PM 15-04-04-b

Nursing Home/Supportive Living Program

To Figure FMNA:

  • Verify income of the dependent family member(s); and
  • only use non-SSI income; and
  • calculate the allowance separately for each dependent family member; and
  • subtract the family member's gross income from the maintenance needs allowance New revision$2030.00 and divide by 3; and
  • enter the allowance on HFS 2500; and
  • When there is more than one dependent family member, figure the total amount of the allowances before deducting from the income.

Example 1: Mr. G resides in a nursing home and receives RSDI of $700 per month and a pension of $900 per month. Total monthly income is $1,600. Mr. G's dependent child resides with Mr. G's spouse and receives Social Security in the amount of $650 per month.

The FMNA equals $460(Revised text$2030.00-$650 = $1,380 divided by 3 = $460).

Example 2: Mrs K resides in a nursing home and receives SSA of $500 per month.  Mrs K's child (age 15) lives at home with Mrs. K's spouse and receives SSI of $300 and SSA of $600 per month. 

Only use non-SSI income to figure FMNA.

The FMNA equals $476.66 (New revision$2030.00-$600 = $1,430 divided by 3 = $476.66)

DoA HCBS waiver services

Follow the procedures above, except enter the family needs allowance on HFS 2382A.

Enter Code 20 in Item 20 of Form 552 to identify a client who applies for or receives DoA HCBS waiver services. When Code 20 is entered in Item 20, enter one of the following indicator codes under the SUP. BY column with Item 80 code 158 CI.

  • Code 3 - determination was made without diverting income to a community spouse or dependent family member; or
  • Code 4 - determination was made diverting income to a community spouse or dependent family member.

Example: Mrs. B lives in the community and receives DoA HCBS waiver services. Total monthly non-SSI income is $900. Mrs. B's dependent child lives with Mr. B and receives income of $590 per month.

The FMNA equals $480(Revised text$2030.00-$590 = $1,440 divided by 3 = $480).