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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 11 The definition of income is the same definition used by the SSI program. Refer to DSSM 20200-20200.9 and 20210- 20210.15 for a detailed description of income.

17908 Unearned Income Exclusion

Unearned income is excluded up to the standard established by Delaware Medicaid and Medical Assistance (DMMA). The unearned income exclusion determined in 2009 was $956.00 per month. The unearned income exclusion is increased annually by the Cost of Living Adjustment (COLA) announced by the SSA in the Federal Register. There is no unearned income exclusion for a spouse who is not applying for MWD. 13 DE Reg. 654 (11/01/09) 28 DE Reg. 48 (07/01/24)

17909 Earned Income Exclusions

Monthly earned income exclusions are applied in the following order:

1. Earned income of children with disabilities that are also students (under age 18) up to the student earned income exclusion monthly limit, but not more than the student earned income exclusion yearly limit. These limits are updated annually by the Social Security Administration.

2. $20.00 general income exclusion

3. $65.00 of earned income

4. Earned income of individuals with disabilities used to pay impairment-related work expenses. Expenses must be directly related to the individual’s impairment. These are the costs paid by the individual for certain items and services that he or she needs in order to work even though such items and services are also needed for normal daily activities. Examples include but are not limited to the cost of certain attendant care services, dog guide, modified audio/visual equipment, specialized keyboards, and vehicle modification. The expense cannot be one that a similar worker without a disability would have, such as uniforms. The expenses are subject to reasonable limits. The amount paid will be considered reasonable if it does not exceed the standard or normal cost for the same item or service in the individual’s community.

5.One-half of remaining earned income 15 DE Reg. 202 (08/01/11)

17910 Deeming of Income The term deeming identifies the process of considering another person's income for the eligibility determination. Deeming provisions recognize some measure of family responsibility as they apply from spouse-to-spouse or parent-to- child. The deeming provisions of the SSI program at 20 CFR Part 416, Subpart K, Deeming of Income, are used for the eligibility determination. The Federal Benefit Rate is used in the SSI program for the deeming calculation. The income standard of 275% of the Federal Poverty Level (FPL) will be substituted for the Federal Benefit Rate in the MWD deeming calculation.

17911 Financial Eligibility Determination

There are 2 income tests used to determine financial eligibility:

1. If the monthly unearned income of the individual exceeds the standard established by Delaware Medicaid and Medical Assistance (DMMA), the individual is ineligible. The unearned income limit was determined to be $956.00 per month in 2009. This unearned income limit is increased annually by the Cost of Living Adjustment (COLA) announced by the SSA in the Federal Register.

2. Countable income must be at or below 275% of the Federal Poverty Level for the appropriate family size (individual or couple). 13 DE Reg. 654 (11/01/09) 28 DE Reg. 48 (07/01/24)

17912 Retroactive Eligibility The individual may be found eligible for up to 3 months prior to the month of application as described at DSSM 14920-14920.6. Eligibility cannot be retroactive prior to October 1, 2009. 13 DE Reg. 652 (11/01/09) 28 DE Reg. 48 (07/01/24)

17913 Premium Requirements

Effective July 1, 2024, premiums are no longer required. 12 DE Reg. 446 (10/01/08) 15 DE Reg. 1716 (06/01/12) 28 DE Reg. 48 (07/01/24) 17914 Managed Care Enrollment Requirements Individuals who are found eligible must enroll with a managed care organization. The Health Benefits Manager (enrollment broker) will be responsible for the enrollment process. 15 DE Reg. 1716 (06/01/12)