0610.000.00 FINANCIAL NEED

To be eligible for SNC, there must be a deficit when the participant's income is subtracted from the basic Residential Care Facility (RCF), Assisted Living Facility (ALF), or nursing home charge. Determine need and the amount of payment as follows:

0610.005.00 DETERMINATION OF GROSS INCOME

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.

1. 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.

2. 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.

3. Consider the payment as income for the month in which it is received, if the payment is made as the result of TPL overages.

0610.010.00 INCOME EXCLUDED

Exclude, as income, any of the following:

1. Income from employment in a sheltered workshop (SW).
2. Income received from employment as a patient worker at sub-minimum wages in an institution, pursuant to the Fair Labor Standards Act, Section 14, Regulation 29CFR, Part 529.
3. Department of Mental Health funds (DH).
4. Contributions for charges not covered in the basic rate.
5. COMPENSATION RECEIVED UNDER THE FEDERAL OLDER AMERICANS VOLUNTEER PROGRAM (OA). Section 611 of Title VI of Public Law 93-29 dated May 3, 1973, (also called the “Foster Grandparent” and Older Americans Community Service Program) excludes income received under this program by individual volunteers, age 60 or over.
6. OUT-OF-POCKET EXPENSES made to individual volunteers, grandparents, senior health aides, or senior companions, and to persons serving in the Service Corps of Retired Executives (SCORE) and Active Corps of Executives (ACE) and any other programs under Titles II and III of the Domestic Volunteer Services Act of 1973 (Public Law 93-113).
7. VOCATIONAL REHABILITATION PAYMENTS (VF, VR) made for maintenance, transportation, tuition, fees, etc., in connection with an individual participating in training or school attendance subsidized by the Division of Vocational Rehabilitation (DVR).
8. LOANS OR GRANTS TO AN UNDERGRADUATE STUDENT (NA, N4) for educational purposes made or insured under any program administered by the Commissioner of Education. This includes the Basic Educational Opportunity Grants Program (BEOG), Supplemental Educational Opportunity Grants (SEOG), National Direct Student Loans (NDSL), Guaranteed Student Loans and PELL grants.
9. That portion of a VETERANS EDUCATION ASSISTANCE(VE) payment that is for the student and is actually used for items such as tuition, books, fees, equipment, transportation for school purposes, child care services necessary for school attendance, etc.
10. AGENT ORANGE SETTLEMENT PAYMENTS (AV).
11. MISSOURI FAMILY TRUST FUND payments made on behalf of a beneficiary who is an applicant or recipient of SNC (PM).
12. Bona Fide Loans (BF) - refer to Section 0205.005.30.40 of the Temporary Assistance manual.
13. Ricky Ray Hemophilia Fund (RI) - refer to Section 0905.012.75.12 of the Family Healthcare manual.
14. PASS Account: Money SSI recipients set aside under an approved plan for achieving self-support (PASS)(PA). SSA must approve the written plan.
15. The allowance provided to children of Vietnam veterans (including adult children) who were born with the congenital defect spina bifida (SP).
16. Supportive service payments, stipends (a payment received while participating in a training program), and needs related payments from WIA program(s) (J7).
17. WIA work experience payments (J2).
18. Any portion of a veteran’s pension designated for Aid and Attendance. In FAMIS enter the full amount of the VA Pension including the Aid and Attendance Pension, as “UI – Unearned Income”, source “VA – Veterans Administration” and enter the Aid and Attendance portion of the pension as income expense code “AA – VA Aid and Attendance Expenses”.
19. Any benefits designated for a veteran’s dependent. In FAMIS enter the full amount of the VA Pension including the portion designated for the veteran’s dependent , as “UI – Unearned Income”, source “VA – Veterans Administration” and enter the portion of the pension designated for the veteran’s dependent as income expense code “DX– VA Dependent Expenses”.
20. Any portion of a veteran’s pension paid for unusual medical expenses. In FAMIS enter the full amount of the VA Pension including the portion of the pension designated for unusual medical expenses, as “UI – Unearned Income”, source “VA – Veterans Administration” and enter the portion of the pension designated for unusual medical expenses as income expense code “ME – VA Unusual Medical Expenses”.
21. VA homebound allowances. In FAMIS enter the full amount of the VA Pension including the homebound allowance, as “UI – Unearned Income”, source “VA – Veterans Administration” and enter the homebound allowance portion of the pension as income expense code “HB – VA Home Bound Expenses”.
22. Achieving a Better Life Experience (ABLE) account (AD). Contributions to and interest, dividends, or other distributed earnings in an ABLE account. Also exclude from income payments made from an ABLE account for qualified disability expenses.

0610.015.00 OVERHEAD EXPENSE OF PRODUCING INCOME

Deduct any of the following overhead expenses for income-producing property:

1. Verifiable cost of ownership, including mortgage or contract payments, taxes and insurance.
2. Any expense relating to the cost of renting property.

   EXAMPLE: Ms. Jones, an SNC participant, receives rent for her home at $265 per month. The eligibility specialist verifies that Ms. Jones pays $780 a year for taxes on the property, and also pays $420 a year for insurance on the property. Her monthly expense of producing income is $100 [($780 + $420) per year / 12 months = $1200/12 = $100).

    $265.00  Income
   -$100.00  Less verified expenses of producing income
    $165.00  Countable income to be subtracted from basic nursing facility charge.

3. Any of the following expenses relating to the cost of farming property: Cost of feed, seed, fertilizers, tools, equipment repair and replacement, labor, cost of operation of farm machinery, shipping costs, custom work, and land rental.

   NOTE: To determine the gross cash income received from farming, refer to the procedures outlined in Section 1025.015.01 of the December 1973 Eligibility Requirements manual.

0610.020.00 SUPPORTED EMPLOYMENT INCOME DISREGARD

Individuals participating in the Division of Vocational Rehabilitation's (DVR) Supported Employment Program are allowed a disregard of a portion of earnings from Supported Employment (SJ). Notification of the individual's participation in Supported Employment may come from the individual, a Supported Employment Service Provider, or DVR.

The amount of Supported Employment income disregarded in the SNC grant determination is the same as the earned income disregard for MO HealthNet for the Aged, Blind, and Disabled. From the gross Supported Employment earnings exclude the first sixty-five ($65) and one-half (1/2) of the remainder. This income exclusion applies only to wages earned through Supported Employment. FAMIS automatically applies the disregard for Supported Employment (SJ) income.

NOTE: Continue to disregard income received from employment in a sheltered workshop and income received from employment as a patient worker at sub-minimum wages in an institution.

0610.025.00 DETERMINATION OF FINANCIAL NEED AMOUNT

Determine the SNC participant's countable income by subtracting any excluded income, overhead expenses, and the Supported Employment Income Disregard (if applicable) from their gross income.

Determine financial need by subtracting the countable income from the amount of the basic nursing facility or residential charge and round to the nearest dollar. The participant or the facility must provide the MONTHLY BASE RATE.

The basic nursing facility charge means the nursing facility's base rate for patient care, excluding any additional charges for personal expenses, clothing, etc.

The basic Residential Care Facility (RCF) or Assisted Living Facility (ALF) charge means the RCF's or ALF's base rate for room, food and laundry service (not personal laundry).

For DMH alternate care placements, a copy of the DMH contract showing the basic Residential Care Facility (RCF), Assisted Living Facility (ALF), or nursing facility charge must be obtained before the application can be approved. If DMH refuses to provide this copy, reject the application.

NOTE: Basic nursing facility rates may vary between facilities and within facilities. Use the specific monthly contracted rate that the participant and the facility, and/or Department of Mental Health have agreed upon.

If necessary, compute the base rate from a contracted daily charge by multiplying the daily charge by 365 days and then dividing by 12 months to arrive at the contracted rate.

When the AB eligibility criteria are used, there are two options for determining the need and grant.

OPTION 1: Determine the need and grant by subtracting the participant's countable income (follow the income exclusions and deductions given in sections 0610.005.00 through 0610.020.00) from the basic nursing or residential care facility charge and round the deficit up to the appropriate maximum.

OR

OPTION 2: Determine the need by completing an SAB need determination on the Income Maintenance Budget (IM-30) following the policy in Section 0410.000.00. If there is need, determine the grant by taking the current Blind maximum and subtracting the SSI amount the individual receives.

Use the option which greater benefits the participant.