Section 210-RICR-40-00-3.3 - SSI Methodology: Treatment of Income3.3.1Scope and PurposeA. This Section focuses on the treatment of income and, specifically, the way earned and unearned income are defined and evaluated when calculating countable income. For the purposes of this Section, countable income is the total income available to a person seeking Medicaid benefits subsequent to the application of any required exclusions, disregards, and/or deductions and, as appropriate, deeming.3.3.2DefinitionsA. For the purposes of this Section, the following definitions apply: 1. "Available income" means when the person has a legal interest in a liquidated sum and has the legal ability to make that sum available for support and maintenance.2. "Countable income" means the total amount of earned and unearned income that is used to determine whether an applicant or beneficiary meets the standard for income eligibility for the applicable IHCC group.3. "Deeming" means the process of attributing income and resources from non-applicant members of the household, a parent or spouse, to the person seeking Medicaid eligibility as a low-income elder or adult with disabilities who is not seeking LTSS coverage.4. "Infrequent income" means income that is received no more than once in a calendar quarter from a single source.5. "PASS" means a written employment plan approved by the SSA that protects an SSI recipient's eligibility for Medicaid as long as the recipient continues to make progress toward work goals in accordance with a set timetable.6. "Non-applicant person" means a parent, child or spouse of the applicant in the IHCC group who is NOT applying for or receiving Medicaid health coverage, but whose finances are considered for the purposes of determining income and resources. For the purposes of Medicaid LTSS eligibility, the term "non-LTSS spouse" refers to the member of a couple who is not applying for or receiving Medicaid.7. "Unavailable income" means the person cannot gain access to the income.3.3.3State ResponsibilitiesA. In calculating countable income, all sources of income a person receives or may be eligible to receive is reviewed. Not all sources of income are reviewed when renewing eligibility as indicated in § 3.3.5 of this Part. When determining initial eligibility using the SSI methodology, State responsibilities include, but are not limited to, the following:1. Evaluation of Income - All income, earned and unearned, must be evaluated including any that is self-reported in the application process or that may become known through authorized electronic data matches using information from other Health and Human Services programs, such as SNAP, Rhode Island Works and outside data sources (State Wage Information Collection Agency or SWICA, SSA, DOH Vital Statistics, etc.).2. Exclusions - Certain forms of earned and unearned income are excluded or treated as "not income" under Federal law or Regulations when determining income eligibility. The State also excludes certain types of income allowed under the Medicaid State Plan and Section 1115 waiver granted pursuant to § 1115 of the Social Security Act, 42 U.S.C. § 1315. All possible exclusions must be applied prior to the determination of eligibility.
3. Application of Disregards and Deductions - There are income disregards and deductions that apply when evaluating income. The State must apply these disregards and deductions in a specific order when calculating countable income.4. Deemed Income, Non-LTSS only - A portion of the income of a non applicant (NAPP) included in the FRU must be deemed as attributable if it is available to the applicant or beneficiary. Deeming is permitted from spouse-to-spouse, parent-to-child and sponsor to non-citizen included within the FRU, but never from sibling-to-sibling or child-to-parent. As only an applicant child seeking MN eligibility is subject to a State determination using the SSI methodology, the instances in which deeming will apply are limited. There is no resource limit in the MACC group for children, which is the principal eligibility pathway for person under age nineteen (19). The deeming of income is subject to conditions and limitations. Subchapter 05 Part 1 of this Chapter sets forth the deeming of income provisions that apply to Community Medicaid when eligibility is determined by the State.5. Availability - In evaluating income, whether it is available affects how it is counted. Specifically, under certain circumstances, the amount of income that is determined to be available may be greater than the amount a person will be able to use. § 3.4 of this Part explains situations in which income may be unavailable.6. Determination of Income Eligibility - Income evaluations are only one (1) facet of the eligibility determination process that must be completed within the specific timeframes required set forth i n Part 2 of this Subchapter. As eligibility is considered across multiple pathways, failure to meet the income standard of one (1) coverage group does not necessarily result in an immediate denial or termination of eligibility as indicated in Part 2 of this Subchapter. 3.3.4Beneficiary ResponsibilitiesA. All persons seeking initial or continuing Medicaid health coverage are required to provide timely and accurate information on all matters related to eligibility. In addition, although attestations and electronic verifications of income are conducted to the full extent feasible, supporting documentation must be provided in the manner indicated in the application process. Failure to provide timely and accurate information may result in delays in the determination process, reapplication, or denial of eligibility due to non-cooperation.3.3.5Types of IncomeA. When determining financial eligibility for Medicaid using the SSI methodology, income types are as follows:1. Not Income - Some items or payment received by a person are not counted as income in the month received, though they may be treated as resources, as indicated in § 3.7 of this Part, if they are retained in the month after receipt. Items that are not income include, but are not limited to: a. Converted resources including cash received from the sale of a resource, money withdrawn from a savings account or other liquid resources, reverse mortgages or home equity loans or lines of credit;b. Distributions from health flexible spending arrangements or a health savings account;c. Federal, State or local tax refunds;d. Interest on excluded resources;e. Health care services if given free of charge or paid for directly to the provider by someone else and room and board received during a medical confinement;f. Assistance provided in cash or in-kind (including food or shelter) through a government program whose purpose is to provide health care services and supports, or social services (including vocational rehabilitation);g. Cash provided by any non-government health care program or under a health insurance policy if the cash is either a reimbursement for service costs incurred and already paid or an advance for future services;h. Direct payment of health insurance premiums by anyone on a person's behalf;i. Payments from the U.S. Department of Veterans Affairs (VA) resulting from unusual health care expenses, such as Aid and Attendance or Housebound Allowance; j. Payments in cash or in-kind excluded by Federal law, as indicated in §§ 3.4 and 3.5 of this Part.2. Countable Earned Income - Any earned income received as cash or an in-kind benefit a person receives in exchange for work must be considered in the financial eligibility determination process. Not all earned income is countable for Community Medicaid and several of the IHCC groups subject to the SSI methodology. In general, countable earned income includes, but is not limited to, the following with the exceptions noted:a. Employee income. When derived from: (2) Severance pay, based on accrued leave time(4) Vacation donation compensation(6) Any other forms of payment provided in exchange for work performed such as payment for babysitting, housekeeping, shoveling and so forth unless irregular or infrequent.b. Irregular or infrequent income. Earned lump sum, non-gift, or income from an employer, trade or business above the first (1st) thirty dollars ($30.00) received in a calendar quarter.c. Net earnings from self-employment. This includes gross income minus all expenses the Internal Revenue Service (IRS) allows as a self-employment expense calculated on a taxable year basis.d. Net rental income. The gross rental income minus verified rental and repair expenses, when the person spends an average of ten (10) hours or more per week maintaining or managing the property. Rental deposits are not income while subject to return to the tenant. Rental deposits used to pay rental expenses become income at the point of use. Verified expenses for providing a room or food or both to a roomer or boarder are subtracted from rental income.e. In-kind. Earned in-kind income is a non-cash payment a person receives in place of wages or money from self-employment. In-kind earned income can be for food or shelter, such as free rent in exchange for apartment maintenance or items that could be sold or converted to obtain food or shelter. The current market value of earned in-kind income is countable, unless the exclusions in § 3.4.7 of this Part apply.f. Other income. Income received in exchange for work or service, such as jury duty pay, picket duty pay, blood and blood plasma sales and royalties and honoraria.3. Countable Unearned Income - Unearned income is cash received that does not require performing a work or service. The following types of unearned income are countable to the extent indicated when determining eligibility using the SSI methodology: a. Adoption assistance involving funds granted under Title IV-E of the Social Security Act, 42 U.S.C. §§ 670-679c. This assistance is counted dollar for dollar and is exempt from the twenty dollars ($20.00) general disregard. See § 3.4.3 of this Part below for types of adoption assistance that are not counted.b. Alimony, spousal and other adult support. These payments are cash or in-kind contributions to meet some or all of a person's needs for food or shelter and are made voluntarily or because of a court order. Alimony payments are unearned income to an adult.c. Annuities, pensions and other periodic payments. Payments counted in this category are usually related to prior work or service and include, for example, private pensions, Social Security benefits, disability benefits, Veterans benefits, Worker's Compensation, railroad retirement annuities and unemployment insurance benefits.d. Child support and arrearage payments. When made for a deceased child, such payments are counted for the person who receives the payment. Otherwise, support payments are countable income for the child, excluding one third (1/3), unless provided for health and/or other such purposes as indicated in § 3.4.3 of this Part.e. Disability payments. If disability payments are part of an employer's benefit package they are counted.f. Extended income Trade Adjustment Assistance (TAA) support payments under 20 C.F.R. Part 618 (2023). The TAA is a Federal program that provides support payments to individuals as a way of reducing the damaging impact of imports on certain sectors of the economy. Under the current structure, such payments are countable.g. Foster care payments. When foster care payments are made under Title IV-E of the Social Security Act, 42 U.S.C. §§ 671-679b, they are countable income for the person receiving care. Such payments are Federally-funded and thus the income is not subject to the twenty dollars ($20.00) general disregard. See § 3.4.4(A)(8) of this Part for types of foster care payments that are not counted.h. In-kind. Unearned in-kind income is a non-cash payment a person receives that is NOT in place of wages or self-employment monies. In-kind unearned income can be either food or shelter or any item that can be sold or converted to buy food or shelter. See § 3.4.7 of this Part for treatment of income.i. Interest, dividends and certain royalties. Dividends and interest are returns on capital investments, such as stocks, bonds, or savings accounts. Royalties are compensation paid to the owner for the use of property, usually copyrighted material or natural resources. Such payments are countable as any income earned on resources unless specifically treated as non-countable under § 3.6 of this Part.j. Irregular or infrequent lump sum. Unearned lump sum income that comes from an individual, organization, or investment if over thirty dollars ($30.00) in a calendar quarter is counted. Treatment of lump sum income more generally is located in § 3.4.4 of this Part.k. Net rental income. Net rental unearned income counts when the person spends an average of less than ten (10) hours per week maintaining or managing the property.l. Regular and frequent gift income. Unearned income from gifts counts when receipt occurs on a continual basis, at expected intervals such as monthly, or periodically on an irregular basis.m. Retirement, Survivor's, and Disability Insurance (RSDI). Monthly RSDI payments are countable as are other pensions and retirement pensions. The amount of any premiums deducted from RSDI for the optional Supplemental Medical Insurance (SMI) under Medicare are also counted.n. Retroactive RSDI. Lump sum payments are counted in the month received. See § 3.4.4 of this Part for information on the treatment of lump sum income more generally.o. Severance pay. Countable as unearned income only when it is not based on accrued leave time.p. Spousal maintenance or allowance.q. Student financial aid, in the following situations:(1) Earnings through the Federal Work Study program are counted only for the Sherlock Plan, in accordance with Subchapter 15 Part 1 of this Chapter if average gross monthly earnings exceed sixty-five dollars ($65.00) and Social Security and Medicare taxes are withheld; and(2) Distributions from a Coverdell Educational Savings Accounts are counted ONLY if not used or set aside for qualified educational expenses.(3) Scholarships, grants, and fellowships. Unless authorized by Title IV of the Higher Education Act (HEA) of 1965, Pub. Law 89-329, or the Bureau of Indian Affairs (BIA), grants, scholarships, fellowships and other non-loan financial aid not used for or set aside for educational expenses is countable.r. Tribal per capita payments from casinos.s. Unemployment Insurance, including Rhode Island Temporary Disability Insurance (TDI) payments. Payments made through insurance programs that provide protection for lost wages as a result of an illness or injury that prevents work are countable unless explicitly prohibited by Federal law.t. VA benefits. Pensions are counted when not related to a disability. Any amounts allocated for a dependent child are not counted, however.
210 R.I. Code R. 210-RICR-40-00-3.3
Amended effective 1/8/2019
Amended effective 4/28/2020
Amended effective 11/5/2020
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