Adult Medicaid Manual MA-2260 FINANCIAL ELIGIBILITY REGULATIONS-PLA

III. MAABD and MQB SSI Budgeting methodology and definitions

The phrase “SSI Budgeting Methodology” means the budgeting methodology that has been employed since January of 1995. Due to the court case which mandated the use Family Size Budgeting in MQB eligibility determinations, it is necessary to distinguish the two forms of budgeting now in use.

Under SSI Budgeting Methodology there are two different methods to calculate income. One way is to lump all of the income of the individual or couple. The second way is to look at the individual and indirectly count or deem income from the ineligible spouse or parent(s). The method employed depends upon whether the a/r is classified as a “Medicaid Individual,” a “Medicaid Couple,” a “Medicaid Individual with and Ineligible Spouse,” or a “Medicaid Child.”

A. Definitions

To determine the appropriate budgeting method, identify the M-AABD/M-QB a/r as one of the following:

1. Medicaid Individual: A "Medicaid Individual" is an a/r who is:

a. Unmarried and age 18 or older; or

b. Married and living with a spouse who receives AAF, SSI, CAP/DA, or CAP/MR/DD; or

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(III.A.1.)

c. Unmarried and under age 18 and living with a parent(s) who receives SSI, AAF, or CAP.

NOTE: If the child lives with both parents and only one of the parents/stepparents receives AAF or SSI, the child is a Medicaid individual.

d. Unmarried and under age 18 and living outside of his/her parent(s)'s home; or

e. Receiving CAP/CC, CAP/DA, or CAP/MR/DD.

2. Medicaid Couple: A "Medicaid Couple" consists of a/rs who are married and living together, and

(1) Who are M-AABD/M-QB Medicaid a/rs and

(2) Neither of whom receives CAP/DA or CAP/MR/DD or SSI.

3. Medicaid Individual with an Ineligible Spouse

a. A "Medicaid Individual with an Ineligible Spouse" is an a/r who is married to and living with a spouse who is not an M-AABD/MQB Medicaid recipient and does not receive SSI, AAF or CAP.

b. "Ineligible" means the spouse is not applying for or receiving M-AABD or M-QB.

4. Medicaid Child

A "Medicaid Child" is an a/r under the age of 18 who lives with his parent(s) who does (do) not receive SSI, AAF or CAP. He remains a Medicaid Child through the month that he moves out of his parents’ home.

B. Methodology

1. If the a/r is a Medicaid Individual

Count the income of the a/r only to determine eligibility.

2. If the a/r is a Medicaid Couple

a. Count the total combined income of both spouses.

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(IV.B.2.)

b. If one a/r of the original couple is denied:

(1) Prior to the disposition of the other spouse's application, the remaining a/r becomes a Medicaid individual with an ineligible spouse for the entire certification period.

(2) After the other spouse is approved, the remaining spouse is budgeted as part of a Medicaid couple through the month of denial.

3. If the a/r is a Medicaid Individual with an Ineligible Spouse

Deem income of the ineligible spouse to the a/r (see IV.D. for deeming instructions.).

4. If the a/r is a Medicaid Child

Deem income from the parent(s) to the child (see IV.E for deeming instructions).