Page 6

6

Title 23: Division of Medicaid, Office of the Governor

Part 104: Income

Part 104 Chapter 1: Introduction to Income – ABD Programs

Rule 1.1: Income Rules.

A. Chapters 1 – 10 discuss sources and treatment of income in the Aged, Blind and Disabled (ABD) programs. Eligibility for the ABD Medicaid programs is based on the rules used to decide eligibility for Supplemental Security Income (SSI). In accordance with 42 CFR 435.601, Medicaid is required to use SSI financial eligibility requirements unless a subsequently issued Medicaid statute or regulation supersedes SSI policy. In addition, 1902(r)(2) of the Social Security Act allows states to apply income rules to certain Medicaid categories that are more liberal than the SSI program.

B. The following income rules are based on SSI income policy:

1. Income is counted on a monthly basis.

2. An individual who has too much income in a particular month is not eligible for Medicaid for that month.

3. Income may include more or less than is actually received. For example:

a) Expenses of obtaining income (less);

b) Garnishment (more); or

c) Gross earnings before any deductions (more).

4. Not all income counts in determining eligibility.

C. The following rules are based on liberalized income policy:

1. Certain liberalized income policies apply to the following categories of eligibility:

a) Qualified Medicare Beneficiaries (QMB);

b) Specified Low-Income Medicare Beneficiaries (SLMB);

c) Qualifying Individuals (QI);

d) Working Disabled (WD); and