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Chapter 8 - Determining Income Eligibility

INTRODUCTION 8.1

A group's countable income is used to determine whether the group is income-eligible for program benefits. The group's income is also used to determine the level of benefits for which the group is eligible in the TANF, GC, and FS programs. With the exception of groups eligible for MA through the spend-down provision (see Chapter 7: Spend-Down in this Part) and groups eligible under the QM category, once a group is determined eligible for Medicaid or D.C. Medical Charities, the group is eligible for a certain package of benefits and services. Groups with incomes further below the income-eligibility threshold are not eligible for different services than groups with incomes closer to the eligibility threshold.

If a group is categorically eligible for Medicaid or categorically eligible for FS because all household members receive TANF or SSI, the SSR does not have to determine income eligibility. The SSR must determine the level of FS benefits to which a categorically-eligible group is entitled.

Groups that have expanded categorical eligibility for FS because of the receipt of a prescribed TANF- funded service are subject to a gross income test, with the exception of groups with an elderly or disabled member. The SSR must determine the level of FS benefits to which an expanded-categorically eligible group is entitled.

Income is budgeted prospectively for all programs. Prospective budgeting means that you use the income receive in the month to determine eligibility. Since benefits are usually issued on the first of the month for the entire month, prospective budgeting requires that you:

 make a 'best estimate' of what the income will be in the month, and  in some circumstances, compute an overpayment or underpayment if that estimate was not correct.

Exhibit VI-2: Summary of Earned/Unearned Income contains a summary table listing various types of income; these various types of income are discussed in greater detail in Chapter 4: Determining Countable Income in this Part.

All issues related to determining eligibility for MA through the spend-down provision are addressed in Chapter 7: Spend-Down in this Part. Similarly, determining eligibility for LTC (and the group's expected contribution toward LTC costs) is addressed in Chapter 2: Long-Term Care/Impoverished Spouse in Part VII.

LEGAL AUTHORITY 8.2 AREA/TOPIC DISTRICT FEDERAL Determining Income Eligibility TANF: D.C. Code 3-205.10-11; 3-205.52 GC: See TANF and D.C. Code 3-205.5a MA: 42 USC 1396a(a)(10); 1396a(l)-(m); 1396u-1; 1396u-3 FS: 7 USC 2014(c); 7 CFR 273.9(a); 7 CFR 273.10(e)(2) INCOME BUDGETING 8.3 MA Total countable income for eligibility is determined on the basis of the income anticipated to be received during the certification period. A person may receive income less often than monthly or may receive a payment that is for a period of more than one month. The SSR enters into ACEDS information on the amount of income and how often