1. (a) The department considers an individual or couple to be living in a vendor living arrangement beginning with the first day that:

   1. (1) the individual (or couple) lives in a Medicare SNF or Title XIX approved NF or ICF-MR facility; and
   2. (2) the individual (or couple) has been confined to one or more Title XIX approved, long-term care facilities (Medicare-SNF, NF, or ICF-MR) for at least 30 consecutive days.
2. (b) If a client dies before he has lived for 30 consecutive days in a Title XIX long-term care facility, or is discharged directly to any 1915(c) home and community-based waiver program, he is considered to have met the 30-consecutive-day requirement. Three-day therapeutic home visits or admissions to hospitals are not considered discharges from the institutional setting.
3. (c) If an individual (or couple) dies before 30 consecutive days of institutionalization have passed but is not discharged to a noninstitutional setting other than a 1915(c) home and community-based waiver program before his death, the department considers the individual (or couple) to be in a vendor living arrangement. The department uses the special income limit to establish the eligibility of individuals and couples living in vendor living arrangements who have countable income that exceeds the reduced SSI payment standard. Using the special income limits, the department determines the individual's or couple's eligibility for medical assistance only until the individual or couple is discharged to home or a non-Title XIX facility. Three-day therapeutic home visits or admissions to hospitals are not considered discharges for this purpose.

4. (d) The department uses the special income limit for the client and considers only the client's income in determining eligibility. An individual budget is prepared if:

   1. (1) the client has no spouse (that is, he is widowed, divorced, or never married);
   2. (2) his spouse is receiving assistance under another type program;
   3. (3) his ineligible spouse becomes eligible for assistance in a month after the month of separation; or
   4. (4) an eligible couple has separated. In the month after separation, the department considers the couple as individuals.
5. (e) Using the special income limit for an individual, the department considers only the client's income in determining eligibility. The ineligible spouse's income is considered in determining the amount of applied income.
6. (f) Clients whose VA benefits are capped at $90 per month retain the full $90 as a personal needs allowance.

Source Note:The provisions of this §358.501 adopted to be effective April 17, 1989, 14 TexReg 1083; amended to be effective October 1, 1990, 15 TexReg 5952; amended to be effective October 1, 1990, 15 TexReg 6018; amended to be effective November 5, 1990, 16 TexReg 3355; amended to be effective September 30, 1989, 16 TexReg 5510; amended to be effective September 1, 1994, 19 TexReg 6574; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013.