0805.015.00  FINANCIAL NEED

If the claimant meets the December 1973 OAA, PTD, or AB eligibility requirements, determine need based on adjusted gross income. Determine the adjusted gross income as follows:

1. Determine whose needs and income must be considered.
2. Determine the gross earned and non-earned income.
3. Determine the adjusted earned income by subtracting the standard earned income deductions from the gross earned income.
4. Add the non-earned income to the adjusted earned income.
5. Subtract the applicable income exemptions/deductions.
6. Round down to the nearest whole dollar amont.

NOTE: Complete a separate computation for each month, if there have been changes in income.

0805.015.05  PERSONS WHOSE INCOME AND NEEDS ARE CONSIDERED

A claimant's need is determined as single individual or a married couple.

1. For a single individual
   • Age 18 and over, consider only the claimant's gross income in determining the adjusted income.
   • Under age 18, refer to the MA disabled child budgeting procedures in Section 0805.020.00.

     EXCEPTION: When a child under age 18 is approved for Missouri's Children with Developmental Disabilities (MOCDD) waiver services, refer to MOCDD budgeting procedures in Section 0825.030.35.

2. For a married couple who are living together:
   • Consider the gross income of the couple in determining the adjusted income.
   • Do not consider the income and expenses of minor children.
   • Consider the medical expenses of the couple in determining whether or not the spenddown is met, when applicable.

When a married couple is living together and one spouse is receiving MO HealthNet under Supplemental Nursing Care (SNC), Supplemental Aid to the Blind (SAB), or Supplemental Payments (SP), treat the MO HealthNet for the Aged, Blind, and Disabled (MHABD) participant as a single individual; do not consider the income and medical expenses of their spouse in the MHABD eligibility determination. The income maximum is that for a single person.

When the spouse of a MHABD claimant is receiving MO HealthNet under Blind Pension (BP), MO HealthNet for Families (MHF) (with or without a Temporary Assistance (TA) cash grant), MO HealthNet for Kids (MHK), MO HealthNet for Pregnant Women (MPW), or Transitional Medical Assistance (TMA), treat the MHABD participant as a couple and include their spouse's needs and income (excluding the BP cash grant) in the MHABD eligibility determination.

When a spouse of a MHABD participant is receiving MHF with a TA cash grant, do not include the TA cash grant in the MHABD eligibility determination.

Medical expenses, of the spouse that has coverage under another MO HealthNet program, that are not paid by MO HealthNet, may be allowed to meet the MHABD participant's spend down. In addition, continue to use the income and expenses of the MHABD participant in determining MHF, MHK, MPW, or TA eligibility if the person meets criteria for inclusion in that assistance group.

0805.015.05.05  COUPLE CASES IN THE IMU5 SYSTEM

To prevent spenddown couples from each paying the full amount of spenddown, the IMU5 system requires married couples to be combined on one Medical Assistance case.  If one spouse is eligible and the other is not, the system requires the non-eligible spouse to be entered as an included person (level of care “Z” in field 13G) in IMU5.

The casehead or payee must be an active MA recipient.  If the payee loses eligibility for any reason the case must be closed and a new case opened in the name of the eligible spouse.  A new application will not be required.

This section only applies to MA cases using a two-person expense.  It does not apply to cases that always use a one-person expense such as BP, SAB, Vendor, MA-HCB, MA-WD, etc.