Part II. Post-Eligibility Treatment of Institutionalized Individuals
12VAC30-40-20. Post-eligibility treatment of institutionalized individuals.
The following amounts are deducted from gross income when computing the application of an individual's or couple's income to the cost of institutional care:
1. Personal needs allowance.
a. Aged, blind, disabled:
Individuals: $40 PLUS *
Couples: $60 PLUS *
For the following individuals with greater need -- * (1) Patients in institutions who participate in work programs as part of treatment. The first $75.00 of earnings plus 1/2 the remainder, up to a maximum of $190.00 monthly is allowed to be retained for personal needs. * (2) Patients receiving institutional or home- and community-based waiver services who pay guardianship fees, the actual cost of guardian fees up to a maximum of 5% of gross income.
b. AFDC related:
Children: $40
Adults: $60
c. Individuals under age 21 covered in this plan as specified in Item b.7 of 12VAC30-30-20: $40
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of Virginia.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 1, 1994; amended, Virginia Register Volume 23, Issue 18, eff. July 1, 2007.
12VAC30-40-30. Maintenance needs of non-institutionalized spouse.
For maintenance of the non-institutionalized spouse only. The amount must be based on a reasonable assessment of need but must not exceed the highest of--
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| SSI level | $_________ |
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| SSP level | $_________ |
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| Monthly medically needy level | $_________ |
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| Other as follows | $_________ |
See 12VAC30-40-80.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 1, 1994.
12VAC30-40-40. Children.
For children, each family member. (Applies only to children not living with the community spouse.)
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| AFDC level | $__________ |
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| Medically needy level | $ See below* |
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| Other as follows | $__________ |
For children living with the community spouse, see 12VAC30-40-80.
* Group I: $216.67; Group II: $250; Group III: $325. For appropriate family size see 12VAC30-40-220.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 16, 1993.
12VAC30-40-50. Medical expenses.
Amounts for incurred medical expenses not subject to payment by a third party
a. Health insurance premiums, deductibles and co-insurance charges
b. Necessary medical or remedial care not covered under the Medicaid plan
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 16, 1993.
12VAC30-40-60. Maintenance of residence.
An amount for maintenance of a single individual's home for not longer than 6 months, if a physician has certified he or she is likely to return home within that period.
Amount for maintenance of home:
$ See below*
* Group I: $216.67; Group II: $250; Group III: $325. For appropriate family size see 12VAC30-40-220.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 16, 1993.
12VAC30-40-70. SSI benefits.
SSI benefits paid under § 1611(e)(1)(E) of the Act to individuals who receive care in a hospital or NF.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-02-2.6100 B, eff. June 16, 1993.
12VAC30-40-80. Maintenance standards.
Maintenance standard for community spouse and other dependent family members under § 1924 of the Act.
1. Community spouses: Standard based on formula contained in § 1924(d) is used.
2. Other family members who are dependent: Standard based on the formula contained in § 1924(d)(1)(c) is used.
3. The standards described above are used for individuals receiving home and community based services in lieu of services provided in medical or remedial institutions.
4. The definition of dependency below is used to define dependent children, parents and siblings for purposes of deducting allowances under § 1924.
a. Dependent children -- A child under age 21 and a child age 21 years old and older of either spouse who lives with a community spouse and who may be claimed as a dependent by either member of a couple for tax purposes under the Internal Revenue Services Code.
b. Dependent parents -- Parents of either member of a couple who reside with the community spouse and who may be claimed as dependents by either spouse for tax purposes under the Internal Revenue Services Code.
c. Dependent siblings -- A brother or sister of either member of a couple (including half-brothers and half-sisters and siblings gained through adoption) who reside with the community spouse and who may be claimed by either member of the married couple for tax purposes under the Internal Revenue Services Code.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Historical Notes
Derived from VR460-02-2.6100 B, eff. October 1, 1989; amended, Virginia Register Volume 17, Issue 13, eff. April 11, 2001.