611.01 Computing Eligibility SR 06-12, 10/06 (FAM-A) |
Income eligibility for NHEP, UP, or FAP financial assistance or for categorically or medically needy medical assistance is computed differently depending on the program requested and the requesting individual’s assistance history. Generally, applicants for financial or categorically needy medical assistance must first have eligibility computed using the 20% earned income disregard. Those that are eligible after these computations will have eligibility recalculated using the 50% earned income disregard. Recipients (those currently receiving NHEP, UP, or FAP financial or categorically needy medical assistance or who have received financial or categorically needy medical assistance in at least 1 of the prior 6 months) have eligibility calculated using only the 50% earned income disregard.
Use the following steps to compute income for assistance groups requesting financial or categorically needy medical assistance.
NHEP/UP/FAP Financial and NHEP/FAP Categorically Needy Medical Assistance: Applicant Eligibility Test
Apply the eligibility test only when determining eligibility for individuals who have not received NHEP, UP, or FAP financial or categorically needy medical assistance within the 6 months prior to application. Use the following steps to compute eligibility.
1. Subtract the following from each Assistance Group (AG) member’s countable gross earned income, including countable self-employment income (see FAM 511, SELF EMPLOYMENT):
- the 20% earned income disregard (see 603.01, Earned Income Disregards); and
- the child/dependent care deduction (see 603.05, Child/Dependent Care Deduction).
The result is individual net earned income.
2. Total all individual net earned income amounts. This is AG net earned income.
3. Total the countable unearned income for all individuals, including assigned child support. This is gross unearned income.
4. Add countable gross unearned income to the AG net earned income.
5. Subtract the allowable deductions (see 603.09,Other Allowable Deductions). The result is AG net income.
6 Compare AG net income to the appropriate payment standard in Table B, Basic Maintenance Payment Allowance and Maximum Payment Standard.
- If net income is less than the payment standard, the AG is income-eligible for NHEP or FAP financial assistance or categorically needy medical assistance. If the application is for NHEP or FAP financial assistance, compute the grant amount.
- If net income exceeds the payment standard, compute eligibility for medically needy medical assistance (see below).
Grant Amount and Financial or Categorically Needy Medical Assistance Recipient Eligibility Computation
For financial assistance applicant AG’s that pass the eligibility test, and for recipients of NHEP or FAP financial or categorically needy medical assistance, use the following steps to compute the amount of the financial assistance grant or income eligibility for categorically needy medical assistance.
1. From each AG member’s countable gross earned income, subtract the following:
- the 50% earned income disregard (see 603.01, Earned Income Disregards); and
- the child/dependent care deduction.
The result is individual net earned income.
2. Total all individual net earned income amounts. This is AG net earned income.
3. Total the countable unearned income for all individuals, including all child support actually received (do not include assigned child support in this calculation). This is gross unearned income.
Exception: If the Standard of Need changes due to shelter costs or group size, determine eligibility using all child support, including assigned child support. If the case remains eligible, proceed with the grant calculation using only the child support amount that is actually received.
4. Add countable gross unearned income to the AG net earned income.
5. Subtract the allowable deductions (see 603.09, Other Allowable Deductions). The result is AG net income.
6. Subtract AG net income from the appropriate payment standard in Table B, Basic Maintenance Payment Allowance and Maximum Payment Standard.
- If the AG is requesting financial assistance, the difference is the grant amount.
- If the recipient AG is requesting categorically needy medical assistance, the AG is eligible if AG net income is no higher than the appropriate payment standard.
NHEP/FAP Medically Needy Medical Assistance Eligibility Computation
If AG net income derived from either computation above exceeds the payment standard for the AG size, compare net income to the appropriate medically needy income limit (PIL) in Table C, Medical Assistance Net Income Limits and Percentages of Poverty Level.
• If AG net income is no higher than the Protected Income Limit (PIL), the AG is income-eligible for medical assistance as medically needy.
• If AG net income exceeds the PIL, compute separate medical assistance eligibility for each individual in the AG. See 611.04, Determining Budgetary Units for Medical Assistance Programs.
• If an individual is not income-eligible for any medical assistance program, determine potential eligibility for In and Out medical assistance. See PART 617, IN AND OUT MEDICAL ASSISTANCE.
HCBC-DD/ABD/IHS TANF-MA Only
Individuals requesting HCBC-DD, HCBC-ABD, or HCBC-IHS services who are not eligible for medical assistance using the computations above, are considered an assistance group size of 1. Use the following steps to determine if the individual is income-eligible.
1. Add the individual’s countable gross earned income to countable gross unearned income to obtain gross income. Note: Countable gross income is determined according to the procedures outlined for the appropriate eligibility category above.
Exceptions: Do not include VA Aid and Attendance and SSI in this step.
If gross income is less than or equal to the nursing facility CAP, income is within categorically needy limits. See Adult Assistance Manual, Chapter 600.
2. Subtract from gross earned income:
• the 20% earned income disregard (EID) for each employed TANF applicant;
• the 50% EID for each employed TANF-recipient;
• the $90 EID for each employed poverty-level individual; and
• the child/dependent care deduction.
The result is net earned income. See Sections 603.01, Earned Income Disregards, and 603.05, Child/Dependent Care Deduction.
3. Add countable gross unearned income to the net earned income calculated in step 2.
4. Subtract any allowable deductions (see Section 603.09, Other Allowable Deductions). The result is net income.
Exception: Do not allow allocated income as a deduction in this step.
5. Compare net income to the monthly cost of HCBC-DD, HCBC-ABD, or HCBC-IHS services. See Form 517-B, Area Agency Information Release to DFA District Office, Home and Community-Based Care Waiver.
- If net income is equal to or less than the cost of HCBC-DD, HCBC-ABD, or HCBC-IHS services, income is within medically needy limits; determine the individual’s cost of care. See PART 614, Cost of Care: HCBC-DD/ABD/IHS Medical Assistance.
- If net income exceeds the cost of HCBC-DD, HCBC-ABD, or HCBC-IHS services, see PART 617 In and Out Medical Assistance, to determine potential In and Out eligibility.