Page 1

Official source

Revision: HCFA-PM-91-4 (BPD) Supplement 4TO ATTACHMENT 2.6-—A Page 1] OMB No.: —-0938- STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: CONNECTICUT

METHODS FOR TREATMENT OF INCOME THAT DIFFER FROM THOSE OF THE SS] PROGRAM

(Section 1902 (f) more restrictive methods and criteria and State supplement criteria in SSI criteria State without section 1634 agreements and in section 1902 (f) States. Use to reflect more liberal methods only if you limit to State supplement recipients. DO NOT USE this supplement to reflect more liberal policies that you elect under the authority of section 1902 (r) (2) of the Act. Use Supplement 8a for section 1902 (r) (2) methods.)

1. Home Equity Conversion Plans are countable income if there are no repayment agreements.

2. Allowances for Unusual Medical Expenses from the Veteran’s Administration are countable income.

TN No. 12-023 Supersedes Approval Date TN No. 96-005

5/9/13 Effective Date. 7/1/2012

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Page 1

Official source

Revision: HCFA-PM-91-4 (BPD) Supplement 4TO ATTACHMENT 2.6-—A Page 1] OMB No.: —-0938- STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT

State: CONNECTICUT

METHODS FOR TREATMENT OF INCOME THAT DIFFER FROM THOSE OF THE SS] PROGRAM

(Section 1902 (f) more restrictive methods and criteria and State supplement criteria in SSI criteria State without section 1634 agreements and in section 1902 (f) States. Use to reflect more liberal methods only if you limit to State supplement recipients. DO NOT USE this supplement to reflect more liberal policies that you elect under the authority of section 1902 (r) (2) of the Act. Use Supplement 8a for section 1902 (r) (2) methods.)

1. Home Equity Conversion Plans are countable income if there are no repayment agreements.

2. Allowances for Unusual Medical Expenses from the Veteran’s Administration are countable income.

TN No. 12-023 Supersedes Approval Date TN No. 96-005

5/9/13 Effective Date. 7/1/2012