10- 144 C.M.R. ch. 332, § 7-3

Current through 2024-51, December 18, 2024

Section 144-332-7-3 - SSI - RELATED BUDGETS FOR AN INDIVIDUAL/CHILD

The following describes budgeting for:

* SSI or State Supplement for eligible individuals.

* Pickle, DAC, DWB for eligible individuals.

* Categorically Needy Medicaid for eligible individuals.

* SSI, State Supplement and Categorically Needy Medicaid for eligible children.

Note: If an individual is over income or assets under Categorically Needy, eligibility needs to be determined under Medically Needy criteria (See Part 10).

Section 3.1: Budget for SSI or State Supplement Payment

I. Combine all gross unearned income.

II. Subtract the $20.00 Federal Disregard where applicable. The remainder is the net unearned income.

III. Combine all gross earned income.

IV. Subtract any remainder of the $20.00 Federal Disregard not deducted from unearned income.

V. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.

VI. Subtract the earned income disregard of $65.00.

VII. Divide the remaining earned income by two. The remainder is net earned income.

VIII. Combine net earned and unearned income. The remainder is total net income.

If total net income is below the appropriate SSI Income Standard for one, based on living arrangement, the individual meets the income criteria for an SSI payment.

If receiving SSI, the individual also gets a State Supplement. If over income for SSI, s/he may be eligible for a State Supplement only payment.

IX. Subtract the State Disregard for one ($55.00), except for those in living arrangements D, E, F, G, I (See Chart 3.6). The remainder is countable income.

If countable income is below the appropriate State Supplement Income Standard for one, based on living arrangement, the individual meets the income criteria for the State Supplement only payment (See Part 11 for more information on State Supplement eligibility).

Section 3.2: Budget for Medicaid Coverage Under Pickle Amendment or Disabled Adult Child (DAC) or Disabled Widow(er) Disregards

Follow the budgeting process in Section 3.1 for an individual, except that the Pickle, DAC, and/or DWB income disregard(s) are subtracted after step I. and before step II (Federal Disregard).

Follow the budgeting process for a disabled child in Section 3.4 of this Part. In determining the child's countable income deduct the Pickle disregard between steps I and II (Federal disregard).

If countable income is below the State Supplement Income Standard, the individual is Medicaid eligible.

Section 3.3: Budget for Categorically Needy Medicaid Coverage

Individuals who are not eligible under Section 3.1 or Section 3.2 or who choose not to apply for SSI/State Supplement, may get Medicaid coverage (if otherwise eligible) by using the following budget process.

I. Combine all gross unearned income.

II. Subtract the $20.00 Federal Disregard, where applicable. The remainder is the net unearned income.

III. Subtract any allocation to an ineligible child. An ineligible child is one who is not receiving TANF, SSI or State Supplement.

To determine the allocation, deduct each child's countable income from the maximum child allocation (see Chart 3.2). The remainder for each child is combined to determine the total allocation. The remainder is the individual's net unearned income.

IV. Combine all gross earned income.

V. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.

VI. Subtract any remainder of the ineligible child allocation not deducted from the unearned income.

VII. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.

VIII. Subtract the earned income disregard of $65.00.

IX. Divide the remaining earned income by two. The remainder is net earned income.

X. Combine the net earned and unearned income.

XI. Subtract the State Disregard for 1 ($55.00). The remainder is the countable income.

If countable income is equal to or below 100% of the Federal Poverty Level for one and eligibility is based on age or disability, the individual is Medicaid eligible.

Note: The State Supplement budgeting criteria must be used for an individual whose eligibility is based solely on blindness. However, if the individual also meets the SSI criteria for disability use the budgeting criteria in this section.

If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.

Section 3.4: SSI, State Supplement and Categorically Needy budget for a child

I.Unearned Income to the Eligible Child(ren)

A. Subtract the allocation for ineligible children and/or aliens from the parental unearned income.

B. If the allocations are greater than the unearned income, or there is no unearned income, subtract the excess allocations from the parental earned income.

C. Subtract the $20.00 Federal Disregard from any remaining parental unearned income.

D. If the remaining unearned income is less than $20.00, subtract the remainder of the $20.00 from the parents' combined earned income.

E. Subtract $65.00 from the remaining earned income.

F. Subtract one-half the remaining earned income from the result of Step V.

G. Add the result of Step III (countable unearned income) to the result of Step VI (countable earned income).

H. Subtract the parental living allowance (see Chart 3.2) from the result of Step VII (parental countable unearned and earned income).

I. Divide the result of Step VIII by the number of eligible children in the household. This is unearned income to the eligible child(ren).

If there is more than one eligible child in the household, divide the deemed income equally among them. However, do not deem in excess of the amount which, when combined with the child's own income, would make the child ineligible. That excess is deemed in equal amounts among the other eligible children in the household in addition to their equal shares of the deemed income (See Example 2 below).

II. Determine the child's countable income:

A. Combine the deemed income with the child's own unearned income.

B. Subtract the $20.00 Federal Disregard. The remainder is the net unearned income.

C. Combine all gross earned income.

D. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.

E. Subtract any Impairment Work-Related Expenses (IRWE) outlined in Appendix B.

F. Subtract the earned income disregard of $65.00.

G. Divide the remainder by two. The remainder is the net earned income.

H. Combine the net earned and unearned income.

I. Subtract the State Disregard for one (see Chart 3.1). The remainder is the countable income.

If the countable income is below the SSI/State Supplement Income Standard for one, see Chart 3.4, (living in the household of another) the child may be eligible for a SSI / State Supplement payment (See Part 11).

If countable income is equal to or below 100% of the Federal Poverty Level for one the child is Medicaid eligible.

If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.

Examples

1. Mr. and Mrs. Fry have two children, Linda (age 10) and Mike (age 11). Mike has been found disabled through the Medical Review Team. Mr. Fry earns $600 weekly. There is no other income for the family.

$ 600 weekly gross income (Mr.)

X 4.3

$2580 monthly gross income

- $ 319 ineligible child allocation to Linda

$2261

- $ 20 federal disregard

$2241

- $ 65 earned income disregard

$2176

- $1088 earned income disregard (1/2 the remainder)

$1088

- $ 956 living allowance for two parents (Chart 3.2)

$ 132 deemed to Mike

- $ 20 federal disregard

$ 112

- $ 55 state disregard

$ 57 countable income for Mike Mike's income is less than the SSI/State Supplement standard for one. He is eligible for Medicaid and may be eligible for SSI.

If the countable income was equal to or above the appropriate SSI/State Supplement Standard compare the countable income to 100% of the Federal Poverty Level for one.

2. Kevin and Beth Ham have two children, Barbara and Dick, both of which meet disability criteria. Dick receives an annuity of $600 monthly due to an accident.

$3765.00 Kevin's monthly earnings

- $ 20.00 federal disregard

$3745.00

- $ 65.00 earned income disregard

$3680.00

- $1840.00 earned income disregard (1/2 the remainder)

$1840.00

-$934.00 parent allocation

$ 906.00 income to be deemed to eligible children The $906.00 would be deemed equally between the two eligible children. Doing so would make Dick over income. As a result, we will deem an amount to Dick up to the Categorical Income limit and the balance is deemed to Barbara. This will result in both Barbara and Dick being eligible for Medicaid.

$ 926.00 Categorical Income limit

$ 600.00 Dick's annuity

$ 326.00 amount deemed to Dick

$ 906.00 income to be deem to eligible children

- $ 326.00 amount deemed to Dick

$ 580.00 amount deemed to Barbara

10- 144 C.M.R. ch. 332, § 7-3