Adult Medicaid Manual MA-2260 FINANCIAL ELIGIBILITY REGULATIONS-PLA

IV. INCOME COMPUTATIONS (BASED ON COMPLETION OF DMA'S BUDGET SHEETS)

A. Background

The following section gives instructions for completion of the Budget Sheets. These forms were developed to assist in determining income eligibility and the appropriate aid/program/category. These forms must be used to calculate income for M-AABD/M-QB/M-WD cases.

NOTE: Ineligible Child: In the deeming process (both spouse to spouse and parent to child), there is a provision for deducting a portion of the deemor's income for the needs of "ineligible children." The definition of an ineligible child is: an unmarried child of the parent from whom income is deemed. The child must live in the household and must not receive SSI or AAF and must not be applying for or receiving M-AABD or M-QB. Allow the Living Needs Allowance (see VII.B.) for each ineligible child in the home under age 18 (or, 21 if a student and regularly attends school or college or training designed to prepare him/her for a paying job).

1. MAABD and MQB-Q (SSI) Budgeting Methodology

a. For "Medicaid Individuals," complete Section A of the DMA-5008aAdult Budget Sheet. Section A determines whether:

(1) The individual is eligible for N coverage, or

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(IV.A.1.a.)

(2) If there is a deductible for M coverage, and/or

(3) If the individual is eligible for M-QB/M-WD.

b. For "Medicaid Couples," complete Section C of the DMA-5008aAdult Budget Sheet.

c. For "Medicaid Individuals with Ineligible Spouses," complete Sections A, B, and C of the Adult Budget Sheet.

d. For "Medicaid Child" living with parent(s), complete Sections A, B and C of the DMA-5008eABD Medicaid Parent to Child Budget Sheet.

2. MQB Family Size Budgeting Methodology

If ineligible for MAABD/MQB-Q using SSI methodology (see 1. above), complete Section D of the Adult Budget Sheet to; determine eligibility for MQB–Q, MQB-B or MQB-E.

B. Medicaid Individual: Complete Section A of the DMA-5008a Adult Budget Sheet

1. Total the individual's gross unearned income from all sources. Enter total GROSS unearned income on Line 1.

2. On Line 2 subtract the $20 General Exclusion unless the income is VA Pension.

3. Enter the Net Unearned income on Line 3 (Line 1 minus Line 2). Go Line 11 if no earned income.

4. Earned Income - Enter total gross earned income of the individual on Line 4. (For certain incomes this is the amount after operational expenses.)

5. On Line 5 subtract remainder of the $20 General Exclusion if any not used by unearned income. If there is only earned income, subtract the $20 from earned income.

6. Line 6 is the subtotal of earned income (Line 4 minus Line 5).

7. On Line 7 subtract the $65 work expense exclusion from earned income.

8. Enter the difference by subtotaling Line 8 (Line 6 minus Line 7).

9. On Line 9 subtract 1/2 of Line 8.

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(IV.B.)

10. The result on Line 10 is the Net Earned Income (Line 8 minus Line 9).

11. The amount on Line 11 is the Total Net (countable) Income (Line 3 plus Line 10).

12. On Line 12 enter the income maintenance amount for aid program/category or categories in which eligibility is being evaluated (CN/MN/M-QB/M-WD).

13. Determination of Eligibility for Appropriate Coverage Group

a. Categorically Needy:

(1) If the a/r's income on Line 11 is equal to or less than the N income level for an individual, the a/r is financially eligible for N coverage.

(2) If the a/r's income on Line 11 is greater than the N income level for an individual, evaluate for M coverage.

b. Medically Needy: Enter the M amount on Line 12 and subtract Line 12 from Line 11. Use the amount of excess income on Line 13 to compute the deductible for the certification period.

c. M-QB (Q, B or E): If the M-QB (Q, B or E) amount was entered on Line 12 and there is no excess income on Line 13, the a/r is income eligible for M-QB provided he has Medicare.

C. Medicaid Couple (Both Applying)

Complete Section C, of the DMA-5008a Adult Budget Sheet to determine whether the couple is financially eligible for N or if there is a M deductible, or if they are eligible for M-QB (Q, B or E).

1. Total the couple's gross unearned income from all sources. Enter total GROSS unearned income on Line 1.a.

2. On Line 2 subtract the $20 General Exclusion unless all of the income is from a VA pension.

3. Enter the net unearned income on Line 3 (Line 1 minus Line 2). Go to line 11 if no earned income.

4. Earned Income - Enter total gross earned income of the couple on Line 4.a. (For certain incomes this is the amount after operational expenses.)

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(IV.C.)

5. On Line 5 subtract remainder of the $20 General Exclusion if any used by unearned income. If there is only earned income, subtract the $20 from earned income.

6. Line 6 is the subtotal of earned income (Line 4 minus Line 5).

7. On Line 7 subtract the $65 work expense exclusion from earned income.

8. Enter the difference by subtotaling Line 8 (Line 6 minus Line 7).

9. On Line 9 subtract 1/2 of Line 8.

10. The result on Line 10 is the Net Earned Income (Line 8 minus Line 9).

11. The amount on Line 11 is the Total Net (countable) Income (Line 3 plus Line 10).

12. On Line 12 subtract the couple income maintenance amount for the aid program/category in which eligibility is being evaluated (CN/MN/M-QB/M-WD).

13. Determination of Eligibility for Appropriate Coverage Group

a. Categorically Needy:

(1) If the couple's income on Line 11 is equal to or less than N income level for a couple, the couple is financially eligible for N coverage.

(2) If the couple's income on Line 11 is greater than the N level for a couple, the case must be evaluated for M coverage. Coverage under N classification can never have deductibles.

b. Medically Needy: Enter the M couple amount on Line 12 subtract this amount from Line 11. Use the amount of excess income on Line 13 to compute the deductible for the certification period.

c. M-QB (Q, B or E)/M-WD: If the couple M-QB (Q, B or E)/M-WD amount was entered on Line 12 and there is no excess income on Line 13, the couple is eligible for M-QB/M-WD provided they have Medicare.

NOTE: If only one spouse has Medicare you still use the M-QB/M-WD amount at this step.

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(IV.)

D. "Medicaid Individual With Ineligible Spouse" (Spouse to Spouse Deeming)

1. Complete Section A of the DMA-5008a Adult Budget Sheet. Follow for budgeting for individual (See IV.B., above). This section of the calculation is based on the individual's income only.

a. Categorically Needy for M-AABD

(1) If the a/r's income on line 11 is equal to or less than the N income level, go to Section B (IV.D.2., below).

(2) If the a/r's income on Line 11 is greater than the N income level for an individual, the individual is ineligible for N coverage. Evaluate for M coverage. This individual cannot be N even if his ineligible spouse's income combined with his is under the N income level in Section C.

b. Medically Needy for M-AABD

Go to Section B (IV.D.2., below).

c. M-QB (Q, B, or E) or M-WD:

(1) If the a/r has Medicare and the income on Line 11 of Section A is greater than the M-QB income limit, stop. The a/r is ineligible for M-QB using SSI budgeting methodology.

(2) If the a/r has Medicare and the income on line 11 of Section A is less than or equal to the M-QB (Q, B, or E) or M-WD income limit for an individual, go to Section B to determine spousal deeming.

2. Complete Section B of the DMA-5008a Adult Budget Sheet to compute ineligible spouse's income.

a. On Line 1 of Section B enter the ineligible spouse's gross unearned income. If it is VA pension, do NOT deem. See MA-2250, VA based on need.

b. On Line 2 of Section B, subtract the Living Allowance (Refer to Income Table VII. B.) for each ineligible child. If the ineligible child(ren) has any income, subtract his gross income from the Living Allowance and subtract the resulting amount on Line 2.

c. On Line 3 enter the ineligible spouse's unearned income (Line 1 minus Line 2).

d. Earned Income - Enter the ineligible spouse's gross earned income on Line 4 of Section B.

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(IV.D.2.)

e. On Line 5 of Section B, subtract any portion of the Allowance allocation that remains after subtracting it from unearned income.

f. On Line 6 enter the amount of the ineligible spouse's earned income (Line 4 minus Line 5).

g. Enter total net countable income on Line 7 (Line 3 plus Line 6) and determine if income is to be deemed from the spouse. Refer back to Section IV.C. 13., to determine the a/r's classification.

(1) Categorically Needy (N)

§ If the a/r's income on Line 11 of Section A is less than or equal to the N income limit for an individual, determine spousal deeming based on the criteria below.

(a) If the amount on Line 7 of Section B is less than or equal to the current Living Allowance for an ineligible spouse, (Refer to Income Table V. B.), do not deem income from the ineligible spouse. Do not use Section C.

Determine eligibility for the a/r based on the N income limit for an individual established in Section A.

(b) If the amount of Line 7 of Section B is greater than the Living Allowance for an ineligible spouse, deem income from the ineligible spouse. Go to Section C.

(2) Medically Needy (M)

§ If the a/r's income on Line 11 of Section A is greater than the N limit for an individual, he may be eligible as M. Determine spousal deeming based on the criteria below.

(a) If the amount on Line 7 of Section B is less than or equal to 1/2 the M income level for an individual, do not deem income from the ineligible spouse. Do not use Section C.

Compute the a/r's deductible in Section A, using the M income limit for an individual.

NOTE: Though income is not deemed from the ineligible spouse, he is financially responsible for the a/r. Therefore, his medical expenses may be applied the a/r's deductible. (Refer to MA-2360 III. E.)

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(IV.D.2.g.(2))

(b) If the amount on Line 7 of Section B is greater than 1/2 the M income level for an individual, deem income from the ineligible spouse. Go to Section C.

(3) M-QB (Q, B, or E) M-WD Coverage

§ If the a/r's income on Line 11 of Section A is less than or equal to the Q, B, or M-WD income limit for an individual, determine spousal deeming based on the criteria below.

(a) If the amount on Line 7 of Section B is less than or equal to the Living Allowance for an ineligible spouse, (Refer to Income Table V. B.), do not deem the ineligible spouse's income to the a/r. Do not use Section C.

Determine eligibility for the a/r based on the Q, B, or M-WD income limit for an individual, established in Section A.

(b) If the amount on Line 7 of Section B is greater than the Living Allowance for an ineligible spouse, deem income from ineligible spouse. Go to Section C.

3. When income is deemed from the ineligible spouse, complete Section C of the DMA-5008a Adult Budget Sheet to calculate the countable income.

Do not use Section C if income is not deemed from the spouse.

a. Unearned Income - On Line 1.b. of Section C enter the total gross unearned income of the a/r (amount on Line 1 of Section A) enter the ineligible spouse's deemed unearned income (amount on Line 3 of Section B).

b. On Line 2 subtract the $20 General Exclusion unless the only income is VA pension. See MA-2250.

c. Line 3 is the net unearned income (Line 1 minus Line 2). Skip line 11 if no earned income.

d. Earned Income - Enter on Line 4.b. the gross earned income of the a/r plus the earned income deemed from the ineligible spouse. (Amount on Line 4 of Section A plus amount on Line 6 of Section B.)

e. On Line 5 subtract remainder of the $20 General Exclusion if any not used by unearned income.

f. Line 6 (Line 4 minus Line 5) is the subtotal of earned income.

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(IV.D.3.)

g. On Line 7 subtract the $65 work expense exclusion from the earned income.

h. Enter the difference by subtotaling (Line 6 minus Line 7).

i. On Line 9 subtract 1/2 of line 8.

j. Line 10 is the total net earned income (Line 8 minus Line 9).

k. Total income - Line 11 is the total net income (Line 3 plus Line 10).

l. On Line 12 enter the income maintenance amount for a couple the aid program/category in which eligibility is being evaluated (CN/MN/M-QB/M-WD).

m. Determination of Eligibility for the Appropriate Coverage Group.

(1) Categorically Needy: Only evaluate for categorically needy (N) if the a/r's income on Line 11 of Section A is equal to or less than the N income level for one.

(a) If the income on Line 11 is equal to or less than the N income level for a couple, the a/r is financially eligible for N coverage.

(b) If the income on Line 11 is greater than the N income level for a couple, the case must be evaluated under the medically needy income level. Coverage under N classification can never have deductibles.

(2) Medically Needy: Enter the M amount on Line 12 and subtract this amount from Line 11. Use the amount of excess income on Line 13 to compute the deductible for the certification period.

(3) M-QB (Q, B or E) M-WD: If the M-QB (Q, B or E) couple amount was entered on Line 12 and there is no excess income on Line 13, the a/r is income eligible for M-QB/M-WD provided he has Medicare.

§ NOTE: Remember that according to IV.D.1.c. (1) above, if the a/r's income is greater than the M-QB income limit for 1 person, he is ineligible for M-QB.

E. Parent to Child Deeming - Based on completion of the DMA-5008e Parent To Child Deeming Budget Sheet.

Complete parent to child budgeting when a "Medicaid Child" residing PLA with his parent(s) applies for/receives ABD Medicaid.

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(IV.E.)

1. Section A: Complete Section A of the ABD Medicaid Parent To Child Deeming Budget Sheet. This section computes the parent(s)'s net unearned income.

a. Unearned Income- On Line 1 enter the parent(s)' Gross Unearned Income.

b. On Line 2 subtract the Living Allowance, for each ineligible child,(Refer to Income Table VII. B.). If the ineligible child(ren) has any income subtract the ineligible child's gross income from the Living Allowance amount prior to subtracting the Living Allowance on Line 2. Use the remainder on line 2.

c. On Line 3 enter parent(s) unearned income (Line 1 minus Line 2).

d. Earned Income - Enter the ineligible parent(s) gross earned income on Line 4 of Section A.

e. On Line 5 of Section A, subtract any portion of the Living Allowance allocation that remains after subtracting it from the unearned income.

f. Line 6 is the amount of parent(s)'s earned income to include in Section B. (Line 4 minus Line 5).

g. Total the net countable income on Line 7 (Line 3 plus Line 6).

(1) If there is zero net countable income on Line 7 of Section A, go to Section C. There is no excess income to deem from the parent(s) to the Medicaid Child.

(2) If there is excess on Line 7 of Section A, complete B of ABD Medicaid Parent to Child Deeming Budget Sheet. Use the unearned and earned income remaining on Lines 3 and 6 of Section A to complete Section B.

2. Complete Section B of the DMA-5008e Parent to Child Budget Sheet. This step computes the amount of the parents' income to deem in Section C.

a. On Line 1 of Section B enter the parent's unearned income (amount from Line 3 of Section A). If it is VA pension, do NOT deem. MA-2250, VA based on need.

b. On Line 2 of Section B, subtract the $20 General Exclusion.

c. Line 3 is the Net Unearned income (Line 1 minus Line 2). Go Line 11 if no earned income.

d. Earned Income - Enter the parent's earned income on Line 4 of Section B (amount from Line 6 of Section A). For certain incomes this is the amount after operational expenses.

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(IV.E.2.)

e. On Line 5 of Section B, subtract remainder of the $20 General Exclusion if any not used by unearned income. If there is only earned income, subtract the $20 from earned income.

f. Line 6 is the subtotal of the parent's earned income (Line 4 minus Line 5).

g. On Line 7 subtract the $65 work expense exclusion from income.

h. Enter the subtotal on Line 8 (Line 6 minus Line 7).

i. Subtract 1/2 of Line 8 on Line 9.

j. Line 10 is the parent(s)' Net Earned Income (Line 8 minus Line 9).

k. Add the Unearned Income from Line 3 to the earned income on Line 10 to get the total net income on Line 11.

l. On Line 12 subtract the individual SSI amount if there is one parent or the couple SSI amount if there are 2 parents in the home.

m. Line 13 is the total parent (s)' income to be deemed to the Medicaid Child. Enter the amount on Line 13.

3. Complete Section C of the Medicaid Parent To Child Deeming Budget Sheet. Include all countable income of the Medicaid child a/r.

a. Unearned Income - On Line 1 of Section C, enter the gross unearned income of the Medicaid child.

b. On Line 2 enter the income deemed from the parent(s) (from Line 13 of Section B).

c. On Line 3 enter the total of Line 1 and Line 2.

d. On Line 4 subtract the $20 General Exclusion.

e. Line 5 is the net unearned income (Line 3 minus Line 4). Go Line 11 if no earned income.

f. Earned Income - Enter on Line 6 the Gross Earned Income of the Medicaid child.

g. On Line 7 subtract remainder of the $20 General Exclusion if any.

h. Subtotal on Line 8 (Line 6 minus Line 7).

i. On Line 9 subtract the $65 work expense exclusion from income.

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(IV.E.3.)

j. Subtotal on Line 10 (Line 8 minus Line 7).

k. On Line 11 subtract 1/2 of line 10.

l. Line 12 is the net earned income (Line 10 minus Line 11).

m. Total income - Line 13 is the total net income (Line 5 plus 12).

n. On Line 14 enter the income maintenance amount for aid program/category in which eligibility is being evaluated (CN/MN/M-QB).

o. Determination of Eligibility for the Appropriate Coverage Group

(1) Categorically Needy:

(a) If the a/r's income on Line 13 is equal to or less than the N income level for an individual, the a/r is financially eligible for N coverage.

(b) If the a/r's income on Line ll is greater than the N income level for an individual, the case must be evaluated under the medically needy income level. Coverage under N classification can never have deductibles.

(2) Medically Needy: Enter the M income amount on Line 14 and subtract this amount from Line 13. Use the amount of excess income on Line 15 to compute the deductible for the certification period.

(3) M-QB (Q, B or E): If the M-QB (Q, B or E) amount was entered on Line 14 and there is no excess income on Line 15, the a/r is eligible for M-QB provided he has Medicare.