Income Considerations 510-03-85-05

(Revised 6/1/2015 ML #3441)

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(N.D.A.C. Section 75-02-02.1-34)

Income is defined as any cash payment, which is considered available to an ACA Medicaid Household for current use. Income may be earned or unearned. It must be reasonably evaluated.

“Earned Income” is income that is currently received as wages, salaries, commissions, or profits from activities in which an individual or family is engaged through either employment or self-employment. Income is “earned” only if the individual or family contributes an appreciable amount of personal involvement and effort. “Earned income” shall be applied in the month in which it is normally received .

Note: If earnings from more than one month are received in a single payment, the payment must be prorated over the months for which it is intended.

MAGI income methodologies must be applied to all ACA Medicaid Households.

Current, point-in-time income must be used.

All income which is actually available must be considered. Income is actually available when it is at the disposal of an applicant, recipient, or responsible individual; when the applicant, recipient, or responsible individual has a legal interest in a liquidated sum and has the legal ability to make the sum available for support, maintenance, or medical care; or when the applicant, recipient, or responsible individual has the lawful power to make the income available or to cause the income to be made available.

An individual may have rights, authority, or powers that he or she does not wish to exercise. An example includes an individual who allows a relative to use excluded assets free or at a reduced rental. In such cases, a fair rental amount will be counted as available income whether the applicant or recipient actually receives the income. Income that is withheld because of garnishment or to pay a debt or other legal obligation is still considered available. Title II and SSI overpayments being deducted from Title II benefits, are normally considered to be available because the applicant or recipient can pursue a waiver of the overpayment. Only if the waiver has been denied after a good faith effort, can the Title II or SSI overpayment deductions be considered unavailable. Occasionally other delinquent debts owed to the federal government may be collected from an individual’s federal payment benefit (i.e. Title II, Civil Service, and Railroad Retirement). These other reductions of federal benefits are not allowed to reduce the countable benefit amount. The award amount of the federal benefit payment is counted as available except to the extent an undue hardship is approved for the individual. Requests for undue hardship exceptions must be submitted to the Medicaid Eligibility Unit where a determination will be made whether an undue hardship exists. An undue hardship may be determined to exist for all or a portion of the debt owed, or all or a portion of the reduction from the monthly income. An undue hardship will be determined to exist only if the individual shows all of the following conditions are met:

The debt is a debt owed to the Federal government; The deduction from the individual’s federal payment benefit was non-voluntary; The amount of the deduction exceeds the Medicaid income level(s) to which the individual and the individual’s spouse is subject; The individual has exhausted all lawful avenues to get the reduction waived, forgiven, or deferred; and The individual or their spouse does not own assets that can be used to pay for the debt.

Financial responsibility of any individual for any applicant or recipient is subject to their tax filing status as well as the individual’s relationship to those with whom the individual resides, as defined at 510-03-35-05 , “ACA Medicaid Household”.

Monthly income is considered available when determining eligibility for ACA Medicaid, however, an individual may die before their income is actually received for the month. An income payment received after death is no longer considered income, but an asset to the individual’s estate. In circumstances where the Department will pursue estate recovery, Medicaid eligibility can be re-determined counting only that income which was received prior to the individual’s death; resulting in the elimination or reduction of the client share (recipient liability).

When a Medicaid provider reports that a recipient’s current month client share (recipient liability) was not paid as of the date of death, determine whether the following conditions are met:

There is no surviving spouse; There is no surviving minor or disabled child; and Countable monthly income was not received prior to death.

If all conditions are met, refer the case to the Medicaid Eligibility Unit. Information regarding the date of death and the dates of the month in which each source of income is received must also be provided. The Medicaid Eligibility Unit will determine whether Medicaid estate recovery is being pursued and an adjustment to the client share (recipient liability) can be approved. If approved, the Medicaid Eligibility unit will process the adjustment.

Income may be received weekly, biweekly, monthly, intermittently, or annually. However income is received, a monthly income amount must be computed.

Many benefit programs deposit an individual’s monthly benefit onto a debit card. Examples of these benefit programs are TANF benefits, Unemployment Insurance Benefits (UIB), Child Support benefits, Workforce Safety and Insurance benefits (WSI), Social Security Administration benefits (SSA), and Supplemental Security Income benefits (SSI).

Individuals may also receive as gifts or bonuses such things as gift cards, debit cards, prepaid credit cards or ‘in-store credits’. Examples include bonus or commission payments, compensation for work performed, or Tribal Gaming Per Capita Distributions from gaming revenues etc.

Note: These benefits must be determined whether countable or disregarded based on ACA Medicaid policy.

Earnings paid under a contract must be prorated over the period the contract covers. Example: A teacher receives paychecks in August through May, however the contract covers 12 months and the contracted salary is $30,000. The annual salary is prorated over 12 months. Countable ACA Income is $2500 per month.

Occasionally, migrants or seasonal farm workers may receive an advance lump sum payment to reimburse or cover travel expenses. Such reimbursement is normally received prior to their arrival and is not considered earned income. An advance for wages, however, is counted as earned income and is prorated over the months it is intended to cover.

Example: Don is a migrant worker who received a reimbursement from his grower for traveling to North Dakota to work. This reimbursement is disregarded from income as a reimbursement. Don’s grower also gave him a wage advance of $900 in May for the months of June, July and August. The wage advance would be prorated over the months of June, July, and August as earned income.

In addition, migrants or seasonal farm workers may not receive an advance lump sum, but will be paid in a lump sum at the end of their employment or contract period. Such income is prorated over the period the payment is intended to cover.

Bonuses, profit sharing, and other similar payments are not considered lump sum earnings or wages received other than monthly, but an extra payment of earned income based on a productive period. These are considered income in the month received.

Individuals who lost a source of income (earned or unearned) in the month of application will not have income from that source annualized. The terminated source of income actually received in the application month will only be counted in the month terminated.