PM 15-04-04-b

Nursing home/supportive living facility cases

  1. Verify income of the dependent family member(s).
  2. To figure the amount of the Family Maintenance Needs Allowance (FMNA), subtract the family member's gross income from the maintenance needs standard. The deduction is equal to 1/3 of the difference between the maintenance needs standard and gross income of the family member. The difference is the amount of the deduction.
  3. Enter the deduction from the person's income for the support of a dependent family member(s) living with the community spouse in AIS or on the HFS 2500.
  4. Send the HFS 2500 with the approval notice.

Example: 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 deduction for the Family Maintenance Needs Allowance (FMNA) is equal to 1/3 of the difference between maintenance needs standard of Revised text$1,938.75 and gross income of the family member ($650). Therefore, Revised text$429.58 (Revised text$1,938.75 - $650 = Revised text$1,288.75 divided by 3 = Revised text$429.58) is deducted as the FMNA.

Medical cases applying for or receiving DoA HCBS waiver services

Follow the procedures above, except enter the deduction from the person's income for the support of a dependent family member(s) living with the community spouse in AIS or on Form 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 deduction for the FMNA is equal to 1/3 of the difference between the maintenance needs standard of Revised text$1,938.75 and gross income of the family member ($590). Therefore, Revised text$449.58 (Revised text$1,938.75 - $590 = Revised text$1,348.75 divided by 3 = Revised text$449.58) is deducted as the FMNA.