37.2.705    ABILITY TO PAY DETERMINATION

(1) Upon receipt of sufficient financial information and documentation, the department may determine the fixed expenses of the resident or financially responsible person. The following shall apply to food, clothing and transportation expenses:

(a) allowances for food and clothing needs shall be based on data reported periodically by the USDA center for nutrition policy and promotion. A copy of the allowances for food and clothing are available upon request from the Department of Public Health and Human Services, Fiscal Services Division, 111 N. Sanders, P.O. Box 6429, Helena, MT 59604-6429; and

(b) transportation expenses shall be allowed for the actual cost of operating one vehicle per family, unless a second vehicle is essential to the production of income. If no vehicle is owned, the actual cost of public transportation shall be allowed.

(2) Ability to pay shall be determined by dividing the resident or financially responsible person’s discretionary income as defined in ARM 37.2.701 by the number of persons dependent upon that income, including the resident or financially responsible person. The quotient shall be the resident's share of discretionary income or the ability to pay.

(3) The ability to pay shall be reduced by the monthly personal needs as defined in ARM 37.2.701 for the resident as determined by the department. If the department learns that the personal needs allowance is not being used for the resident’s benefit, the department may discontinue the allowance.

(4) Liquid assets which exceed eligibility standards for medicaid shall be considered available to pay the cost of care unless protected as follows:

(a) as protected by law;

(b) an order of the court; or

(c) the medicaid spousal impoverishment program.

(5) The department shall determine ability to pay based on the real property of a resident or the resident's spouse as follows:

(a) if the real property has been listed or advertised for sale, or is not occupied as the home of the resident, the resident's spouse, or a dependent child or parent of the resident or the resident's spouse, it shall be considered as provided in 53-1-405 , MCA; or

(b) upon the sale of real property, the proceeds shall be considered available to pay the cost of care and shall be added to the ability to pay unless the property sale proceeds will be used to purchase a home within 18 months or are used for primary residence living expenses.

(6) The department shall review each determination of ability to pay as follows:

(a) annually, as provided in 53-1-408 , MCA; or

(b) upon the request of a resident or financially responsible person providing documentation of a changed circumstance that would substantially affect the previous determination;

(c) the determination shall be effective upon completion of the review, unless the department finds one of the conditions in 53-1-408 , MCA applies. Refunds of any overpayment resulting from an assessment retroactively reduced because of a new determination of ability to pay shall be made according to 53-1-405 , MCA.

History: Sec. 53-1-403 and 53-1-405, MCA; IMP, Sec. 53-1-405, MCA; NEW, 1983 MAR p. 302, Eff. 4/15/83; AMD, 1984 MAR p. 1367, Eff. 9/14/84; TRANS & AMD, from DOC, 1999 MAR p. 1300, Eff. 6/18/99; AMD, 2003 MAR p. 2440, Eff. 10/31/03.