Determine the participant’s gross income from all sources (SSI, OASDI, earned, etc.) Do not include RSDI, VA, or RR penalty amounts being deducted from RSDI, VA, or RR benefits due to a previous overpayment in those benefits.
OASDI and/or SSI recipients with drug addition or alcoholism (DA&A) as a contributing factor for disability must have payments made through a representative payee. The representative payee is allowed to charge the individual a service fee when disability is based on DA&A. This fee is NOT an allowable expense for SNC.
If a payment is made by a third party (other than DMH) for the basic nursing, Assisted Living Facility, or Residential Care Facility (RCF) charge, evaluate whether to count the payment as income.
- Consider the payment as income if it is made as a result of an insurance policy, retirement benefits, or other binding agreement. EXAMPLE: A participant has an insurance policy which covers nursing facility care. According to the terms of the policy, while the participant resides in a nursing facility the company pays $15.00 per day. This payment is not reduced if the participant’s income increases or if the nursing facility is also paid from another source. Therefore, in addition to other income, the participant has $455 ($15 x 30) which is counted in determining SNC eligibility.
NOTE: If income is not currently being received by the participant, set a priority for a grant adjustment.
- Do NOT consider the payment as income if it is only being made because the participant does not have sufficient income to pay the basic nursing, Assisted Living Facility (ALF), or Residential Care Facility (RCF) charge and not as a part of an insurance policy, retirement benefits, or other binding agreement. EXAMPLE: The nursing facility base rate is $1000. The participant’s income is $600. The participant’s daughter makes up the $400 difference. Do not count the $400 payment as income to the participant.
- Consider the payment as income for the month in which it is received, if the payment is made as the result of TPL overages.