What is a NAMI? (Net Available Monthly Income)

A NAMI is a Medicaid term that is used to denote a value of how much of a resident’s (and/or their spouse’s) income must be contributed to the Nursing Home on a monthly basis.

How is NAMI Calculated?

• A NAMI is calculated differently for a single or widowed individual needing Nursing Home Medicaid than it is for a married couple. A spousal budgeting calculation is used when there is a spouse in the community. Medicaid does not wish to impoverish the community spouse, therefore a spousal allowed amount factored in the calculation when there is a spouse.
• In general, the total gross monthly income is calculated, and then health care and appropriate income allowances are deducted to arrive at the NAMI figure.

What is Considered Income?

• Social Security: Current bank statements typically show NET Social Security. There is usually (but not always) a deduction for Medicare that comes out, which changes yearly.
• Pensions: Pensions often have a tax withholding. This is NOT an allowable deduction. Families should be advised to stop this deduction.
• VA Benefit: There is a difference between Aid and Attendance and a VA pension. Aid and Attendance does drop to $90 (the VA must be notified of the Medicaid approval and then will decrease the benefit – you need the VA letter and provide it to Medicaid to make the change to $90) but needs to be calculated as part of the NAMI until the benefit drops. While receiving the aid and attendance amount AND the $90 allowance should both be part of the calculation.
• Interest: On Financial Accounts
• Dividends: Usually, seen if there is stock or Life Insurance
• Rental: Need to obtain verification of rental amount – either from leases or actual statement from renters. The Net rental income will be added as line item under appropriate person. If it is a married couple than the rent will be divided in two. Please remember when a house is in life estate and is rented the rental income needs to be attributed to resident (and spouse).
• Annuity: Annuities in the name of the resident must have a Medicaid maximized distribution or it is counted as a resource.

The maximized amount is provided directly by the Medicaid Case Examiner from County DSS. It is counted as part of monthly income – even if deduction is quarterly or annually. Beneficiary change may be required as directed by the DSS.

An annuity in the name of the spouse does not need to be maximized but the distribution still counts as monthly income for spouse. Beneficiary change may be required by DSS.

• IRA – For income purposes an IRA has the same parameters as an annuity BUT no beneficiary change needs to take place.
• Employment
• Workman’s Compensation
• Court Ordered Support
• Disability – Short or Long Term
• Long Term Care Policy
• Royalties – Income for use of an asset (property, patent, book sales)