213.03 UP: Definition of Unemployed SR 11-30, 07/11 (FAM-A)

The Principal Wage Earner (PWE) meets the definition of "unemployed" in the UP medical assistance determination process, when the PWE provides documentation validating:

• work hours of less than 100 hours per month on average;

• that future work hours will be less than 100 hours per month on average, using a "best estimate;" and

• the PWE is not eligible for unemployment compensation benefits. See Section 213.15, UP: Ineligibility for UC Benefits.

"Best Estimate" Determination

The "best estimate" is determined as follows:

• if the hours worked by the PWE in the current month are less than 100 hours and are representative of anticipated future hours, the best estimate is the number of hours worked in the current month;

• if the hours worked in the current month are less than 100 hours and are not representative of anticipated future hours, the best estimate is the number of hours per month anticipated to be worked in the future;

• If the number of hours worked in the current month is greater than 100 hours, and documentation indicates the PWE is anticipated to work less than 100 hours in future months, review the number of hours worked in the previous 2 month period when determining the best estimate, subject to the following:

- the average number of hours worked by the PWE in both of the previous 2 months must be less than 100 hours, or the PWE does not meet the definition of unemployed; and

- if the average number of hours worked in the previous 2 months is less than 100 hours, but future hours are anticipated to be more than 100 hours, the best estimate is equal to the number of hours anticipated to be worked in the future.

Exceptions to the two-month averaging:

- if fluctuating hours have been worked less than 2 months, use the actual number of hours worked in the most recent month. If this number is more than 100 hours, the PWE does not meet the definition of unemployed; or

- if earned income in the previous 2 months is higher or lower than current or anticipated earnings and does not reflect a best estimate of current and future hours as determined above, the best estimate is based on the number of anticipated hours to be worked in the future.

Continuing Eligibility: Changes in Employment Status

• If documentation indicates that a currently eligible individual worked more than 100 hours in a month, or anticipates working more than 100 hours in a month in the future, determine a new best estimate to ascertain whether the individual expects to continue working more than 100 hours per month for longer than 1 month. If the individual will work 100 hours or more for longer than one month, the definition of unemployed is no longer being met.

• if earned income in the previous 2 months is higher or lower than current or anticipated earnings and does not reflect a best estimate of current and future hours as determined above, determine a new best estimate for the remainder of the current period of eligibility based on anticipated hours to be worked in the future.