of All Inclusive Care for the Elderly (PACE) in a PACE setting, or receiving services under a Home and Community Based Waiver program.

When determining the copayment, consider the total income available to the individual from all sources. Certain payments that are not income and certain exempt income are not considered in the copayment budget. The total income for the copayment budget may be different from the total income for the eligibility budget.

When determining the copayment, do not include the following:

  • exempt income (see Section E-2000);
  • things that are not income (see Section E-1700), such as:
    • medical care and services;
    • certain social services;
    • receipts from the sale of a resource;
    • miscellaneous items, such as income tax refunds;
    • proceeds of a loan;
    • wage-related payments;
    • mandatory payroll deductions from earned income (see E-1770); and
    • cafeteria plans.
  • interest or dividends accrued on certain excluded or partially excluded resources (see E-3331.2);
  • interest and dividends earned on an ABLE account (see E-3331.4); and
  • VA Aid and Attendance allowance, housebound allowance, and payment adjustment for unusual medical expenses (see E-4300, E-4311.2, E-4315). Reminder: If these payments are deposited into a qualifying income trust (QIT) account, they are countable as copayment.

Note: Income tax withheld from unearned income is not a deductible expense for the copayment calculation.