J-7200, Spousal Co-Payment

Revision 22-1; Effective March 1, 2022

Budget Steps

To determine the co-payment for a spousal companion case, determine the person's and their spouse's net monthly earned income 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.

A separate deduction for maintenance of the home is not allowable 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 $60 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.
6 Subtract incurred medical expenses. The remainder is the co-payment for the payment plan.

See 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 plan is $0.
  • If the person has signed a statement and is refusing 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 greater than the MMMNA, count only the MMMNA in step 3 above.

The following examples are for demonstration purposes only. They may not reflect the current protected resource minimum and maximum amounts.

Examples

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
    • – $60 PNA
    • = $405 Income available for diversion
    • + $635 Spouse's income
    • = $1,040 Total
    • – $3,435 Spousal allowance
    • = $0 Co-payment

Another person and their spouse have the following income:

  • Person
    • $490 RSDI
    • + $509 Private retirement
    • = $999 Total
  • Spouse
    • $450 RSDI
    • + $300 Private retirement
    • + $750 Net earnings
    • = $1,500 Total
  • Co-payment calculation:
    • $999 Person's gross income
    • – $60 PNA
    • = $939 Income available for diversion
    • + $1,500 Spouse's income
    • = $2,439 Total
    • – $3,435 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:
    • $2,178 Base amount of dependent allowance
    • – $500 Dependent's gross income
    • = $1,678 Remainder
    • $1,678 divided by 3
    • = $559 Dependent allowance
  • Co-payment calculation:
    • $2,050 person's gross income
    • – $60 PNA
    • = $1,990 Income available for diversion
    • + $1,590 Spouse's income
    • = $3,580 Total
    • – $3,435 Spousal allowance
    • = $145 Remainder
    • – $559.00 Dependent allowance
    • = $0.00 Remainder
    • – $16 Incurred medical expenses
    • = $0.00 Co-payment

Related Policy

Co-Payment, Chapter H