Family and Children's Medicaid MA-3300 Income

III. APPLICANT/RECIPIENT’S RESPONSIBILITIES

A. Application for Benefits

1. The a/r must apply for all countable unearned income (e.g. RSDI, unemployment, retirement benefits, Veteran’s Assistance, etc.) to which he may be entitled before eligibility can be determined. Accept the applicant’s statement that he has applied for benefits.

a. If the a/r chooses to waive, delay, renounce, or fails to comply with requirements to receive the unearned income, count as income the amount to which he is entitled. If the a/r refuses or fails to cooperate in determining the amount of potential unearned income to which he is entitled, deny the application.

b. If the a/r fails to apply for potential benefits within the processing time standard, count the benefit the day following the processing deadline if you are able to determine the amount. If the amount of benefits cannot be determined, deny the application.

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(III.A.1.b.)

Due to the fact that the Social Security Administration often schedules appointments for completing applications with a delay of as much as four to six weeks after contact by the a/r or must contact the a/r with an appointment time, consider the requirement to apply for Social Security benefits met when the appointment has been scheduled or the a/r provides proof that an appointment will be scheduled by SSA at a future date. Flag the case to verify that the a/r completed the application process.

(1) If the appointment to complete the Social Security application is scheduled in the third month of the certification period or earlier, within a week of the date of the applicant’s appointment to complete his Social Security application, verify that the recipient kept his appointment and completed the application.

(2) If the appointment to complete the Social Security application is scheduled for the fourth month of the certification period or later, verify that the individual completed his application for Social Security benefits when completing the first Medicaid re-enrollment.

c. Terminate an ongoing case when the a/r states that he refuses to apply or cooperate in determining the amount of potential unearned income to which he is entitled unless the amount can be verified (e.g. unemployment). If so, count the "phantom" benefit.

d. If the client's statement has been accepted as proof of application for benefits or client never reported that he received an appointment with SSA and benefits are not being received by the first re-enrollment, the recipient is responsible for proving that an application has been completed. Send a DMA-5097, Request for Information, and give the recipient 12 calendar days to provide proof. If proof is not received at the end of the 12 calendar days, send a timely notice proposing termination.

2. Budget Unit Members

Even though you must complete inquiries on all budget unit members, you cannot require a person not included in the assistance unit to provide a Social Security number or apply for benefits. Verbally inform the budget unit member of these potential benefits. However, do not pend or deny the application or propose termination of an ongoing case if the budget unit member fails to apply.

B. Reporting Income

Changes in earned income must be reported by the applicant/recipient within 10 calendar days of beginning the changed employment or earnings. Changes in unearned income must be reported within 10 calendar days of receipt of the changed income. Refer to V.C. for the definition of change.

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(III.B.)

Changes in income do not affect eligibility for MPW during the postpartum period. Children are entitled to continuous eligibility in MIC and NC Health Choice and changes in income do not affect their eligibility. If the recipient reports a change in an MPW or MIC/NC Health Choice case, note the change in the record.

C. Income Verification Requests and Client Responsibility to Supply Information

1. Applications

On the DMA-5097, always request the actual, countable income received in the base period as specified for each aid program/category in IV-VII. Also ask for operational expenses for self-employment income, paid during the same period, if applicable.

2. Re-enrollments

An ex parte review process is used for MIC and NCHC cases. The DMA-5067, Re-enrollment Information Notice, is mailed on or about the 15^th day of the 10^th month of the certification period. The notice informs the recipient that it is time to complete the re-enrollment process and a re-enrollment form is not necessary for evaluating continuing eligibility. The recipient can report all changes on the DMA-5067. Changes must be reported by the first day of the following month. See MA-3420, Re-enrollment for MIC and NC Health Choice re-enrollment procedures.

For all other reviews, request actual income and specify the base period. Also ask for operational expenses for self-employment, paid during the same period, if applicable.

3. Retroactive

Always request the actual, countable income for the month(s) of retroactive need, except for certain types of income described in VIII. Do not project to a monthly amount. Also refer to MA-3220, Retroactive Coverage.

4. The applicant/recipient must assist in the determination of eligibility by providing verification of income and the source of the income or signing a release for information to request the income.

D. Client Statement As Verification of Income for Applications and Re-enrollment

Accept the applicant/recipient’s statement as verification only if:

1. The applicant or IMC cannot obtain the verification from any source, i.e., the source refused to provide verification or cannot be located, and

2. The statement is not questionable. Do not accept the statement if the applicant/recipient refuses or simply fails to provide verification of income.

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(III.D.2.)

Examples:

a. The a/r provides a statement of income but has lost the previous month’s pay stubs. The IMC contacts the employer who refused under any circumstances to provide verification. Accept the statement of income unless questionable.

b. The a/r provides a statement of income but does not provide pay stubs with the application. The IMC requests proof of income.

If the a/r does not return pay stubs and does not indicate that they are unavailable, the IMC should deny Medicaid. This is true even if the IMC contacts the employer and he refuses to verify income.

E. Verification of income for MIC/NCHC Re-enrollments:

For verification of income procedures for MIC/NCHC Reenrollment see MA-3420, Reenrollments and MA-3410, Termination, Deletions and Ex Parte.