523 MEDICAID EXCEPTIONS TO APA INCOME POLICY

523 MEDICAID EXCEPTIONS TO APA Adult Public Assistance INCOME POLICY

Countable income is determined according to the criteria of the APA Adult Public Assistance program, except as provided below:

523 A. SOCIAL SECURITY BENEFITS

Increases in Social Security retirement, survivors, and disability insurance benefits and SSA Social Security Administration COLAs are disregarded for certain grandfathered individuals. See sections 531 and 540 .

523 B. REASONABLE COMPATIBILITY

Reasonable compatibility refers to the standard used to address discrepancy between the client stated earned income and the earned income reported by an electronic data source.

The reasonable compatibility standard is only used when client stated earned income is below the standard and data sources are above the standard.

To be considered reasonably compatible, income electronically reported by Department of Labor (DOL) must be within 10% of the client stated gross monthly income. The most recent quarter reported by DOL Department of Labor and Workforce Development is divided by three to get the average monthly income amount.

Note: Apply the Income Exclusions listed in APA MS 442 before comparing the client's statement of earnings and DOL Department of Labor and Workforce Development electronic verification. The verification code will need to be "interface" for client statement. Actual income information must be used for the cost of care calculation described in section 570 and Working Disabled Medicaid cases.

Actions :

Both the client stated earned income and the electronic data are at or below the income standard. Take client statement and authorize Medicaid. There is no need to check for reasonable compatibility.

Both the client stated earned income and the electronic data are above the income standard. Take client statement and deny the Medicaid. There is no need to check for reasonable compatibility.

Client stated earned income is above the income standard and the amount verified using electronic data is at or below the income standard. Accept client statement and deny the Medicaid. There is no need to check for reasonable compatibility.

Client stated earned income is at or below the income standard and the amount verified using electronic data is above the income standard. Check for reasonable compatibility. If the data source is within 10% of the client stated income, approve Medicaid using the client stated income.

Client stated they have a new job; there is no electronic history. In this type of scenario, the caseworker must pursue further verification of income.

Example: Client stated monthly gross earned income is $3,500 Subtract $20 = $3,480 Subtract $65 = $3,415 Subtract one half = $1,707.50 Client stated monthly gross earned income $1,707.50 10% of $1,707.50 is $170.75 Add $170.75 to $1,707.50 = $1,878.25 Subtract $170.75 from $1,707.50 = $1,536.75 The 10% range determined by the client stated income is $1,536.75 - $1,878.25 The DOL Department of Labor and Workforce Development monthly average is $3,733.33 Subtract $20 = $3,713.33 Subtract $65 = $3,648.33 Subtract one half = $1,824.17 There is reasonable compatibility as the DOL Department of Labor and Workforce Development monthly average of $1,824.17 is within the 10% range.

523 C. POST-ELIGIBILITY DETERMINATION

SSI Supplemental Security Income benefits are disregarded in the post-eligibility determination process for the first two months of institutionalization of persons eligible under sections 1619(a) or (b) of the Social Security Act if the person was receiving SSI Supplemental Security Income benefits in the month before entering the institution. See section 530-E for policy on 1619(b) eligible individuals.

523 D. COST-OF-CARE DETERMINATION

The withheld portion of an SSA Social Security Administration overpayment is disregarded in the post-eligibility cost of care determination. Payments from Alaska’s Senior Benefits Program count as income in the cost of care determination. Because federal income tax returns are disregarded as income, they cannot be used to determine the cost of care for institutionalized individuals and certain individuals eligible for services under a HCB Home and Community-Based waiver. However, the PNA Personal Needs Allowance may still be increased to cover mandatory withholding from earned and unearned income to cover federal, state, and local taxes. See section 570-E(1) .

523 E. VETERANS AFFAIRS PAYMENTS

Payments made by the Veterans Affairs up to $200 per month are not counted as income in the post-eligibility computation for a Medicaid recipient residing in a state Veteran’s Home or an institutional facility.

523 F. INCOME DISREGARDS

Income disregards are not applied to an adult applicant's gross income when determining financial eligibility for the Special Long Term Care eligibility category. These recipients do not receive the $20 general income disregard. Deductions to support a non-institutionalized spouse and dependents are not allowed when determining initial financial eligibility. See section 550-C for policy on Special Long Term Care eligibility.

If the applicant is institutionalized or receiving Home and Community Based ( HCB Home and Community-Based ) waiver services and has a spouse remaining in the community, the spouse’s income is deemed available to the applicant through the month they ceased living together. The community spouse’s income is no longer considered available to the institutional spouse beginning the first full month that the institutional spouse lived in the institution or received HCB Home and Community-Based waiver services.

If a couple is living together and only one is receiving HCB Home and Community-Based waiver services, the income eligibility standard for one individual is used to determine Medicaid eligibility for the HCB Home and Community-Based waiver recipient.

Note: This section does not apply to a disabled child living at home who is eligible under MS 533 ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ), which looks only at the child’s income.

523 G. FEDERAL POVERTY GUIDELINES FOR ALASKA

The Federal Poverty Guidelines for Alaska are used in place of the APA Adult Public Assistance standard when determining eligibility for Qualified Medicare Beneficiary ( QMB Qualified Medicare Beneficiaries ), Special Low-Income Medicare Beneficiary ( SLMB Specified Low Income Medicare Beneficiaries ) categories, and Qualified Disabled and Working Individuals ( QDWI Qualified Disabled and Working Individuals ) eligibility categories. See Addendum 1 .

523 H. IN-KIND SUPPORT AND MAINTENANCE

The APA Adult Public Assistance policy regarding the value of any support and maintenance that an individual or couple receives in-kind at APA Manual section 440-3 does not apply when determining eligibility for the Special Long Term Care category. See section 526-D for policy on how in-kind income is counted for the Special Long Term Care category.

523 I. INDIVIDUAL INDIAN MONEY ACCOUNTS

Funds deposited or held in an Individual Indian Money ( IIM Individual Indian Money ) account are excluded as income. (See section 524-K for resource policy on IIM Individual Indian Money accounts.)

IIM Individual Indian Money accounts primarily contain money collected by the federal government from farming and grazing leases, timber sales, mining, oil and gas production, and other activities on trust land, as well as certain per capita distributions. The funds in IIM Individual Indian Money accounts are held in trust by the federal government for the benefit of individual Indians.

523 J. ALASKA NATIVE / AMERICAN INDIAN REAL PROPERTY RENTAL INCOME

Rental income received from exempt property in Alaska belonging to an Alaska Native / American Indian is exempt income when determining Medicaid eligibility and post eligibility treatment of income (cost of care).

523 k. dEVELOPMENT OF INCOME REQUIREMENTS DO NOT APPLY TO MEDICAID

Medicaid applicants and recipients are not required to pursue sources of income as a condition of Medicaid eligibility.

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