Maine Medicaid aged, blind and disabled budgeting: ineligible spouse standard, disregard order, blind-only standard and parent deeming #10474

Maine budgets its SSI-related Medicaid groups (the 100% of poverty aged and disabled group) in ways the optional aged, blind and disabled pathway does not follow. #10386 fixes Maine's savings exclusion and couple disregard but leaves these four rules alone, so Maine's aged, blind and disabled coverage stays Partial until they are encoded.

Sources: 10-144 C.M.R. ch. 332, the MaineCare Eligibility Manual (official text, filing 2025-101, effective April 29, 2025; charts). Cornell LII copies: Part 7, § 7-2, § 7-3, § 7-4, Chart 3.

(a) Ineligible spouse standard

Part 7, Section 4.3 (categorically needy budget for "A couple or an eligible individual with an ineligible spouse") says "See Section 2.2.2 of this Part on Deeming of Income for special income exclusions allowed from the income of an ineligible spouse." Section 2.2.2.I.D:

When deeming from an ineligible spouse to an eligible spouse, exclude an amount equal to the "ineligible spouse standard" in Chart 3.5. This exclusion is taken first from unearned income and any remainder is taken from earned income.

Chart 3.5: "Ineligible spouse in the deeming process Maximum Federal Supplemental Security Income (SSI) payment amounts for an eligible individual, divided by 2" ($994 / 2 = $497 a month in 2026).

Maine then combines the result with the applicant's income, subtracts $20 and the $80 "State Disregard for two", and compares the total with 100% of the poverty guideline for two. It does this whether or not the spouse's income passes SSI's deeming threshold.

The model follows SSI deeming (medicaid_optional_senior_or_disabled_income_deemed_from_ineligible_spouse). It deems only when the spouse's income exceeds the SSI couple-minus-individual differential, and then deems all of it. Example, 2026: applicant Social Security $1,000 a month, ineligible spouse pension $600 a month. Maine: (1,000 + (600 - 497) - 20 - 80) x 12 = $12,036 a year. Model: (1,600 - 100) x 12 = $18,000. In 2026 the Chart 3.5 standard happens to equal the SSI differential ($497), but Maine subtracts it instead of deeming everything above it.

(b) Order of the disregards

Part 7, Section 2.1 lists the disregards "in this order": the $20 federal disregard (2.1.1), impairment-related work expenses (2.1.2), "$65.00 is deducted from earned income. One half of the remaining earnings is also disregarded" (2.1.3), then the state disregard, "an added deduction of $55.00 for an individual and $80.00 for a couple" (2.1.4). Section 3.3 step XI and Section 4.3 step X subtract the state amount last.

The model subtracts the combined $75 / $100 as the SSI general exclusion, before the earned income exclusion (_apply_medicaid_optional_senior_or_disabled_exclusions default branch). For an applicant whose unearned income covers the disregard, the results match. For an earner, countable income comes out too high: (E - 20 - 65) / 2 - 55 in Maine versus (E - 75 - 65) / 2 in the model, a difference of up to $27.50 a month for an individual and $40 for a couple.

After #10364 merges, this can be encoded as Maine's senior_or_disabled.income.disregard = $20 plus senior_or_disabled.income.additional_disregard = $55 (individual) / $80 (couple), which that PR subtracts after the SSI exclusions.

(c) Applicants eligible only through blindness

Section 3.3 Note: "The State Supplement budgeting criteria must be used for an individual whose eligibility is based solely on blindness. However, if the individual also meets the SSI criteria for disability use the budgeting criteria in this section." Section 4.3 has the same note for a couple.

The State Supplement budget (Section 3.1) ends: "If countable income is below the appropriate State Supplement Income Standard for one, based on living arrangement, the individual meets the income criteria". Chart 3.4 sets the maximum countable income at the SSI rate plus $10 for an individual living alone or with others ($8 in the household of another), and the couple rate plus $15 ($12). So a blind-only applicant is tested strictly below that standard, not at or below 100% of the poverty guideline.

The model tests every aged, blind or disabled Mainer against 100% of the guideline. Keep the savings exclusion for blind-only applicants: 22 M.R.S. § 3174-AA covers "all individuals and families subject to an asset test".

(d) The state disregard in parent deeming

Section 3.4 (budget for a child) takes only the $20 federal disregard from the parents' income (I.C-D), then the $65 and one half, then the parental living allowance. It subtracts the "State Disregard for one" once, from the child's own countable income (II.I).

medicaid_optional_senior_or_disabled_unearned_income_deemed_from_ineligible_parent passes the state's individual disregard ($75 for Maine) as the general exclusion on the parents' income, so the state amount is taken from the parents' income as well as from the child's.

(e) Maine's savings exclusion in the medically needy asset test

22 M.R.S. § 3174-AA requires the savings exemption "in determining eligibility for medical assistance under the Medicaid program for all individuals and families subject to an asset test", and 10-144 C.M.R. ch. 332, Part 16, § 16-4, Section 4.47 applies it to the SSI-related categories. #10386 applies it only in is_optional_senior_or_disabled_asset_eligible. is_medically_needy_for_medicaid tests assets without it, so a Mainer aged 70 with $1,600 a month of Social Security, $20,000 of medical expenses and $9,000 in the bank passes the pathway asset test but fails the medically needy one. Two other differences in that test: it sums assets over the tax unit rather than the individual or couple, and it uses <= where Part 7 § 7-1 says assets "must be under" the limits.

(f) The couple disregard for an applicant with an ineligible spouse, without deeming

Section 4.3 budgets "A couple or an eligible individual with an ineligible spouse" with the $80 "State Disregard for two". medicaid_optional_senior_or_disabled_countable_income chooses the disregard by ssi_couple_computation_applies, so an aged Mainer whose spouse is not aged, blind or disabled gets the $75 individual amount when SSI deeming does not apply: $1,100 a month of Social Security gives (1,100 - 75) x 12 = $12,300 a year, not (1,100 - 20 - 80) x 12 = $12,000.

Done when

• Maine's spouse deeming applies the Chart 3.5 standard and the $80 couple disregard as in Section 4.3.
• Maine's state disregard is subtracted after the earned income exclusion.
• Blind-only applicants in Maine are tested strictly below the Chart 3.4 standard.
• Maine's parent deeming subtracts only the $20 federal disregard from parental income.
• Maine's medically needy asset test applies the savings exclusion to the individual's or couple's assets, strictly under the limit.
• An eligible Mainer with an ineligible spouse gets the $80 couple disregard whether or not anything is deemed.
• YAML cases for each rule in the variable-named test files, with expected values from the manual.

Related: #10386, #10364.