Family and Children's Medicaid MA-3300 Income
XII. COUNTABLE UNEARNED INCOME
A. General Information
1. Explore potential benefits for each budget unit member at each application/review. Document discussion in the case record. If it appears there is a potential for benefits even though a/r denies receipt, explore the possibility.
2. The assistance unit members must apply for all unearned income to which they are entitled before eligibility can be determined. 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. Refer to III.A. for the requirements to apply for benefits.
3. Count benefits to which the assistance unit member is entitled if he has waived, renounced, or delayed receipt and the amount of entitlement can be verified. If entitlement cannot be verified, eligibility cannot be determined. Refer to MA-3210, Verification Requirements for Applications.
4. Benefits are not available for a child when the representative payee other than the caretaker refuses to use them for the child’s needs.
a. Notify the Social Security office or other agency immediately so that a change of payee may be made.
b. Flag the case for review in one month. A change of payee action should not take more than one or two months.
REVISED 10/01/11 – CHANGE NO. 13-11
(XII.)
B. RSDI Benefits
At application and review, explore potential benefits for each budget unit member. The potential depends on the situation of the children as well as the work history of parents or specified relatives. Even if the a/r denies that anyone receives the benefit, explore the possibility. The assistance unit members are required to apply for all benefits to which they are entitled.
If an assistance unit member who is aged 65 or older or disabled has already applied for RSDI benefits but has been determined financially ineligible because they did not meet the work quarters requirements, do not require the a.u. member to reapply for RSDI at re-enrollment or reapplication. Document the record.
1. Eligibility may be based on:
a. Disability
(1) Disabled workers under 65 and certain members of their families.
(2) Persons who become disabled before reaching age 22 if an insured parent or under certain circumstances a grandparent dies or becomes entitled to retirement or disability benefits.
(3) Disabled widows and widowers 50 or older if the disability began no later than 7 years after the death of an insured spouse or within 7 years after the end of the widow’s entitlement to benefits as a parent caring for his children.
b. Dependency or survivorship
The dependents and survivors of disabled, dead or retired individuals who may be eligible for benefits include:
(1) Unmarried children under 18 or up to age 19 if they are enrolled full-time in high school.
(2) Unmarried sons and daughters 18 or over who were disabled before they reached 22 and who continue to be disabled.
(3) A wife under 65 or widow/widower under 62 who is caring for a child that is under 16 or disabled and is entitled to benefits.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.B.1.b.)
REVISED 10/01/11- CHANGE NO. 13-11
(XII.B.)
3. Except for 4. immediately below, count the monthly RSDI entitlement amount for each budget unit member even when:
a. The benefit amount is reduced to recoup an overpayment, or
b. The a/r is not yet on the State Buy-in.
4. For an individual under 21 who is budgeted for Long Term Care (LTC), count the RSDI amount actually received.
C. Veteran’s Benefits
At application and review, explore potential benefits for each budget unit member. Even if the a/r denies that anyone receives the benefit, explore the possibility. Refer to www.ncveterans.com and click on US Veterans Benefits Admin. to locate information regarding types of VA benefits and requirements for pension and compensation. To locate Veterans Service Officers in your county, click Veterans Service Officers on the right.
The veteran or survivor must file an application with the VA to establish or apply for entitlement amounts to increased benefits (improved pension, aid and attendance, or homebound rating). VA benefits increase at different times based on the increase in cost-of-living.
1. Potential eligibles include:
a. Disabled individuals with disabilities incurred or aggravated by military service and the spouse or dependents of such individuals.
b. Permanently and totally disabled veterans including veterans, age 65 or older, who have sufficient active duty service. The surviving spouse may be eligible for pension also.
c. Surviving spouse and dependent children of veterans who die in service or who died of a service connected disability.
d. Parents of a veteran who died in service or of a service connected disability when the veteran has no other surviving dependents.
REVISED 10/01/11 – CHANGE NO. 13-11
(XII.C.)
2. Appointment of NC Division of Veteran’s Affairs as a/r’s representative
The Division of Veteran’s Affairs (DVA) assists veterans and their families in obtaining Veteran’s Benefits. DVA is working with DMA to make sure all a/r’s and financially responsible individuals receive the maximum veteran’s benefits to which they are entitled. In order to aid this task, DVA may be appointed as a “Claimant’s Representative” by the veteran or family member signing VA form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative. The signed VA form 21-22 also enables DVA to verify veteran’s benefits for dss.
Take the following actions:
a. Obtain a copy of VA form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative from the VA website: http://www.vba.va.gov/pubs/forms/VBA-21-22-ARE.pdf) and fill in the following blocks:
(1) In block 1, writer the name of veteran
(2) In block 2, write the VA file number (if available)
(3) In block 3A, write “North Carolina Division of Veterans Affairs”
(4) In block 3B, write “Veterans Service Officer”
(5) In block 4, write the Social Security Number of the veteran
(6) In block 7, write the name of the claimant (a/r)
(7) In block 8, write the address of the claimant (a/r)
(8) In block 12, write the date of the appointment (must be the same as the date signed in block 16)
(9) Have the a/r sign in block 15. VA will not accept the signature of a POA. If the a/r is incapable of signing, the a/r’s “X” is acceptable if witnessed by any two individuals. The witnesses must sign their names next to the “X.”
(10) In block 16, write the date signed (must be the same as the date of appointment in block 12)
REVISED 10/01/11 – CHANGE NO. 13-11
(XII.C.2.)
b. Contact a/r’s identified as being potentially eligible for veteran’s benefits (see D.1. above) using cover letter DMA-5026 and VA form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative. Cover letter DMA-5026 informs the a/r that he must either sign VA form 21-22 or provide proof that he has applied for veteran’s benefits within 12 days.
c. If the a/r chooses to sign the VA 21-22, Appointment of Veterans Service Organization as Claimant’s Representative, fax the signed form to the DVA District Service Officer identified in 2d. below.
d. Determine the appropriate DVA District Service Officer.
(2) Click on the link to the left labeled “veterans service officers.”
(3) Click on the county where the individual for whom you are verifying benefits resides.
(4) The page that opens provides the District Number. Do not contact the individuals listed on this page. Use the drop down box labeled “North Carolina District Service Officers” and locate the appropriate District Number. Click on the “Go” button. The page that opens provides the appropriate District Officer’s name and contact information. (see example in XI.C.3.i. below)
3. To verify and calculate Veterans Benefits use the following:
a. Fill out the top portion of the DMA-5027, Verification of Veteran’s Benefits,
If you do not have the VA claim number, leave that space blank. There is a space in the DVA portion of the DMA-5027, Verification of Veteran’s Benefits, for DVA to supply the VA claim number if not provided by the county.
b. Determine the appropriate DVA District Service Officer.
d. Click on the link to the left labeled “veterans service officers.”
e. Click on the county where the individual for whom you are verifying benefits resides.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.C.3.)
f. The page that opens provides the District Number. Do not contact the individuals listed on this page. Use the drop down box labeled, “North Carolina District Service Officers” and locate the appropriate District Number. Click on the “Go” button. The page that opens provides the appropriate District Officer’s name and contact information.
g Fax the DMA-5027, Verification of Veteran’s Benefits to the District Service Officer identified in 2. f. above.
h. When DMA-5027, Verification of Veteran’s Benefits, is returned by fax, complete the lower portion of the form to determine the amount of the veteran’s benefit that is countable income.
i. Follow up questions should be addressed to the individual from DVA who completed the DMA-5027, Verification of Veteran’s Benefits.
Example: Applicant is a veteran who lives in Alamance County. Go to the DVA web site and click on the “veterans service officers by county” link. Click on “Alamance County” and see that it is in District 7. Locate “District 7” in the drop down menu and click on “Go.” The page that opens shows the name, title, telephone number, fax number, e-mail address, etc. for the District Service Officer for Alamance.
4. Other verification methods (the following methods of verification may not give an accurate picture of countable income)
a. Award letter. However, a general increase may have occurred since the date of the award letter,
or
5. Count the total gross monthly VA entitlement amount received by each budget unit member, including any increased benefits such as Aid and Attendance and homebound assistance.
6. Exception to counting VA: The only exception is when an individual receives VA to attend school (except for individuals under 21 budgeted for Long Term Care).
a. Apply the VA benefits received for education toward school expenses prior to any other educational benefits that the a/r or financially responsible person, (parent or spouse) may receive. (The one exception is when the other source of educational benefits are benefits received because of attendance at an approved school. These benefits should be applied prior to VA benefits).
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.C.6.)
b. Count as income any amount remaining after school expenses are deducted.
7. Do not count Agent Orange payments as income.
8. Using the eligibility file and information obtained from the applicant/recipient/ representative, explore the veteran status of the veteran, including dates of service and whether compensation or pension may be appropriate.
a. Parent Disability Indemnity Compensation (DIC):
If the a/r’s adult child died in service or died of a service-connected disability, the a/r may be eligible for Disability and Indemnity Compensation (DIC). The amount of the VA payment may be reduced by his other income if he is in a private living arrangement. However, if he is in a nursing home, he should be eligible for the maximum payment.
b. Surviving Dependent Disability Indemnity Compensation (DIC)
If the a/r is the surviving spouse of a veteran who died in service or died of a service-connected disability, the VA benefit amount will be based on the veteran’s rank at the time of death or discharge. (DIC to a surviving spouse or child is not reduced by other income.)
c. Compensation
If the a/r is a veteran receiving compensation because his disability is service-connected, his VA payment will be based on his percentage of disability. An individual who is in a nursing home is considered to have a 100% disability. An individual can be classified as disabled with as little as a 10% disability. Therefore, disability determination by VA does not meet disability requirements for Medicaid purposes. Compensation to a disabled veteran is not reduced by other income.
d. Pension
(1) If the a/r is an institutionalized veteran with spouse/dependents at home, or the institutionalized surviving spouse of a veteran with dependents at home who meet the requirements for pension, the individual may receive additional benefits. This additional benefit is referred to as “Aid and Attendance” rating.
(2) If the a/r is a single institutionalized veteran with no dependents or a surviving spouse without dependents and he is eligible for Medicaid, his VA benefit will be reduced to $90. The reduced $90 payment is non-countable unearned income for Medicaid purposes and is the recipient’s personal needs allowance. Do not allow an additional $30.00.
e. If the a/r is potentially eligible for pension, he must apply for improved pension under the Pension Improvement Act to receive the Aid and Attendance rating.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
D. Railroad Retirement Benefits
At application and review, explore potential benefits for each budget unit member. Even if the a/r denies that anyone receives the benefit, explore the possibility.
The potential for Railroad Retirement Benefits is based on the railroad work history of adults and parents of the children in the b.u. If the a/r denies receipt of benefits but his Social Security number begins with a 7, he may have been employed by the railroad.
Railroad Retirement Benefits (RRB) information can be requested by letter. Provide the applicant's name and social security number or railroad retirement claim number.
Mail written requests to:
Quorum Business Park
7508 E. Independence Blvd., Suite 120
Charlotte, NC 28228-9409
Telephone (877) 772-5772
Fax (704) 344-6429
The a/r or financially responsible person can also access the Railroad Retirement Benefits information from the website at: www.rrb.gov.
1. Other Verification Sources
a. Use the award letter. However, a general increase may have occurred since the date of the award letter.
b. Examine a current check.
c. The client’s Railroad Retirement (RRB) suspension notice is verification of suspended payments.
2. Count the gross monthly Railroad Retirement benefits received by each budget unit member.
3. Benefits increased because of a dependent child are income to the RR beneficiary, not the child.
4. Survivor benefits paid to or for a child is income to the child.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
E. Annuities, Pensions and Retirement Benefits
At application and review, explore potential benefits for each budget unit member. Annuities are paid yearly or at specified intervals. They may be purchased from an insurance company or by an employer for services rendered.
Explore the work history of the adults in the b.u. regarding pensions paid by a former employer, insurance company, or other public/private agency.
If receipt of benefits is denied but there is a record of several years service in a particular organization and retirement in the past six months, contact the employer to determine benefit potential. A labor union or a fraternal organization also may provide benefits.
1. Verification sources
a. Annuities
Contact the insurance company or employer.
b. Pensions
Contact the payer of the benefit.
c. Retirement
(1) Contact the payer of the benefit.
(2) For a retired federal employee receiving U.S. Civil Service award, use the award letter or other document.
2. Count the gross monthly amounts received by each budget unit member.
F. Worker’s Compensation
1. Count Worker’s Compensation as unearned income if the individual no longer remains employed.
2. Count as earned income if provided during illness or injury as a temporary wage replacement. See X.E.
REISSUED 10/01/11 - CHANGE NO. 13-11
(XII.F.)
3. Verification Sources
a. Contact the employer.
b. Current check
c. Award letter. Verify that an increase hasn’t occurred since the award letter was issued.
4. Count the gross monthly amount of Worker’s Compensation received by the budget unit member.
G. Unemployment Insurance (UI)
Definition - Income received by an individual as compensation for loss of employment due to layoff, suspension, or firing. It may include additional amounts paid by unions or employers. At application and review, explore the potential benefits for each budget unit member.
1. Verification sources
a. On-line UI inquiry.
b. Award letter. However, a general increase may have occurred since the date of the award letter.
c. Current check.
2. Count the gross monthly amount of UI received by the budget unit members.
3. Convert UI benefits to a monthly amount. Use this amount to determine eligibility. Flag the case to recompute the budget when benefits end.
4. See MA-3515, Automated Inquiry and Match Procedures, to determine when to complete an ESC/UI on-line inquiry and on whom. At re-enrollment, an inquiry is not required for a.u. members as they will be included in the quarterly paper match. See 8., below. An inquiry is also not required at re-enrollment for individuals in a nursing home, retirees, or under age 16.
5. Except for assistance unit members listed in 8. below, the assistance unit member must apply for UI when you find in the on-line UI inquiry that:
a. The assistance unit member is “monetarily eligible;” and
b. There is no “File Date” or the “File Date” is earlier than the 12 months prior to the month of application.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.G.)
6. If the “File Date” is within the 12 months prior to the month of application, do not refer the applicant to ESC. Do not count the amount of UI as income to the assistance unit member unless you verify he actually receives this income.
7. An assistance unit member who is employed and earning 20% or less of the amount of benefit for which he is monetarily eligible must apply for UI within 12 days of filing an application. (For example, if a person is receiving $100 per week in UI, they can earn up to $20 and still receive the UI.)
8. Even if the following assistance unit members are shown as monetarily eligible in the ESC/UI Inquiry, they are not available for work. Do not refer those who are:
a. Employed full-time as defined by the employer
b. Registered for and attending school or on vacation during or between successive quarters.
c. Receiving or applying for benefits under any state or federal law based on temporary or permanent total disability
d. Disabled or incapacitated for 30 days or more as evidenced by a hospital stay, doctor’s statement, or receipt of disability checks
e. Receiving a government or other pension, retirement, annuity, or other similar periodic payment that is more than the potential monthly Unemployment Insurance Benefit payment
f. Placed on disciplinary suspension by his employer. If the family member is on a single disciplinary suspension that lasts more than 10 consecutive calendar days, he is considered dismissed from the employment and must apply for UI.
g. Unavailable for work due to a medical condition, including childbirth, as verified by a physician's statement, or a medical condition that is obvious to the worker.
h. Women on maternity leave whose job is held for their return. If the woman has a job and intends to return to it after her maternity leave ends, she is not entitled to UI even if monetarily eligible.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.G.)
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.G.10.)
b. Upon receipt of the quarterly ESC/UI Match, review the report to determine if any of your recipients are listed
(1) If so, complete an on-line inquiry to determine the “File Date.”
(2) When the “File Date” is within the 12 months prior to the first month of the next certification period, no referral to ESC is needed.
(3) If there is no “File Date” or the "File Date" is beyond the 12 months, and the recipient is showing as currently monetarily eligible, he must apply for UI.
c. When you determine a recipient is required to apply for UI, take the following action:
(1) Notify the recipient that he is required to apply for unemployment benefits.
(a) Tell the recipient that he must report the date he applies for UI as well as the receipt of the benefits.
(b) Follow the appropriate timeframes.
(2) Verify the recipient’s application for unemployment benefits by completing an on-line UI inquiry. Refer to the EIS Manual, Vol. 1., 1106 for instructions.
(a) If the recipient fails to apply for UI by the deadline date, count the “phantom” benefit if it can be verified. If not, send a DSS-8110. On the DSS-8110, explain the termination is for failure to apply for all benefits to which he may be entitled. See 8.b.(5). above.
(b) If the recipient applies for UI by the deadline but has not begun receiving benefits, continue eligibility.
1) Inform the recipient of his responsibility to inform the caseworker within 10 calendar days once entitlement for the benefit is determined.
2) Flag the case for review to determine if entitlement is established or the recipient is receiving UI.
(c) If the recipient applies for and begins receiving UI by the deadline set, determine the monthly UI amount to count. Complete the re-enrollment.
(d) If the recipient waives or renounces his rights to UI, count the amount under “WBA” on the on-line UI screen when determining his eligibility.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
H. Private Disability or Unemployment Benefits
Definition - Benefits paid by private insurance plans for persons incapacitated/unemployed.
At application and review, explore the potential benefits for each budget unit member. If receipt of benefits is denied, but the a/r is disabled and has a history of employment, contact the employer to determine benefit potential, amount and duration.
1. Verification sources
a. Contact the payer of the benefit.
b. Current check.
c. Award letter. However, an increase may have occurred since the date of the letter.
2. Count the gross monthly benefit amount received by each budget unit member.
I. Sick Pay
Definition - Income not subject to tax deductions that is received by a budget unit member who is unable to work due to illness or incapacity. Sick pay subject to tax deductions is treated as earned income.
1. Verification sources
a. Contact the employer.
b. Current check.
2. Count the monthly amount of sick pay received by each budget unit member.
J. Trade Readjustment Benefits
Definition - Benefits for persons who have lost their job because of imports and the federal government has approved their petition for assistance. Persons can only receive this assistance after other unemployment sources have been exhausted. These benefits are not shown on the ESC/UI inquiry.
At application and review, explore the potential benefits for each budget unit member.
1. Verification sources
a. Contact ESC.
b. Current check.
c. Award letter. However, an increase may have occurred since the date of the letter.
REISSUED 10/01/11 - CHANGE NO. 13-11
(XII.J.)
2. Count the gross monthly Trade Readjustment Benefit received by each budget unit member.
K. Work Release Funds
Definition - Funds to dependents from a prisoner employed under the Department of Correction Work Release Program.
At application and review, explore the potential benefits for each budget unit member, particularly if a child has a parent who is in prison.
1. Verification sources
a. County department of social services’ records.
b. On-line Department of Correction inquiry. Refer to the EIS Manual.
2. Count the gross amount of work release received by each budget unit member. If some dependents are not budget unit members, divide the amount of the check equally between the dependents, i.e. assign a share to each dependent.
3. Notify the local child support enforcement staff that the assistance unit is receiving work release funds. Any court order for support has to be amended due to Work Release funds. If there was no court order, the local child support staff may find it appropriate to pursue court action.
4. Upon receipt of a DC-190, Work Release Action Form, the county director must designate who is responsible for contacting a prisoner’s dependents, whether known to the agency or not, to determine their needs. The designee must contact the prisoner’s dependents.
a. The prisoner’s dependents may include:
(1) Spouse,
(2) Dependent children,
(3) Parents of the prisoner,
(4) Parents of the prisoner’s spouse, or
(5) Other relatives for whom the prisoner has assumed responsibility in the past.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.K.4.)
b. Report to prison officials any legal dependents not previously acknowledged. Do not consider as dependents:
(1) Remarried spouses, or
(2) The parent of the dependent children if the parents were never married.
c. Determine the dependent’s need for work release funds. Disregard any other income or resources available to the dependents. To determine the needs:
(1) Use the amount for monthly needs specified below for the number of dependents, and
(2) Add to this the dependents’ monthly payments on health and life insurance, medical expenses not covered by Medicaid, school lunches, and expenses for college, vocational or technical courses not being met by loans, scholarships, grants, etc.
Number of Dependents
|
Monthly Needs
|
1
|
|
2
|
|
3
|
|
4
|
|
5
|
|
6
|
|
7
|
|
8
|
|
9
|
|
10
|
|
11
|
|
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.L.)
2. Verification sources - For dividends and interest from stock, bonds, investments:
a. Current dividend check.
b. Contact the financial institutions. Use form DSS-3431, “Request for Financial Information”. Financial institutions will not release information without this signed consent. All persons whose name is on the account must sign a DSS-3431.
c. Current dividend statement. A statement for tax purposes is issued to each recipient of a dividend.
d. Bank/savings and loan passbook.
Consider as income any interest which is earned on a savings or checking account that is withdrawn by the a/r on a regular basis or that is paid to him as a regular dividend. Consider as part of the reserve interest that is accumulated or reinvested automatically.
e. Contact a bank with issue date and serial number of bonds.
f. Contact the stockholder or brokerage firm that sold the stocks/ bonds.
g. Contact the company in which the stocks/bonds are owned.
NOTE: If dividends are paid out in stock, verify value of additional shares.
3. Dividends From A Closely Held Corporation
a. The primary source of verification is the business records of the corporation, including tax returns. See X.C., above.
b. The income is the amount of profit made by the corporation multiplied by the percentage of stock owned by the a/r. Profit is calculated by subtracting operational expenses from the gross receipts of the business. The dividends are countable regardless of whether actually disbursed.
REISSUED 10/01/11 - CHANGE NO. 13-11
(XII.L.3.b.)
For example, a/r and his brother and sister-in-law own a pet store that is incorporated. A/R owns 40% of the stock and his brother and sister-in-law own 30% each. The pet store profits for the base period were $62,000 (income minus operational expenses). A/R’s dividends from the business are $62,000 x .40 = $24,800.
c. If the a/r is also employed in the business and receives a salary, treat the salary as wages separately from the calculation of dividend income. See X.B.1., above, for treatment of wages.
4. Dividends From a Limited Partnership
a. The primary source of verification is the business records of the company, including tax returns. See X.C., above.
b. The income is the amount of profit (gross receipts minus operational expenses) made by the business multiplied by the percentage of stock owned by the a/r. The dividends are countable regardless of whether actually disbursed.
For example, a/r is a limited partner in a dairy operation. The partnership agreement stipulates that in return for his investment he is entitled to 25% of the dairy’s profits. The business records indicate a profit of $40,600 during the base period. A/R’s share is $10,150.
5. Count the monthly income from dividends or interest received by each budget unit member. If dividends fluctuate or are paid less often than monthly, use the prior 6 months (or 12 months) and project based on that. Flag the case to recompute when the dividend is due to be received.
M. Income from Trust Funds
At application and review, explore the potential benefits for each budget unit member. The principal of a trust is not a countable resource. However, income paid directly to a member of the budget unit from a trust is countable income.
Verification sources
1. Examine the trust fund documents.
REIVISED 10/01/11 - CHANGE NO. 13-11
(XII.M.)
2. Contact the executor or administrator of the trust fund. This may be:
a. A family relative,
b. The Clerk of Court,
c. A lawyer, or
d. The trust department of a local bank.
3. Contact the lawyer who handled the legal aspects of the trust funds.
4. Contact the local office of the Internal Revenue Service as all trust funds must be reported. A signed release statement is required.
N. Educational Loans, Grants and Scholarships
If a budget unit member receives any educational loans, grants, or scholarships not administered by the U.S. Department of Education or Bureau of Indian Affairs Student Assistance program, and an amount is designated for room and board expenses, count this designated amount as unearned income. These items may be listed as “Living Costs” on the document. See IX.B.6. for exclusions.
If educational benefits are received because of attendance at an approved school, and the individual also receives another source of educational benefits, always apply the benefits received because of attendance at an approved school toward school expenses first. If there is any of the educational benefit remaining after paying the school expenses have been paid, count as unearned income.
If the budget unit member receives VA educational benefits and educational benefits from another source, apply the VA benefits toward the educational expenses first. (The one exception is when the other source of educational benefits are benefits received because of attendance at an approved school. These benefits should be applied prior to VA benefits). If there is any VA educational benefits remaining after educational expenses have been paid, count it as unearned income.
1. Verification source - Contact the provider in writing or by telephone.
2. Verify if the assistance is received yearly or on a basis other than yearly.
3. If the educational loan, grant, or scholarship not administered by Title IV of the U.S. Department of Education or Bureau of Indian Affairs student assistance programs is received on a yearly basis:
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.N.3.)
a. Subtract the allowable yearly expenses of tuition, books, fees, equipment, special clothing needs, required school insurance, and child care services necessary for school attendance.
b. Count the remainder as a lump sum.
4. If the educational loan, grant, or scholarship not administered by the U.S. Department of Education or Bureau of Indian Affairs student assistance programs is received on a basis other than yearly:
a. Subtract the allowable expenses of tuition, books, fees, equipment, special clothing needs, required school insurance and child care services necessary for school attendance for the same number of months the loan, grant, or scholarship covers.
b. Divide the remainder by the appropriate number of months to determine a monthly amount.
c. Use this amount as countable income.
O. Brown Lung Benefits
Definition - Payments made to persons disabled by lung disease resulting from exposure to raw cotton dust.
1. At application and review, explore potential benefits for each budget unit member if there has been textile work, particularly if lung ailments exist.
2. Verification Sources
a. Contact the Industrial Commission, Department of Economic and Community Development, 4334 Mail Service Center, Raleigh, N.C. 27699-4334. Include the a/r’s file number, name of former employer, and the date of the onset. Attach a signed consent for release of information.
b. Award letter. However, an increase may have occurred since the date of the letter.
c. Current check.
3. Count the gross amount of Brown Lung Benefits received by each budget unit member.
P. Black Lung Benefits
Definition - Payments to a disabled worker, dependents, or survivors, usually as the result of working in a coal mine. At application and review, explore potential benefits for each budget unit member if there has been coal mining work and the a/r has a lung ailment.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.P.)
1. Verification Sources
a. Contact the U.S. Department of Labor, Black Lung District Office, 500 Springdale Plaza, Spring St., Mt. Sterling, Kentucky, 40353 for checks dated the 15th of the month. Attach a signed consent for release of information, or
b. Contact your local Social Security District Office for checks paid the first week of the month.
c. Current check.
d. Award letter. However, an increase may have occurred since the date of the letter.
2. Count the gross amount of monthly Black Lung Benefits received by each budget unit member.
Q. Military Allotments
Benefits received by dependents of military personnel. Explore benefits if the spouse/parent of the a/r is in the military.
1. Verification sources:
Attach a signed, valid consent form for release of information.
a. Copy of the check or a current bank statement showing a direct deposit.
b. Award letter. However, an increase may have occurred since the date of the letter.
c. The a/r or financially responsible person may, while still in the office and by using the public computers, if available, access the military allotment pay table and a copy of the service members Leave and Earnings statements from the website at, http://www.dfas.mil/militarypay.html by clicking on “myPay,” "Military Pay Tables” or other appropriate links on this site depending on the information needed.
To access immediate allotment information by computer, or by telephone, to request a mailed allotment statement, the a/r or financially responsible person would need his password and the following information:
(1) The allotment amount
.
(2) The social security number of the active/retired service member
(3) The six or nine digit financial institution company code where the allotment is direct deposited or, the address where the allotment is being mailed.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.Q.1.)
d The military allotment verification contact telephone number for a member in the Army Reserves is 1-877-462-7782. For the Army National Guard, the number is 1-877-276-4729. The a/r or financially responsible person may call to request a copy of a military allotment. The county caseworker may call for a current address to submit allotment verification requests. Attach a signed valid consent form for release of information
e. Caseworkers may contact the military payment information center for current addresses by calling 1-888-332-7411.
R. Sheltered Workshop Income
1. Count as unearned income if no employer/employee relationship exists. If there is an employer/employee relationship, see X.B.
2. Verification sources
a. Contact the workshop where a/r is employed.
b. Current check(s).
S. Lump Sum Payment
Definition - A one-time payment, not expected to recur, that is received by a member of the budget unit. This includes personal injury awards and tobacco settlement payment. It does not include the receipt of earned income received on a yearly basis such as farm or rental income.
1. Use a lump sum payment as income in the month of application when:
a. Payment was received in a month included in a request for retroactive coverage for medical expenses.
b. Payment was received in the month of application for ongoing coverage or in any month prior to approval of the case.
c. Payment was received prior to authorization of a case in deductible status.
2. Do not count a lump sum as income when:
a. It is paid directly to another person outside the a.u/b.u.
b. The payment is for past months’ benefits from SSI.
c. Payment was received as compensation for loss of assets or a lump sum was earmarked for a specific purpose. For example, the a/r receives an insurance settlement to replace a motor vehicle, a home, or for other catastrophic events.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.S.)
3. Verification sources
a. Provider of benefit.
b. Copy of check.
c. Award letter.
4. Applications - Retroactive Period
Count the lump sum payment as income for the retroactive certification period during which it is received.
5. Applications - Prospective Period
To calculate the period of ineligibility when the lump sum is received at any time during the application process:
a. Categorically Needy
(1) Add together the lump sum payment and any other countable earned and unearned income.
(2) Determine the number of persons in the Needs Unit.
(3) Compare the total countable income to the income level for the number in the Needs Unit used to establish eligibility (income level or categorically needy).
(4) If the income does not exceed this income level, establish eligibility.
(5) If the total countable income exceeds the income level used to determine eligibility, divide the total countable income by that income level.
(a) The assistance unit is ineligible for Medicaid for this number of months.
(b) Any remainder counts as unearned income for the month after the last month of ineligibility.
(c) Evaluate the assistance unit for Medically Needy.
b. Medically Needy
(1) Upon receipt of the lump sum, add this lump sum to the other countable earned and unearned income.
(2) Use this total income to determine a deductible for the assistance unit.
REISSUED 10/01/11 - CHANGE NO. 13-11
(XII.S.)
6. Ongoing Cases
While a lump sum payment would be income for an authorized case in the month of receipt, benefits received prior to receipt of a lump sum payment cannot be reduced. Therefore, treat lump sum payments to authorized cases as reserve in the month following receipt. See MA-3320, Resources. Count a lump sum payment as income when received prior to case authorization, i.e., in deductible status.
T. Child/Spousal Support
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.T.6.)
b. From this amount, subtract up to $50 of child support paid from each source of support. Divide the result by the number of children supported by each source. This determines the average monthly support to budget for each child receiving support in the assistance unit. (The $50 disregard does not apply to LTC budgeting.)
Example 1: Mother applies for Medicaid for her 3 children. The absent parent is father of all children. He pays his child support through the State Child Support Enforcement Program. His support obligation is $600 monthly. $600 has been paid for each of the last 6 months, $3600 ÷ 6 = $600. $600 - $50 = $550. $550. ÷ 3 = $183.33. The average monthly child support to budget for each child is $183.33. If all children are included in the same Medicaid application and budgeting the full amount of child support causes ineligibility, budget the children separately.
Example 2: Mother applies for Medicaid for her 2 children in January. She receives direct support for child #1 from the absent parent. She does not receive support from the absent parent of child #2. She provides a signed, written statement from the absent parent stating the following amounts as being paid for support for the previous six months. July-$120.00, August-$100.00, September-$120.00, October-$80.00, November-$100.00, and December-$120.00. The total support received from this absent parent for the last six months is $640.00. The average monthly support was $106.67. Subtract $50.00 from the average monthly support ($106.67-$50.00 = $56.67. $56.67 is the amount of support to budget for child #1. If both children are included in the same Medicaid application, and the support causes ineligibility, budget the children separately.
c. Lump Sum Payments of Back Support
(1) Count any portion of the lump sum that is for months in the base period.
Example: Absent parent's support obligation is $300/mo. The base period is Sept.-Feb. He did not pay in Sept.-Dec. but made the regular payments in Jan.-Feb. In Feb. he also paid a lump sum of $900 for the months missed. The $900 is countable in the base period.
(2) Disregard the portion of the lump sum arrearage support that, when added to actual ongoing support payments made, exceeds the total ongoing support obligation for the base period.
Example: Absent parent's support obligation is $300/mo but the amount he pays fluctuates. In the 6 month base period he paid $1,050, which is $750 less than his obligation (300 x 6 = 1,800 - 1,050 = 750). He also paid a lump sum of back support in the amount of $1,000. This was for months prior to the base period. Count $750 of the lump sum.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.T.)
7. If support began or the amount of the obligation changed during the past 6 month period, project an average based on the new amount.
a. Verify the total amount paid for the month(s) since the support began or changed. To get the average, add the amounts paid. Divide by the number of months since support began/changed.
b. From this amount, subtract up to $50 of child support paid from each source of support. Count the balance as the average monthly support in determining eligibility.
c. Flag the case to recompute when the support has been received for six months at the changed amount.
U. Contributions
REVISED 10/01/11 - CHANGE NO. 13-11
(XII)
V. Loans and Promissory Notes Money
Money received by the a/r as a repayment for a loan or promissory note is countable unearned income.
1. When the loan or promissory note is an excluded resource to the a/r, count the payments received by the a/r as unearned income. This includes any interest payments.
2. When the loan or promissory note is a countable resource to the a/r, count only the interest received as unearned income.
3. Money received as a loan (other than educational loans) by the a/r is not countable income if there is an agreed upon timetable and plan for repayment. Refer to MA-3320, Resources. Obtain a written statement from the parties involved if there is no formal loan agreement.
W. Deemed Income
1. Count income deemed from an institutionalized spouse to the a/r who is the community spouse.
2. Count income deemed from an institutionalized spouse to the a/r who is a dependent family member.
X. Living Needs Benefits
A living needs benefit is a provision that allows a terminally ill person (or in some cases, individuals permanently confined to a medical institution) to receive all or part of the proceeds of their life insurance policy while living. Depending on circumstances, these payments can be received either as a lump sum or on an ongoing basis.
1. If an a/r has a life insurance policy that allows him to receive the death benefit while living, do not require the a/r to file for such proceeds even if he meets the insurance company's requirements for receiving the proceeds.
2. If an a/r does file for and receive the benefits, the payment will be considered income in the month received. Any portion remaining in the following month will be considered an available resource.
3. If payment is received on an ongoing basis, verify the amount and count as a monthly benefit.
4. If payment is received as a lump sum, refer to XI.S. for treatment of lump sums.
5. Verification source - Contact with the insurance company administering the policy or award letter.
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
Y. Tobacco Settlement
Money paid to tobacco farmers and quota owners as part of the settlement by tobacco companies is treated as a lump sum payment. Refer to XI.S. for treatment of lump sums.
Farmers may receive this settlement payment on a yearly basis depending upon the settlement terms. Continue to treat the payment as a lump sum.
Z. Pigford/Brewington vs. Glickman Settlement
This is a settlement for black farmers who were discriminated against when applying for farm loans. Taxes may be withheld by the government. Since this is a one-time payment, refer to S above for treatment as a lump sum payment.
AA. Gaming Proceeds for the Eastern Band of Cherokee Nation
Members of the Eastern Band of Cherokee Indians receive a distribution of profits as permitted under P.L. 98-64, from gaming operations on their reservations. Payments are made semi-annually in June and December.
1. Base Period - The base period is the 6 calendar months prior to the month of application or review. Divide the total amount by 6 to calculate the monthly countable income.
2. Payments to minors or incompetent adults are paid into trust funds administered by the tribe or fiscal agent. The trust funds are accessible only upon petition to the tribe, and if approved they are limited to medical or educational purposes.
a. Payments to minors are not countable since they go into a trust. Trust funds are an exempt resource. Refer to MA-3320, Resources.
b. Payments to parents are countable when determining the child's eligibility. Refer to XI.M. for treatment of income from trusts.
3. Verify the per capita payment by copy of the check or award letter, or contact:
REVISED 10/01/11 - CHANGE NO. 13-11
(XII.)
