Authority: IC 12-13-7-3; IC 12-15

Affected: IC 12-15-7-2

Sec. 7. (a) This section applies to individuals who are determined eligible under section 5(g) of this rule who are either residing in an institution or are receiving home and community based waiver services.

(b) Except as provided in 405 IAC 2-3-17, the following procedure shall be used to determine the amount of income to be paid to an institution for an applicant or member who has been determined eligible under section 5(g) of this rule and who is residing in an institution as defined in 405 IAC 2-1-1(4) or receiving home and community based waiver services:

1. (1) Determine the applicant's or member's total income that is not excluded by federal statute, which includes amounts deducted in the eligibility determination under section 5(g)(3) of this rule.

2. (2) Subtract the minimum personal needs allowance equal to either of the following amounts:

   1. (A) Specified in IC 12-15-7-2 for an individual residing in an institution.
   2. (B) The special income level for an individual receiving home and community based waiver services.
3. (3) Subtract an amount for increased personal needs as allowed under Indiana's approved Medicaid state plan. The increased personal needs allowance includes, but is not limited to, court ordered guardianship fees paid to an institutionalized applicant or member's legal guardian, not to exceed thirty-five dollars ($35) per month. Guardianship fees include all services and expenses required to perform the duties of a guardian, as well as any attorney's fees for which the guardian is liable.
4. (4) Subtract the amount of any health insurance premiums.
5. (5) Subtract an amount for expenses incurred for necessary or remedial care recognized by state law but not covered under the state plan, subject to any reasonable limits set forth in Indiana's approved Medicaid state plan.
6. (6) Subtract an amount for federal, state, and local taxes owed and paid by the applicant or member. This deduction is limited to one (1) calendar month per year.

The resulting amount is the amount by which the Medicaid payment to the institution where the individual resides, or to other Medicaid approved providers, when the individual is receiving home and community based waiver services, shall be reduced.

(c) A child under eighteen (18) years of age determined eligible for benefits under section 5(g) of this rule will not have any resources or income from his or her parents deemed to such child under this section.

(Office of the Secretary of Family and Social Services; 405 IAC 2-1.1-7; filed Apr 8, 2014, 12:37 p.m.: 20140507-IR-405130533FRA; readopted filed Nov 13, 2019, 11:54 a.m.: 20191211-IR-405190487RFA; filed Jun 11, 2021, 2:35 p.m.: 20210707-IR-405190602FRA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-405240502RFA)