Section 29-9801. INCOME TEST

 

9801.1In order to be eligible for LTCSS, an applicant or beneficiary shall have gross countable income at or below the Special Income Standard (SIS), which is equal to three hundred percent (300%) of the SSI federal benefit rate (FBR), except as identified at Subsection 9801.6.

 

9801.2Individuals identified at Subsection 9800.2(a) shall be exempt from the income test in Subsection 9801.1.

 

9801.3If an applicant or beneficiary has a community spouse, gross countable income shall be determined after spousal impoverishment protections for income have been applied.

 

9801.4Gross countable income shall include the following:

 

(a)Taxable income received from employment;

 

(b)Income received from sources other than employment; and

 

(c)Income from self-employment.

 

9801.5Gross countable income shall exclude the following:

 

(a)Earnings from an unmarried minor child who is living with an individual who provides care or supervision;

 

(b)Adoption subsidies;

 

(c)AmeriCorps/VISTA Income received under the National and Community Service Trust Act of 1993, effective September 21, 1993 (Pub.L. 103-82, 107 Stat. 787), as amended by the Serve America Act of 2009, effective April 21, 2009 (Pub.L. 111-13, 123 Stat. 1463; 42 U.S.C. §§ 12501 et seq.);

 

(d)Child Nutrition Payments;

 

(e)Payments received under the Domestic Volunteer Service Act of 1973, effective October 1, 1973 (Pub.L. 93-113, 87 Stat. 396), as amended by the Domestic Volunteer Service Act Amendments of 1984, effective May 21, 1984 (Pub.L. 98-288, 98 Stat. 189), as amended by the National and Community Service Trust Act of 1993, effective September 21, 1993 (Pub.L. 103-82, 107 Stat. 899), as amended by the Serve America Act of 2009, effective April 21, 2009 (Pub.L. No. 111-13, 123 Stat. 1581; 42 U.S.C. §§ 12501 et seq.);

 

(f)Earned Income Tax Credits;

 

(g)Educational benefits;

 

(h)Energy assistance;

 

(i)Foster care payments;

 

(j)Housing assistance provided by the federal or District of Columbia government or non-profit organizations;

 

(k)Incentive payments for Prenatal & Well-Baby Care and from the Work Incentive programs for current or former recipients of Temporary Aid to Needy Families (TANF) under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, effective August 22, 1996 (Pub. L. 104-193, 110 Stat. 2105; 42 U.S.C. §§ 1305 et seq.);

 

(l)Non-cash benefits in the form of voucher, commodity or service;

 

(m)Jury duty payments;

 

(n)Money received by a third party for an applicant, beneficiary, or community spouse, unless an applicant, beneficiary, or community spouse has or will have access to the funds;

 

(o)Money received by an applicant, beneficiary, or community spouse, on behalf of any third party;

 

(p)Nutrition payments;

 

(q)Rehabilitation Services Administration (RSA) Payments received under the Rehabilitation Act of 1973, effective September 26, 1973 (Pub.L. 93-112, 87 Stat. 355);

 

(r)Reimbursements received from an individual or organization to cover past, current, or future expenses, if all the following conditions are met:

 

(1)The reimbursement is for actual expenses;

 

(2)The reimbursement is earmarked to cover those expenses; and

 

(3)The reimbursement is paid or documented separately from any other payment such as wages;

 

(s)Payments received from roommates to cover their share of household expenses such as rent and utilities and which are paid by the applicant or beneficiary to the landlord or utility company;

 

(t)Senior Community Service Employment Program (SCSEP) Income received under the Older Americans Act of 1965, approved July 14, 1965 (Pub.L. 89-73, 79 Stat. 218), as amended by the Older Americans Act Amendments of 2000, approved November 13, 2000 (Pub.L. 106-501, 114 Stat. 2226), as amended by the Older Americans Act Amendments of 2006, approved October 17, 2006 (Pub.L. 109-365, 120 Stat. 2522);

 

(u)TANF underpayments;

 

(v)Training income, such as Training Expense Allowances/Stipends; and

 

(w)Utility allowances received through a federal or District government housing assistance program.

 

9801.6An applicant or beneficiary who has gross countable income exceeding the SIS shall be permitted to spend down the excess income to the MNIL, in accordance with 42 C.F.R. § 435.831, to become financially eligible for LTCSS.

 

9801.7The following standards shall apply in determining the income allocated to an applicant or beneficiary with a spouse:

 

(a)If there is no trust or other legally enforceable document establishing ownership of the income, one half (1/2) of the income shall be considered available to each spouse;

 

(b)If payment of income is provided for in a trust or other legally enforceable document, the income shall be considered available to each spouse in accordance with the allocation made in the document;

 

(c)If there is no trust or other legally enforceable document establishing ownership of the income and payment of income is made in the names of both spouses, one half (1/2) of the income shall be considered available to each spouse;

 

(d)If there is no trust or other legally enforceable document establishing ownership of the income and payment of income is made solely in the name of one spouse, the income shall be considered available only to that spouse; and

 

(e)If there is no trust or other legally enforceable document establishing ownership of the income and payment of income is made in the names of either spouse, or both, and to another individual or individuals, the income shall be considered available to each spouse in the proportion to the spouse’s interest.  If payment is made to both spouses and no other interest is specified, one half (1/2) of the joint interest shall be considered available to each spouse.

 

9801.8Following an initial eligibility determination, no income of a community spouse shall be considered available to a beneficiary during any month in which the beneficiary receives LTCSS.

 

9801.9A community spouse shall be entitled to retain a Community Spouse Allowance.

 

9801.10A Community Spouse Allowance shall equal the minimum monthly maintenance needs allowance (MMMNA) plus any excess shelter allowance.

 

9801.11A community spouse may retain an amount higher than the Community Spouse Allowance if either spouse demonstrates at a fair hearing that a higher amount is necessary due to exceptional circumstances resulting in severe financial duress. Exceptional circumstances may include but are not limited to:

 

(a) Recurring or extraordinary non-covered medical expenses;

 

(b) Amounts to preserve, maintain, or make major repairs to a home;

 

(c) Transportation costs; and

 

(d)  Amounts necessary to preserve an income-producing resource.

 

9801.12In accordance with Section 2970 of Title 1 DCMR and 42 C.F.R. § 431.200, an applicant, beneficiary, or community spouse may request a fair hearing to address the following matters:

 

(a)The amount of the Community Spouse Allowance; or

 

(b)The amount of income determined available to the community spouse. 

 

9801.13At the first annual renewal following the initial eligibility determination, the District shall verify that an institutionalized spouse has made available any amount of income under a Community Spouse Allowance to the community spouse.

 

 

authority

An Act to enable the District of Columbia (District) to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2014 Repl. & 2015 Supp.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 63 DCR 1605 (February 12, 2016).