5160:1-3-03.11 Medicaid: income exclusions.

 

 

 

TO BE RESCINDED

 

5160:1-3-03.11            Medicaid: income exclusions.

 

 

 

(A)   When determining medicaid eligibility for the aged, blind, or disabled, certain types of income, including income from certain sources, are not counted. This rule sets forth the types of income that are to be excluded, and the order in which they must be excluded from the individual's income.

 

(B)  Definitions.

 

(1)   "Blind work expense" means the portion of the individual's earned income used to meet any expenses reasonably attributable to the earning of the income if the individual is blind and under age sixty-five.

 

(2)   "Countable income" means the total income in cash or in kind minus the income exclusions set forth in this rule. It is compared to the appropriate need standard in determining medicaid eligibility.

 

(3)   "Exclusion" means an amount of income which does not count in determining medicaid eligibility.

 

(C)   Order of exclusions. Unearned income exclusions must be applied before applying earned income exclusions, and the specific order of exclusions described in paragraphs (D) and (E) of this rule must be followed.

 

(D)  Unearned income exclusions.

 

(1)   Unearned income excluded by federal laws other than the Social Security Act. The exclusions listed in this paragraph must be applied before applying the exclusions in paragraph (D)(2) of this rule:

 

(a)   Supplemental security income (SSI);

 

(b)   Income paid by public or private agencies or community groups which is either designed by law to be disregarded or given for a special purpose for medical or social services that are not food, shelter, or clothing, in accordance with 20 C.F.R. 416.1103 (as in effect on March 1, 2014);

 

(c)   Agent orange settlement payments;

 

(d)  Child care assistance under the Child Care and Development Block Grant

 

 

 

Act of 1990, in accordance with 20 CFR 416, appendix to subpart K, section V (as in effect on March 1, 2014);

(e)   The first two thousand dollars per calendar year received as compensation for participation in clinical trials that meet the criteria detailed in section 1612(b) of the Social Security Act (as in effect March 1, 2014);

(f)   Payments made for supporting services or reimbursement of out-of-pocket expenses to volunteers participating in corporation for national and community service (CNCS, formerly ACTION) programs, in accordance with 20 CFR 416, appendix to subpart K, section V (as in effect on March 1, 2014):

(i)   Americorps vista;

(ii)   Special and demonstration volunteer program;

(iii)   University year for ACTION (UYA);

(iv)   Retired senior volunteer program (RSVP);

(v)   Foster grandparents program;

(vi)   Senior companion program;

(g)    Energy employees occupational illness program, in accordance with 20 CFR 416, appendix to subpart K, section V (as in effect on March 1, 2014);

(h)    Federal food and nutrition programs, in accordance with 20 CFR 416, appendix to subpart K, section I (as in effect on March 1, 2014):

(i)   Food assistance (formerly known as food stamps);

(ii)    The value of surplus commodities donated by the U.S. department of agriculture;

(iii)   School breakfast, lunch, and milk programs;

(iv)   Women, infants, and children program (WIC);

(v)   Nutrition programs for older Americans;

(i)   Federal housing assistance provided by either:

(i)   The office of housing and urban development (HUD); or

(ii)    The U.S. department of agriculture's rural housing service (RHS), formerly known as the farmers home administration (FHA);

(j)    Filipino veterans equity compensation fund payment, in accordance with section 1002 of the American Recovery and Reinvestment Act of 2009;

(k)    Student financial assistance received under the Higher Education Act of 1965 or Bureau of Indian Affairs is excluded from income and resources, regardless of use:

(i)   Pell grants;

(ii)   Academic achievement incentive scholarships;

(iii)   Byrd scholars;

(iv)   Federal supplemental education opportunity grants;

(v)     Federal  educational  loans  (federal  PLUS  loans,  Perkins  loans, Stafford loans, Ford loans, etc.);

(vi)    Gear up (gaining early awareness and readiness for undergraduate programs);

(vii)     State educational assistance programs funded by the leveraging educational assistance program;

(viii)   Work-study programs;

(l)   Home energy assistance provided on the basis of need, in accordance with 20 C.F.R. 416.1157 (as in effect on March 1, 2014);

(m)   Matching funds that are deposited into individual development accounts

(IDAs), either demonstration project or TANF-funded, in accordance with 42 U.S.C. 604 (as in effect on March 1, 2014);

(n)   Japanese-American and Aleutian restitution payments, in accordance with 50 App. U.S.C. 1989 (as in effect on March 1, 2014);

(o)   Payments to victims of Nazi persecution, in accordance with 20 CFR 416, appendix to subpart K, section V (as in effect on March 1, 2014);

(p)   Netherlands WUV payments to victims of persecution from 1940-1945;

(q)   Department of defense payments to certain persons captured and interned in North Vietnam, in accordance with the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1998;

(r)   Radiation exposure compensation trust fund payments, in accordance with the Radiation Exposure Compensation Act of 1990;

(s)   Payments to veterans' children with certain birth defects;

(t)   Austrian social insurance payments received under the provisions of the Austrian General Social Insurance Act, paragraphs 500 through 506. These payments must be documented and identifiable from countable insurance;

(u)   Funds deposited into, or accrued interest on, escrow accounts established and credited as the direct result of the assistance group's involvement in the  family  self-sufficiency  program  in  accordance  with  24  C.F.R.

984.103 (as in effect on March 1, 2014);

(v)   VA aid and attendance and household allowances, in accordance with 20 CFR 416.1103 (as in effect on March 1, 2014). When the individual who receives an allowance pays someone else to provide services, that payment is income to the person providing the services unless that individual is a person from whom income is deemed to the original recipient of the allowance.

(w)   Payments, made to members of American Indian tribes and groups, that are excluded under the supplemental security income (SSI) program, as listed in 20 C.F.R. 416, appendix to subpart K, section IV (as in effect on March 1, 2014);

(2)   Unearned income excluded by the Social Security Act, in accordance with 20

C.F.R. 416.1124 (as in effect on March 1, 2014) unless otherwise noted. The exclusions listed in this paragraph must be applied after the exclusions listed in paragraph (D)(1) of this rule, and in the following order:

(a)   Any public agency's refund of taxes on real property or food;

(b)      Payments, including supplemental, retroactive, or auxiliary benefit payments, of assistance based on need that is wholly funded by a State or political subdivision. Disability financial assistance (DFA) and residential state supplement (RSS) payments are included in this category.

(c)   Income tax refunds, in accordance with 20 C.F.R. 416.1103 (as in effect on March 1, 2014);

(d)    Grants, scholarships, fellowships, or gifts used for paying educational expenses are either excluded or countable, depending upon their use:

(i)     Any portion of a grant, scholarship, fellowship, or gift used for paying tuition, fees, or other necessary educational expenses at any educational institution, including vocational or technical education, is excluded from income.

(ii)    Any portion of such educational assistance that is not used to pay current tuition, fees or other necessary educational expenses but is set aside to be used for paying this type of educational expense at a future date is excluded from income in the month of receipt. If these funds are not spent after nine months, they become a countable resource as of the tenth month following receipt.

(iii)    Any portion of a grant, scholarship, fellowship, or gift that is not used or set aside for paying tuition, fees, or other necessary educational expenses is income in the month received and a resource the month after the month of receipt, if retained.

(e)   Food which an individual or his/her spouse raises if it is consumed by the household;

(f)   Assistance received under the Disaster Relief and Energy Assistance Act and  assistance  provided  under  any  Federal  statute  because  of  a

presidentially-declared disaster;

(g)     The  first  twenty  dollars  of  infrequent  or  irregular  unearned  income received in a month;

(h)   Alaska longevity bonus payments;

(i)   Foster care payments;

(j)    Any interest earned on excluded burial funds and any appreciation in the value of an excluded burial arrangement which are left to accumulate and become a part of that burial fund;

(k)   Support and maintenance assistance based on need:

(i)   Provided in kind by a private nonprofit agency; or

(ii)   Provided in cash or in kind by a supplier of home heating oil or gas, or by a private or municipal utility company.

(l)   One-third of child support payments made by an absent parent;

(m)   Twenty dollar general income exclusion;

(n)   Unearned income used to fulfill an approved plan to achieve self-support (PASS);

(o)     Any  interest  on  excluded  burial  space  purchase  agreement  if  left  to accumulate as part of the value of the agreement;

(p)   The value of any commercial transportation ticket which is received as a gift and is not converted to cash;

(q)   Payments from a state compensation fund for victims of crime;

(r)   Relocation assistance;

(s)   Hostile fire pay received from the uniformed services;

(t)   Interest on a dedicated account in a financial institution, the sole purpose

of which is to receive and maintain past-due supplemental security income (SSI) benefits which are required or allowed to be paid into such an account, and the use of which is restricted by section 1631(a)(2)(F) of the Social Security Act (as in effect on March  1, 2014);

(u)    Gifts to children with life-threatening conditions, within the following limitations:

(i)   Gifts not converted to cash;

(ii)    The first two thousand dollars of any cash gifts within a calendar year;

(v)    Interest and dividend income from a resource, whether it is exempt or countable.

(w)      AmeriCorps state and national and AmeriCorps national civilian community corps cash or in-kind payments to AmeriCorps participants or on AmeriCorps participants' behalf. These include, but are not limited to: food, shelter and clothing allowances;

(x)   State annuities for certain veterans;

(E)    Earned income exclusions. The exclusions listed in this paragraph must be applied after the unearned income exclusions, and in the following order:

(1)   Earned income tax credit payments and child tax credit payments;

(2)    The first ten dollars of infrequent or irregular earned income received in a month;

(3)   Student earned income exclusion (SEIE) is applied as follows:

(a)    Earned income of blind or disabled student children under the age of twenty-two, up to the SEIE monthly limit, and not more than the SEIE yearly limit. The SEIE monthly and yearly limits are updated and published annually in the medicaid eligibility policy letter that lists standards and limits that are changed by the social security administration's cost of living allowance (COLA).

(b)   Available to a student attending full-time school, college, university or a course of vocational or technical training designed to prepare students for gainful employment. The statement of the school official as to whether the child is a full-time student is acceptable verification.

(4)   Wages paid by the census bureau for temporary employment related to census activities.

(5)   Any portion of the twenty-dollars monthly general income exclusion which has not been excluded from unearned income in that same month;

(6)     The first sixty-five dollars of earned income in a month. This exclusion is applied to gross earnings except in cases of self-employment, where it is applied to net income.

(7)    Earned income of disabled individuals used to pay impairment-related work expenses (IRWEs), as described in 20 C.F.R. 404.1576 (as in effect on March 1, 2014);

(8)   One-half of remaining earned income in a month;

(9)   Blind work expenses, as defined in paragraph (B) of this rule;

(10)    Any earned income used to fulfill an approved plan to achieve self-support (PASS);

(11)   Earned income contributed to individual development accounts (IDAs), either demonstration project or TANF-funded;

(F)   Unused exclusions.

(1)   Exclusions never reduce earned or unearned income below zero.

(2)     Unused portions of a monthly exclusion cannot be carried over for use in subsequent months.

(3)   Unused earned income exclusions are never applied to unearned income.

(4)    Other than the twenty-dollar general income exclusion, no unused unearned income exclusion may be applied to earned income.

(G)   The twenty-dollar general and sixty-five-dollar earned income exclusions are applied only once to an eligible couple, even when both members have income, since the couple's earned income is combined in determining medicaid eligibility.

Effective:                                                             08/01/2016

Five Year Review (FYR) Dates:                         04/14/2016

CERTIFIED ELECTRONICALLY

Certification

07/12/2016

Date

Promulgated Under:                           111.15

Statutory Authority:                           5160.02, 5163.02

Rule Amplifies:                                  5160.02, 5163.02

Prior Effective Dates:                         9/3/77, 12/31/77, 3/1/79, 10/1/79, 12/1/79, 1/3/80,

3/1/84, 10/1/88 (Emer.), 12/20/88, 7/1/89 (Emer.),

9/23/89, 10/1/89 (Emer.), 12/16/89, 2/ 7/91 (Emer.),

5/1/91, 7/18/91, 10/1/91, 1/1/92, 4/1/92, 6/1/92 (Emer.), 8/13/92, 10/1/92 (Emer.), 12/21/92, 8/ 18/93

(Emer.), 11/1/93, 3/1/94 (Emer.), 4/18/94, 7/1/94, 10/7/94, 1/1/95, 4/1/95, 7/1/96 (Emer.), 9/1/96, 5/1/97,

10/31/97 (Emer.), 1/26/98, 3/1/98 (Emer.), 5/1/98,

9/10/99