55 Pa. Code § 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 ACategorically Needy Nonmoney PaymentMonthly Income Limits for the Aged,Blind and Disabled CategoriesEffective 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 BCategorically Needy Nonmoney PaymentMonthly Income Limits for the Aged,Blind and Disabled Categories ReceivingSkilled Care, Heavy Care/IntermediateServices or Intermediate CareEffective 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 CCATEGORICALLY NEEDY NONMONEY PAYMENT MONTHLYINCOME LIMITS FOR THE AID TO FAMILIES WITHDEPENDENT CHILDREN RELATED CATEGORIES AND THE GENERALASSISTANCE RELATED CATEGORIESEFFECTIVE JANUARY 1, 1990

NUMBER OF PERSONS IN APPLICANT/RECIPIENT GROUP

							eachadditional
Schedule	1	2	3	4	5	6	person

1	$215	$330	$421	$514	$607	$687	$83
Bucks	Chester		Lancaster		Montgomery		Pike

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 DMonthly Federal Benefit RateEffective January 1, 2013

1 Person	$710.00
2 Persons	$1,066.00

Percentages of Monthly FederalBenefit RateEffective 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 EONE-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 CATEGORIESEFFECTIVE JANUARY 1, 1990

MONTHLY AMOUNT	ONE-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 FSIX-MONTH PERIODMEDICALLY 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

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 GMONTHLYMEDICALLY 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

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 HONE-THIRD OF THE MONTHLYMEDICALLY 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

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 ISTANDARD 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 JNMP-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

Bucks	Chester	Lancaster		Montgomery		Pike

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 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 $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

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).