§ 181.453. Determination of MA payment toward cost of care in institutions.

 (a)  A person who is eligible for MA is eligible for a contribution from the Department toward the cost of his skilled nursing care, heavy care/intermediate services or intermediate care or services in an ICF/MR facility, if the amount of his payment determined under §  181.452 (relating to posteligibility determina tion of income available from an MA eligible person toward his cost of care) is less than the MA payment rate multiplied by the total number of days of care received by the MA eligible person.

 (b)  The contribution from the Department toward the cost of care is the difference between the MA payment rate multiplied by the total number of days of care received by the MA eligible person less the amount of the payment determined under §  181.452.

 (c)  If an MA eligible person is determined under §  181.452 to have income sufficient to reduce the Department’s payment to zero, the MA eligible person is not obligated to pay a greater amount than the Department’s payment rate toward his cost of care.

Authority

   The provisions of this §  181.453 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this §  181.453 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended August 28, 1992, effective upon publication and apply retroactively to October 1, 1989, 22 Pa.B. 4432. Immediately preceding text appears at serial page (168654).

APPENDIX A
Categorically Needy Nonmoney Payment
Monthly Income Limits for the Aged,
Blind and Disabled Categories
Effective January 1, 2013




       1 Person$710.00
       2 Persons$1,066.00

Authority

   The provisions of this Appendix A issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix A adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 12, 1991, effective January 1, 1991, 21 Pa.B. 3184; amended March 20, 1992, effective January 1, 1992, 22 Pa.B. 1307; amended January 14, 1994, effective January 1, 1994, 24 Pa.B. 414; amended March 24, 1995, effective January 1, 1995, 25 Pa.B. 1129; amended April 12, 1996, effective January 1, 1996, 26 Pa.B. 1762; amended April 11, 1997, effective January 1, 1997, 27 Pa.B. 1891; amended May 4, 2001, effective January 1, 2001, 31 Pa.B. 2443; amended April 26, 2002, effective January 1, 2002, 32 Pa.B. 2166; amended April 16, 2004, effective April 17, 2004, 34 Pa.B. 2139; amended February 3, 2006, effective January 1, 2006, 36 Pa.B. 628; amended May 18, 2007, effective May 19, 2007, 37 Pa.B. 2353; amended March 14, 2008, effective January 1, 2008, 38 Pa.B. 1318; amended May 24, 2013, effective January 1, 2013, 43 Pa.B. 2968. Immediately preceding text appears at serial pages (332749) to (332750).

Cross References

   This appendix cited in 55 Pa. Code §  178.91 (relating to deeming of resources); 55 Pa. Code §  178.105 (relating to presumption of disposition of assets to qualify for MA for transfers on or after July 30, 1994); 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.11 (relating to continuing eligibility); 55 Pa. Code §  181.12 (relating to retroactive eligibility); 55 Pa. Code §  181.13 (relating to eligibility under NMP-MA spend-down); 55 Pa. Code §  181.110 (relating to income deemed available from the spouse); and 55 Pa. Code §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care).

APPENDIX B
Categorically Needy Nonmoney Payment
Monthly Income Limits for the Aged,
Blind and Disabled Categories Receiving
Skilled Care, Heavy Care/Intermediate
Services or Intermediate Care
Effective January 1, 2013




       1 Person$2,130.00

Authority

   The provisions of this Appendix B issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix B adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 12, 1991, effective January 1, 1991, 21 Pa.B. 3184; amended March 20, 1992, effective January 1, 1992, 22 Pa.B. 1307; amended January 14, 1994, effective January 1, 1994, 24 Pa.B. 414; amended March 24, 1995, effective January 1, 1995, 25 Pa.B. 1129; amended April 12, 1996, effective January 1, 1996, 26 Pa.B. 1762; amended April 11, 1997, effective January 1, 1997, 27 Pa.B. 1891; amended May 4, 2001, effective January 1, 2001, 31 Pa.B. 2443; amended April 26, 2002, effective January 1, 2002, 32 Pa.B. 2166; amended April 16, 2004, effective April 17, 2004, 34 Pa.B. 2139; amended February 3, 2006, effective January 1, 2006, 36 Pa.B. 628; amended May 18, 2007, effective May 19, 2007, 37 Pa.B. 2353; amended March 14, 2008, effective January 1, 2008, 38 Pa.B. 1318; amended May 24, 2013, effective January 1, 2013, 43 Pa.B. 2968. Immediately preceding text appears at serial page (332750).

Cross References

   This appendix cited in 55 Pa. Code §  178.175 (relating to presumption of disposition of assets to qualify for MA for transfers on or after July 30, 1994); 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.11 (relating to continuing eligibility); and 55 Pa. Code §  181.71 (relating to special NMP-MA income limit for institutionalized aged, blind and disabled persons).

APPENDIX C
CATEGORICALLY NEEDY NONMONEY PAYMENT MONTHLY
INCOME LIMITS FOR THE AID TO FAMILIES WITH
DEPENDENT CHILDREN RELATED CATEGORIES AND THE GENERAL
ASSISTANCE RELATED CATEGORIES
EFFECTIVE JANUARY 1, 1990


 NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP


eachadditional
Schedule1
2
3
4
5
6
person

1
 $215 $330 $421 $514 $607 $687$83
BucksChesterLancasterMontgomeryPike


2
Adams Allegheny Berks Blair Bradford Butler
 $205CentreColumbiaCrawfordCumberlandDauphinDelaware$316 $403ErieLackawannaLebanonLehighLuzerneLycoming$497
 $589MonroeMontourNorthamptonPhiladelphiaSullivanSusquehanna $670$83Union Warren Wayne Westmoreland Wyoming York


3
BeaverCameronCarbonClinton
 $195ElkFranklinIndiana $305 $393LawrenceMcKeanMercer $479 $569MifflinPerryPotter $647 $83SnyderTiogaVenangoWashington


4
ArmstrongBedfordCambria
 $174ClarionClearfieldFayette $279 $365ForestFultonGreene $454 $543HuntingdonJeffersonJuniata $614 $83Northumber-landSchuylkillSomerset


   Note: If a pregnancy is medically verified, the unborn child is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn child is counted.

Authority

   The provisions of this Appendix C issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix C adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 2, 1990, effective February 3, 1990, 20 Pa.B. 554. Immediately preceding text appears at serial page (130659).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.11 (relating to continuing eligibility); 55 Pa. Code §  181.12 (relating to retroactive eligibility); 55 Pa. Code §  181.13 (relating to eligibility under NMP-MA spend-down); and 55 Pa. Code §  181.285 (relating to income deemed available from the LRR).

APPENDIX D
Monthly Federal Benefit Rate
Effective January 1, 2013




       1 Person$710.00
       2 Persons$1,066.00

Percentages of Monthly Federal
Benefit Rate
Effective January 1, 2013


    Item 1) 50% of Federal Benefit Rate for 1 person = $355.00

    Item 2) 50% of Federal Benefit Rate for 2 persons = $533.00

Authority

   The provisions of this Appendix D issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix D adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 12, 1991, effective January 1, 1991, 21 Pa.B. 3184; amended March 20, 1992, effective January 1, 1992, 22 Pa.B. 1307; amended January 14, 1994, effective January 1, 1994, 24 Pa.B. 414; amended March 24, 1995, effective January 1, 1995, 25 Pa.B. 1129; amended April 12, 1996, effective January 1, 1996, 26 Pa.B. 1762; amended April 11, 1997, effective January 1, 1997, 27 Pa.B. 1891; amended May 4, 2001, effective January 1, 2001, 31 Pa.B. 2443; amended April 26, 2002, effective January 1, 2002, 32 Pa.B. 2166; amended April 16, 2004, effective April 17, 2004, 34 Pa.B. 2139; amended February 3, 2006, effective January 1, 2006, 36 Pa.B. 628; amended May 18, 2007, effective May 19, 2007, 37 Pa.B. 2353; amended March 14, 2008, effective January 1, 2008, 38 Pa.B. 1318; amended May 24, 2013, effective January 1, 2013, 43 Pa.B. 2968. Immediately preceding text appears at serial page (332752).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); and 55 Pa. Code §  181.110 (relating to income deemed available from the spouse).

APPENDIX E
ONE-THIRD OF THE CATEGORICALLY NEEDY NONMONEY PAYMENT MONTHLY INCOME LIMITS FOR THE AID TO FAMILIES WITH DEPENDENT CHILDREN RELATED CATEGORIES AND THE GENERAL ASSISTANCE RELATED CATEGORIES
EFFECTIVE JANUARY 1, 1990




MONTHLY AMOUNTONE-THIRD AMOUNT
$ 83.00 =$ 27.66
174.00 = 58.00
195.00 = 65.00
205.00 = 68.33
215.00 = 71.66
279.00 = 93.00
305.00 = 101.66
316.00 = 105.33
330.00 = 110.00
365.00 = 121.66
393.00 = 131.00
403.00 = 134.33
421.00 = 140.33
454.00 = 151.33
479.00 = 159.66
497.00 = 165.66
514.00 = 171.33
543.00 = 181.00
569.00 = 189.66
589.00 = 196.33
607.00 = 202.33
614.00 = 204.66
647.00 = 215.66
670.00 = 223.33
687.00 = 229.00

   Note: If a pregnancy is medically verified, the unborn is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn is counted.

Authority

   The provisions of this Appendix E issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix E adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 2, 1990, effective February 3, 1990, 20 Pa.B. 554. Immediately preceding text appears at serial page (130641).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA).

APPENDIX F
SIX-MONTH PERIOD
MEDICALLY NEEDY INCOME LIMITS
(MNIL)




1 PERSON$2,450
2 PERSONS$2,650
3 PERSONS$2,800
4 PERSONS$3,400
5 PERSONS$4,050
6 PERSONS$4,550
EACH ADDITIONAL PERSON$ 550

   Note: If a pregnancy is medically verified, the unborn is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn is counted.

Authority

   The provisions of this Appendix F issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix F adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 2, 1990, effective February 3, 1990, 20 Pa.B. 554. Immediately preceding text appears at serial page (130642).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.11 (relating to continuing eligibility); 55 Pa. Code §  181.12 (relating to retroactive eligibility); 55 Pa. Code §  181.14 (relating to eligibility under MNO-MA spend-down); and 55 Pa. Code §  181.110 (relating to income deemed available from the spouse).

APPENDIX G
MONTHLY
MEDICALLY NEEDY INCOME LIMITS
(MNIL)




1 PERSON$408
2 PERSONS$442
3 PERSONS$467
4 PERSONS$567
5 PERSONS$675
6 PERSONS$758
EACH ADDITIONAL PERSON$ 92

   Note: If a pregnancy is medically verified, the unborn is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn is counted.

Authority

   The provisions of this Appendix G issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix G adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 2, 1990, effective February 3, 1990, 20 Pa.B. 554. Immediately preceding text appears at serial pages (130642) to (130643).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.12 (relating to retroactive eligibility); 55 Pa.Code §  181.110 (relating to income deemed available from the spouse); and 55 Pa. Code §  181.285 (relating to income deemed available from the LRR).

APPENDIX H
ONE-THIRD OF THE MONTHLY
MEDICALLY NEEDY INCOME LIMITS




1 PERSON$136.00
2 PERSONS$147.00
3 PERSONS$156.00
4 PERSONS$189.00
5 PERSONS$225.00
6 PERSONS$253.00
EACH ADDITIONAL PERSON$ 31.00

   Note: If a pregnancy is medically verified, the unborn is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn is counted.

Authority

   The provisions of this Appendix H issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix H adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 2, 1990, effective February 3, 1990, 20 Pa.B. 554. Immediately preceding text appears at serial page (130643).

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA).

APPENDIX I
STANDARD OF NEED





SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
1
1
$313
2
$481
3
$614
4
$749
5
$885
6
$1001
EachAdditionalPerson$121

Bucks Chester Lancaster Montgomery Pike


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
2
1
$298
2
$461
3
$587
4
$724
5
$859
6
$976
EachAdditionalPerson$121

Adams Allegheny Berks Blair Bradford Butler Centre Columbia Crawford Cumberland Dauphin Delaware Erie Lackawanna Lebanon Lehigh Luzerne Lycoming Monroe Montour Northampton Philadelphia Sullivan Susquehanna Union Warren Wayne Westmoreland Wyoming York


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
3
1
$284
2
$444
3
$573
4
$698
5
$829
6
$943
EachAdditionalPerson$121

Beaver Cameron Carbon Clinton Elk Franklin Indiana Lawrence McKean Mercer Mifflin Perry Potter Snyder Tioga Venango Washington


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
4
1
$253
2
$406
3
$532
4
$662
5
$791
6
$894
EachAdditionalPerson$121

Armstrong Bedford Cambria Clarion Clearfield Fayette Forest Fulton Greene Huntingdon Jefferson Juniata Northumberland Schuylkill Somerset


   Note: If a pregnancy is medically verified, the unborn child is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn child is counted.

Authority

   The provisions of this Appendix I issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix I adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code §  181.311 (relating to deductions from earned income for the AFDC categories of NMP-MA); 55 Pa.Code §  181.313 (relating to deductions from earned income for the GA categories of NMP-MA); and 55 Pa. Code §  181.314 (relating to deductions from earned income for the GA categories of MNO-MA).

APPENDIX J
NMP-MA GROSS INCOME TEST LIMITS




SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
1
1
$579
2
$890
3
$1136
4
$1386
5
$1637
6
$1852
EachAdditionalPerson$224

BucksChesterLancasterMontgomeryPike


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
2
1
$551
2
$853
3
$1086
4
$1339
5
$1589
6
$1809
EachAdditionalPerson$224

Adams Allegheny Berks Blair Bradford ButlerCentre Columbia Crawford Cumberland Dauphin DelawareErie Lackawanna Lebanon Lehigh Luzerne LycomingMonroe Montour Northampton Philadelphia Sullivan Susquehanna Union Warren Wayne Westmoreland Wyoming York


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
3
1
$525
2
$821
3
$1060
4
$1291
5
$1534
6
$1745
EachAdditionalPerson$224

Beaver Cameron Carbon Clinton Elk Franklin Indiana Lawrence McKean Mercer Mifflin Perry Potter Snyder Tioga Venango Washington


SCHEDULE NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP
4
1
$468
2
$751
3
$984
4
$1225
5
$1463
6
$1654
EachAdditionalPerson$224

Armstrong Bedford Cambria Clarion Clearfield Fayette Forest Fulton Greene Huntingdon Jefferson Juniata Northumberland Schuylkill Somerset


   Note: If a pregnancy is medically verified, the unborn child is counted as a member of the applicant/recipient group when establishing the income limits. If multiple births are expected and verified, each unborn child is counted.

Authority

   The provisions of this Appendix J issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

Source

   The provisions of this Appendix J adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

Cross References

   This appendix cited in 55 Pa. Code §  181.1 (relating to general policy on MA income common to all categories of MA).



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