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REV. MARCH 7, 2023 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY
477-000-002 477-000-002 – Renewal Process Renewals A redetermination of eligibility for continued Medicaid benefits must be completed every twelve (12) months. If information is not available to complete a renewal, a prepopulated renewal form shall be sent by the Department to the applicant or his/her authorized representative. The completed renewal form and necessary verifications shall be returned within thirty (30) days of the date the renewal form was sent. A renewal notice is sent to the client when the eligibility determination is complete. If the eligibility determination results in a negative action, the client or his/her authorized representative will receive a notice of action sent at least ten (10) calendar days before the date the action becomes effective, which is always the first day of the month. If the renewal form and necessary information are submitted within ninety (90) days after termination, a new application shall not be required. Note: A renewal application may be submitted in person, by mail, by telephone, by fax, or by electronic submission at www.accessnebraska.ne.gov. The application is considered valid the date it is received by the Department if it contains the applicant’s name, address, and proper signature of the applicant or authorized representative. MAGI (Modified Adjusted Gross Income) Renewal:
A renewal application is only needed if permission to attempt a renewal using electronic data sources is not on file or the electronic data sources do not provide verification as defined by the Nebraska Verification Plan. Non-MAGI Renewal (Non SSI): A prepopulated renewal form shall be required every twelve (12) months for Non-MAGI based eligibility renewals. The completed renewal form and necessary verifications shall be returned within thirty (30) days of the date the renewal form was sent.
Note: A medical need must exist to be approved in a medically needy category. If there is no medical need, the client must reapply in the future when a medical need exists. Non-MAGI Renewal (SSI): Clients receiving SSI at the time of renewal do not require an application.
SSI clients who are determined eligible for Medicaid by the Social Security Administration (SSA) under the provisions of 1619(b) are not required to complete an application at renewal, and resources do not need to be verified. A renewal is not required for periodic non-pay for income due to an extra pay period.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
477-000-003 – Citizenship/Identity
Primary Citizenship and Identity verified by one of the following: 1. The Federal data services hub, which includes Social Security and SAVE 2. U.S. Passport 3. Vital Statistics 4. Certificate of Naturalization (N-550 or N-570) 5. Certificate of Citizenship (N-560 or N-561) 6. Receipt of Supplemental Security Income(SSI) as shown on SDX interface 7. Receipt of Social Security Disability Insurance (SSDI) as shown on BDE interface 8. Documentation of child receiving foster care or adoption assistance payments under Title IV-B or IV-E 9. Deemed Newborn 10. Entitlement to or enrollment in Medicare as shown on BDE interface 11. A document issued by a federally recognized Indian Tribe evidencing membership, enrollment in, or affiliation with such tribe. The document must identify the federally recognized Indian Tribe which issued it, identify the individual by name, and confirm the individual’s membership, enrollment in, or affiliation with that Tribe. Some examples include Tribal enrollment and membership cards, a certificate of degree of Indian blood issued by the Bureau of Indian Affairs, a Tribal census document, or a document issued by a Tribe indicating an individual’s affiliation with the Tribe.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
If none of the above is available, you must have one document from the Citizenship listing and one document from the Identity listing below.
Citizenship (secondary list start at top) Identity (start at top)
A U.S. public birth record showing birth in: One of the 50 U.S. States or Nebraska DHHS IM-22 proof of birth District of Columbia American Samoa Swain’s Island Puerto Rico (if born on or after 1-12-1941) Virgin Islands of the U.S. (on or after 1-17- 1971) Northern Mariana Islands (after 11-4- 1986) Guam (on or after 4-10-1899)
Any of the following identity documents in the Immigration and Nationality Act: Driver’s license issued by a U.S. State or Territory either with a photograph of the individual or other identifying information such as name, age, sex, race, height, weight or eye color School identification card with a photograph of the individual U.S. military card or draft record Identification card issued by the Federal, State, or local government with the same information included on driver’s licenses such as name, age, sex, race, height, weight, or eye color Military dependent’s identification card Native American Tribal document U.S. Coast Guard Merchant Mariner card
Note: For children under 16, school records may include nursery or daycare records. If none of the above documents in the preceding charts are available, an affidavit may be used. An affidavit is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of the birth of the child and cannot be used if an affidavit for citizenship was provided. The parent’s signature on the DHHS application for assistance meets the requirement for this affidavit. Certification of Report of Birth (DS-1350) issued by Department of State if born outside the U.S. School record that shows date and place of birth and parent(s) name.
Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240) Clinic, doctor or hospital record showing date of birth Certification of Birth Abroad (FS-545 or DS- 1350) Daycare or nursery school record showing date and place of birth United States Citizen Identification Card (I- 197) or the prior version I-179
Religious record (cradle roll, naming certificate, baptismal record, Amish or Mennonite bishop’s letter) Northern Mariana Card (I-873)
Life/health insurance policy for the child showing in addition to the child’s name, the child’s age or date of birth
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
Citizenship (secondary list start at top) Identity (start at top) American Indian Card (I-872)
Final adoption decree showing the child’s name and U.S. place of birth.
Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native tribal document. Must contain photograph of the applicant/recipient, or other personal identifying information relating to the individual. Evidence of civil service employment by the U.S. government showing employment by the U.S. government before 6-1-1976.
Official Military record of service showing a U.S. place of birth (for example a DD-214)
Citizenship (start at top) (level 3 & 4 list to be used if no other Citizenship documents are available) Extract of hospital record on hospital letterhead established at the time of the person’s birth and was created at least 5 years before the initial application date and indicates a U.S. place of birth Life or health or other insurance record showing a U.S. place of birth and was created at least 5 years before the initial application date Federal or State census record showing U.S. citizenship or a U.S. place of birth (Generally for persons born 1900 through 1950) Any of the following documents that were created at least 5 years before the application for Medicaid: Seneca Indian tribal census record Bureau of Indian Affairs tribal census records of the Navaho Indians U.S. State Vital Statistics official notification of birth registration An amended U.S. public birth record that is amended more than 5 years after the person’s birth Statement signed by the physician or midwife who was in attendance at the time of birth Institutional admission papers from a nursing home, skilled nursing care facility or other institution and was created at least 5 years before the initial application date and indicates a U.S. place of birth Medical (clinic, doctor, or hospital) record and was created at least 5 years before the initial application date and indicates a U.S. place of birth Written Affidavit. Affidavits should ONLY be used in rare circumstances. An affidavit by at least 2 individuals of whom one is not related to the applicant/recipient and who have personal knowledge of the event establishing the applicant’s or recipient’s claim of citizenship. The person(s) making the affidavit must be able to provide proof of his/her own citizenship and identity for the affidavit to be accepted. If the affiant has information which explains why documentary evidence establishing the applicant’s claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well. It must also be signed under penalty of perjury by the person making the affidavit. A second affidavit from the applicant/recipient or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily obtained must also be requested.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
USCIS Documents Issued by the Department of Homeland Security: Person Documents An alien lawfully admitted to the U.S. for permanent residence under the INA NFOCUS - select "Lawful Permanent Resident Form I-551, Alien Registration Receipt Card annotated with Section 101(a)(15), 101(a)(20), 212(b)(5), 245A, 245(b)(1), 249. A refugee admitted under the INA NFOCUS - select "Refugee- Section 207" Form I-94/I-94A, Arrival/Departure Record annotated with Section 207, Form I-688B annotated with Section 247A.(a)(3), which is valid until the refugee receives Form I-766, Employment Authorization Document (EAD) annotated with 271a12(a3). Asylum granted under the INA NFOCUS - Select "Asylee- Section 208" Form I-94/I-94A, annotated with Section 208, and/or a notation such as “asylum granted indefinitely.” Grant letter/Order from Asylum Office of USCIS; Form I-688B annotated 274a12(a)(5) or Form I-766 annotated 274a12(A5). Deportation is being withheld under the INA NFOCUS - Select "Deportation Withheld - Section 243(h)" Form I-94, annotated with Section 243(h), or 241(b)(3) of the INA. Order of an Immigration Judge showing deportation withheld under 243(h) or 241(b)(3) and date of the grant or Form I-688B annotated 274a12(c)(10) or Form I-766 annotated 274a12(A10). An alien granted parole for at least 1 year under INA NFOCUS - Select "Public Interest Parolee - Section 121(d)(5) Form I-94, annotated with Section 212(d)(5) and showing granting of parole for at least one year. Cuban or Haitian entrant NFOCUS - Select "Cuban- Haitian Entrant - Section 207" (207 will be corrected) Form I-94, annotated as "Cuban/Haitian Entrant CU6, CU7, CH6 Reviewable January 15, 1981." annotated 501(e). Form I-511 with coding CH6 or unexpired temporary card I-511. Form I-94 annotated 212(d)(5). Alien who has been battered or subjected to extreme cruelty NOCUS - Select "Worker determined Eligible" Letter stating approval of applicant's petition, Section 204(a)(1)(A)(iii) or Form I-511 "COA." Form I-797 indication that applicant has established prima facie case. Amerasian (Vietnam) NFOCUS - Select "Amerasian" Form I-94 annotated 204 or 584, Form I-511 annotated 204 or 584.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
How to Identify USCIS Documents:
Current Lawful Permanent Resident Card – Form I-1551 This card is often referred to as a “green card.”
FRONT: Green and blue background with the person’s photograph on the left and the Statue of Liberty on the right side. The top of the card reads “United States of America Permanent Resident.” The person’s USCIS number, category code, country of origin, and date of birth are printed in the center. A laser-engraved fingerprint is found in the lower right-hand corner. The expiration date is on the front: month, day, and year.
Note: this card may contain no expiration date, a 10-year expiration date, or a two-year expiration date. Cards that expire in 10 years or not at all are issued to lawful permanent residents with no conditions on their status. Cards that expire in two years are issued to lawful permanent residents with conditions on their status. Conditional residents can lose their status if they fail to remove these conditions.
BACK: Color gradually changes from pink to blue. A barcode strip is found at the top. Three lines of machine readable printing are found at the bottom on white background.
An expired Permanent Resident Card along with a Form I-797, Notice of Action, indicates that the card is valid for an additional year.
Unexpired Foreign Passport with I-551 Stamp A foreign passport may contain a temporary I-1551 stamp or temporary I-1551 printed notation on a machine-readable immigrant visa (MRIV). Verify when the stamp or MRIV expires. If the stamp or MRIV does not contain an expiration dated, the document expires one year after the issuance date.
Unexpired Foreign Passport with Arrival/Departure Report - Form I-94/I-94A The Form I-94 must bear the same name as the passport and contain an endorsement of the alien’s nonimmigrant status that authorizes the person to work for a specific employer incident to this status.
This documentation may only be used if the period of endorsement has not yet expired and the proposed employment does not conflict with any restrictions or limitations listed on Form I-94 or I-94A, Arrival/Departure Report.
Proof of entry is signified by U.S. immigration stamp. Date of entry is stamped. Non-immigrant visa classification (letter or letter and number) is printed or stamped on "Admitted" line. Valid status expires on date enumerated at "Until" section of stamp. Refugees and asylees each receive a separate INS stamp. Asylum seekers have "valid to" date, while refugees have a date of admission.
REV. MARCH 24, 2016 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003
Employment Authorization Card – Form I-688, Form I-688A, Form I-688B, or Form I-766 FRONT: Blue and gray background with a red header bar at the top reading “United States of America Employment Authorization Card.” The person’s USCIS number, category code, country of origin, and date of birth are printed in the center. A laser-engraved fingerprint is found in the lower right-hand corner. The expiration date is on the front: month, day, and year.
BACK: White background with barcode across the top and a light blue bar across the middle. The USCIS insignia is printed on the upper left-hand corner next to a disclaimer that begins with “This card is not evidence of U.S. citizenship or permanent residence.” Three lines of machine readable printing are found at the bottom on white background.
Federally Recognized American Indian Tribes
In Nebraska:
1. Omaha Tribe of Nebraska; 2. Ponca Tribe of Nebraska; 3. Santee Sioux Nation, Nebraska (formerly the Santee Sioux Tribe of the Santee Reservation of Nebraska); and 4. Winnebago Tribe of Nebraska.
Tribes with Overlap into Nebraska:
1. Iowa Tribe of Kansas and Nebraska, and 2. Sac and Fox Nation of Missouri in Kansas and Nebraska.
For the complete list of federally recognized tribes, see 78 FR 26384.
REV. OCTOBER 29, 2019 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY
477-000-004 477-000-004 – Verification Plan/Verification and Document Guide Verification and Documentation Guide When making a determination of eligibility, it is necessary for the worker to document how the determination was made. All points of eligibility must be considered. Certain elements require verification while others require only that they be considered when determining eligibility. Throughout the process, the worker must record pertinent facts establishing why and how a particular determination was made. Verification is the process by which the worker establishes the accuracy of the client’s declaration. This is usually accomplished by viewing electronic data sources, documents, statements, or other pertinent materials which substantiate the client’s statement. Documentation is the process whereby the worker records facts pertaining to the verification process or means by which the worker establishes the point of eligibility or ineligibility. Documentation consists of, but is not limited to, the following information: 1. A description of what is being verified or considered; i.e., checking account number 123 456 7, ABC Bank; 2. A description of the source and date of verification. Example: “See bank statement from ABC Bank dated 4-10-06 in the case record. Worker received bank statement from ABC Bank on 4-12-06 for the period from 1-1-06 to 3-31-06”; 3. For a resource, description of current ownership, i.e., Mary and/or John Jones; and 4. Current value, i.e., checking account balance $5.12. For every element of eligibility, the case record must contain an explanation of how a determination regarding that point was made. In all cases the worker shall check reasonable compatibility in determining whether to use more than the minimum verifications. If the worker doubts the validity of a particular verification, s/he should investigate further and determine if a referral is needed for the Special Investigation Unit.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-004 MANUAL LETTER #43-2018 Nebraska MAGI-Based Eligibility Verification Plan for Medicaid & CHIP (MAGI) Eligibility Factor Verification Source Reasonable Compatibility/ Reasonable Explanation Electronic Sources to be Utilized Comments Income Electronic data sources shall be utilized to verify income if available.
If the electronic data sources are not available, reasonably compatible or a reasonable explanation does not apply, paper documentation will be required. If an applicant/beneficiary attests to income below the applicable standard and the electronic data source indicates income above the applicable standard, a 10% threshold shall be applied. If the attested income and the electronic data source is within 10% or less, the income is reasonably compatible and no further action is required.
A reasonable explanation shall be used if for example, the individual ended employment the month (March) before the application was made (April). Internal Revenue Service (IRS), TALX, SEW, SSA, or unemployment. New hire matches (NHM) and Provider payments are a lead only (not to be used to verify income). Applicable information gathered from TANF and SNAP (I.e. current paystubs) If the self- attested income and electronic data source is both below the applicable standard, the income is verified. If the self- attested income and electronic data source is both above the applicable income standard, the individual is ineligible for Medicaid. If the self- attested income is above and the electronic data source is below the applicable standard, the individual is ineligible for Medicaid.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Eligibility Factor Verification Source Reasonable Compatibility Electronic Sources to be Utilized Comments Residency Self-Attestation without additional documentation shall be applied. If the attested information is not reasonably compatible to information known to the agency, additional information shall be required. No electronic data sources are available to verify residency. Paper documentation is required if the self-attested information is not reasonably compatible. I.e. a copy of the clients lease or utility bill that shows the clients address. Age (date of birth) Electronic data sources shall be utilized to verify age if available.
If the attested information is not reasonably compatible to information known to the agency, additional information shall be required. Social Security Administration (SSA), Vital Statistics, Department of Motor Vehicles (DMV), Office of Child Support Enforcement, Medicare Part D Interface. Applicable information gathered from TANF or SNAP in the case file. If the electronic data sources listed are not available or not reasonably compatible, paper documentation shall be required. Social Security Number (SSN) Electronic data sources shall be utilized to verify SSN if available. If the attested information is not reasonably compatible to information known to the agency, additional information shall be required. SSA, Vital Statistics, or applicable information gathered from TANF or SNAP in the case file. A copy of the card is not necessary.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Eligibility Factor Verification Source Reasonable Compatibility/ Reasonable Explanation Electronic Sources to be Utilized Comments
Citizenship Electronic data sources shall be utilized to verify Citizenship if available. If the attested information is not reasonably compatible to information known to the agency, additional information shall be required. SSA, Department of Homeland Security (DHS)- SAVE, Vital Statistics, State Verification and Exchange System (SVES) or applicable information gathered from TANF or SNAP in the case file. If the electronic data sources listed are not available or not reasonably compatible, paper documentation shall be required. Consider the 90- day reasonable opportunity period. Immigration Status Electronic data sources shall be utilized to verify Immigration if available. If the attested information is not reasonably compatible to information known to the agency, additional information shall be required. DHS-SAVE or applicable information gathered from TANF or SNAP. If the electronic data sources listed are not available or not reasonably compatible, paper documentation shall be required. Consider the 90- day reasonable opportunity period. Household Composition Self- attestation without additional documentatio n shall be applied for household composition. If the attested information is not reasonably compatible with information that is known the agency, additional documentation shall be required. No electronic data sources are available to verify household composition. Paper documentation is required if the self-attested information is not reasonably compatible. I.e. a signed statement from the landlord.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Eligibility Factor Verification Source Reasonable Compatibility/ Reasonable Explanation Electronic Sources to be Utilized Comments
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY Pregnancy Self- attestation without additional documentation shall be applied for pregnancy and due date. If the attested information is not reasonably compatible with information that is known to the agency additional documentation is required. No electronic data sources are available to verify pregnancy. Paper documentation is required if the self-attested information is not reasonably compatible (i.e., a statement from a doctor verifying the pregnancy). Caretaker Relative Self- attestation without additional documentation shall be applied for caretaker relative. If the attested information is not reasonably compatible with information that is known to the agency additional documentation is required. If necessary: Vital Statistics, Office of Child Support Enforcement, or applicable information gathered from TANF. Paper documentation is required if the self-attested information is not reasonably compatible (i.e., court ordered guardianship /conservatorship papers). Medicare Electronic data sources shall be utilized to verify Medicare. If the attested information is not reasonably compatible with information that is known to the agency, additional documentation is required. SSA, SNAP, or Medicare Part D interface. If the electronic data sources listed are not available or not reasonably compatible, paper documentation is required. Application for Other Benefits Electronic data sources shall be utilized to verify application for other benefits. If the attested information is not reasonably compatible with information that is known to the agency, additional documentation is required. SSA, PARIS, or applicable information gathered from TANF. If the electronic data sources listed are not available or not reasonably compatible, paper documentation is required.
MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Reasonably Compatibility Scenarios The following scenarios provide examples related to reasonable compatibility with respect to income:
Scenario 1: Charles submitted an initial application for Medicaid. He is a single, parent/caretaker relative to three children. Individual self-attestation of income is below the Medicaid MAGI eligibility level and the Data match shows Charles’ income is below the Medicaid eligibility level: o Eligibility level= $1175 (monthly) o Self-attested current income= $700 o IRS data= $800 Determination: Charles is determined eligible for Medicaid because the information received from the electronic data sources and the self-attested information is all below the Medicaid eligibility level. Scenario 2: Betty submitted an initial application for Medicaid. She is a single, parent/caretaker relative to one child. Individual self-attestation of income is above the Medicaid MAGI eligibility level and the Data match shows that the Betty’s income is above the Medicaid MAGI eligibility level. o Eligibility level= $774 o Self-attested current income= $1,655 o IRS data= $1,542 Determination: The self-attested income and the information from the data sources are all above the Medicaid eligibility level, so Betty is determined ineligible for Medicaid and screened for eligibility for APTC/CSR through the Exchange. Scenario 3: Sophie submitted an initial application for her two children, Scarlett (age 3) and Ben (age 7). The children have creditable health insurance. Ben: Individual self-attestation of income is below the Medicaid MAGI eligibility level and the Data match shows that Sophie’s income is above the Medicaid MAGI eligibility level. Scarlett: Individual self-attestation of income is below the Medicaid MAGI eligibility level and the data match shows that Sophie’s income is below the Medicaid MAGI eligibility level. o Eligibility level for Scarlett= $ 2,436 o Eligibility level for Ben= $2,234 o Self-attested current income= $2,100 o IRS data= $2,250 Determination: Scarlett is determined eligible for Medicaid as the information received from the electronic data source and the self-attested information is below the Medicaid eligibility level. The reasonable compatibility standard is applied in Ben’s scenario as the self-attested income is below the Medicaid level and the data source is above the applicable income level. Ben is determined Medicaid eligible as the self-attested income and the electronic data source is at 10%.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Scenario 4: Sophie submitted an initial application for her two children, Scarlett (age 3) and Ben (age 7). The children have no creditable health insurance. Individual self-attestation of income is below the Medicaid MAGI eligibility level and the Data match shows that Sophie’s income is above the Medicaid MAGI eligibility level. o Eligibility level for Scarlett= $2,436 o Eligibility level for Ben= $2,234 o CHIP level= $3,578 o Self-attested current income= $3,400 o IRS data= $3,850 Determination: The reasonable compatibility standard is applied in Scarlett and Ben’s scenario. Paper documentation is required as the self-attested income is not within 10% of the electronic data source. Once verification is received the determination will be made. Scenario 5: James submitted an initial application for Medicaid. James is a single parent to four children. Individual self-attestation of income is above the Medicaid MAGI eligibility level and the data match shows that James’ income is below the Medicaid MAGI eligibility level. o Eligibility level= $1375 o Self-attested current income= $2,450 o IRS data= $1,000 Determination: James is determined ineligible for Medicaid based on his self-attested income and screened for APTC/CSR through the Federally Facilitated Marketplace (FFM). Scenario 6: Kimberly submitted an initial application for Medicaid. Kimberly is a single parent to one child. o Eligibility level= $774 o Self-attested current income= $1,500 o IRS data= $2,000 Determination: Kimberly is determined ineligible for Medicaid based on her self-attestation and the data match over the applicable income standard. Kimberly is screened for APTC/CSR through the FFM. Data Sources and Verifications The following is a listing of some of the most common verification sources. There may be other acceptable sources that are not listed here. A. Age Primary Source Federal Data Hub (Social Security data match), BDE, or SDX.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Secondary Sources
a. Birth certificate (Bureau of Vital Statistics); b. Department of Motor Vehicles (DMV); c. Office of Child Support Enforcement (CSE); d. Adoption papers or records; e. Hospital or clinic birth records; f. U.S. Passport; Immigration or Naturalization Papers; or g. Indian census records. Sources of Third Level Documentation a. School records; b. Census records; c. Court support order; d. Juvenile court records; e. Child welfare records; f. Voluntary social service agency records; g. Insurance policy or insurance company records; h. Affidavits; i. Baptismal certificate recorded before age five; j. Church records; k. Military service record; or l. Midwife’s record of birth. B. Relationship 1. Specified Relative Accept attestation. If information is conflicting for any reason, follow up with verifications. Primary Sources State data interfaces available on N-FOCUS (Bureau of Vital Statistics, Child Support Enforcement). Secondary Sources a. Birth certificate; b. Adoption records; c. Court order records; d. Indian census records; e. Marriage licenses; f. Divorce papers; g. Court records of parentage; h. Signed paternity acknowledgement; i. Hospital or clinical records; j. Social service and welfare records; or k. Child support orders.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
2. Marital Status
Accept attestation. If information is conflicting for any reason, follow up with verifications. Primary Sources a. Bureau of Vital Statistics; b. Marriage license; c. Divorce papers; or d. Separation papers. Secondary Sources a. Local judicial records; b. Social Security Administration. C. Citizenship See 477-000-003. D. Identity Accept attestation. If information is conflicting for any reason, follow up with verifications. See 477-000-003. E. Residency See 477 NAC 6-002, 6-004 for residency requirements for institutionalized individuals and individuals entering a facility. Primary Sources 1. Rent or mortgage receipt, lease, agreement, etc.; 2. A signed statement from a landlord; 3. Property ownership records; or 4. A signed statement from an employer. Secondary Sources 1. A current driver’s license; 2. Utility bills or company records; 3. Verification of vehicle registration from the Department of Motor Vehicles; 4. County assessor records; 5. Post Office records; 6. Church or synagogue records; or 7. A signed statement from an individual(s) who has knowledge of the situation.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
F. Household Composition
Accept attestation. If information is conflicting for any reason, follow up with verifications. Primary Sources 1. Rent or mortgage receipt, lease, agreement, etc.; 2. School records; or 3. A signed statement from a landlord; Secondary Sources 1. A current driver’s license; 2. Utility bills or company records; 3. Verification of vehicle registration from the Department of Motor Vehicles; 4. County assessor records; 5. Post Office records; 6. Church or synagogue records; or 7. A signed statement from an individual(s) who has knowledge of the situation. G. Pregnancy Accept attestation. If information is conflicting for any reason, follow up with verifications. Verification may be provided by a physician or another licensed medical professional who verifies pregnancy for programs such as Maternal Health, WIC, Family Planning, or presumptive eligibility. Licensed medical professionals may include but are not limited to – 1. Physicians; 2. Nurse practitioners; 3. Physician assistants; 4. Nurse midwives; 5. Qualified providers (for presumptive eligibility determinations); or 6. Other, with approval of the DHHS Central Office. The verification statement must include the licensed medical professional's name, title, date completed, and expected due date. H. Social Security Number Primary Source Federal Data Hub (Social Security data match)
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Secondary Sources 1. Attestation of Social Security number; 2. Signed copy of Form SS-5; 3. Copy of a birth certificate with permission checked to provide Social Security Administration with information for a Social Security card; 4. Form SSA-2853 with the name of the newborn, and a signature and date by an authorized hospital official; 5. Medicare card with a claim number with a suffix "A"; or 6. Dated documentation from SSA that an application for an SSN has been made. Note: A copy of an individual’s Social Security card is NOT required. As a courtesy, a client who does not have a Social Security number but would like to apply for a one may be given a Referral for Social Security Number Application form. I. Non-MAGI Resources Please see 477-000-052 for the Non-MAGI Resource Verification Plan J. Income: Verify income declared by the client or appearing on SEW and evaluate the possibility of additional income. Also consider potential income for which the client may be eligible. 1. Earned Income: Verify the employment status (full time, part time, or temporary), name of the employer, and the gross amount and frequency of the earnings. Primary Sources Federal Data Hub (Tax interface is only applicable to MAGI-based methodology and TALX is applicable for MAGI-based methodology and non-MAGI). Secondary Sources a. Nebraska’s electronic data sources (SEW); b. Paystubs; c. Employer's wage records; or d. A statement from the employer. K. Self-Employment: Verify the amount of income as well as the allowable expenses directly related to producing the goods and services. Primary Source Federal Data Hub (The tax interface is only applicable to MAGI-based methodology).
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
Secondary Sources
a. An income tax return; b. Self-employment bookkeeping records; c. Sales and expenditure records; d. State income tax bureau; or e. Business expense receipts. Source of Third Level Documentation A Statement from the client of estimated earnings. L. Unearned Income: Explore all potential sources of unearned income. When the client states s/he does not receive a benefit, evaluate this in terms of the client's background, marital history, past work history, and present circumstances. For example, a review of the client's employment history may indicate a possible eligibility for unemployment compensation, a company retirement pension, or benefits from past union membership.
1. RSDI Benefits: Verify the amount of RSDI benefits and evaluate the existence of RSDI as potential income. A routine check should be made in all cases where a child is deprived of parental support because of death or incapacity, or when a client is retired, disabled, widowed, or divorced. Primary Sources Federal Data Hub, BDE, or SDX file. Secondary Sources a. RSDI benefit payment check; b. Recent RSDI award letter or other correspondence from SSA; or c. Contact with SSA. 2. Veteran's Income: Verify the amount and type of VA income and evaluate the existence of VA as potential income. Explore the client's and spouse's background and past military service record. Primary Sources a. VA check; b. VA award letter or other written correspondence; c. VA Form 21-0172, Certificate of Permanent and Total Disability; d. IRS Form 1099-R (May be issued to a veteran by the Defense Finance and Accounting Services which reflects the taxable portion of compensation received.) e. A release from active duty showing disability; f. Other contact from VA; or g. SDX financial file. NOTE: Income alerts from interfaces such as PARIS regarding Veterans/Military income are to be treated as leads only.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
3. SSI: If any person is aged, blind, or disabled, explore the client's eligibility for SSI benefits. Verify the amount of the benefit.
Primary Sources Federal Data Hub or SDX file. Secondary Sources a. Current award letter or other correspondence; b. Recent SSI check; or c. Contact with SSA. 4. Unemployment Compensation: Verify the amount of unemployment compensation received. Explore the client's background, past work history, and recent employment to determine eligibility for unemployment compensation. Primary Sources a. Unemployment data match; b. Unemployment compensation award letter; or c. Correspondence from unemployment compensation office. 5. Workers’ Compensation: Verify receipt, continuation of, and amount of worker's compensation. Examine the client's past work history and present circumstances, especially if the client is disabled, to determine eligibility for or receipt of worker's compensation. Primary Sources a. Workers’ compensation award notice; b. Workers’ compensation payment check; or c. Workers’ compensation office correspondence. 6. Other Unearned Income: Verify the receipt and amount of pensions, benefits, annuities, child support, etc. Explore the potential for other income by evaluating the client's background, past work history, and present circumstances. Primary Sources a. Current award letter; b. Current benefit check; c. Correspondence; d. Contact with the agency; e. Court records; or f. Computer printouts. Secondary Sources a. Past award letter; or b. Copies of past checks.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
7. Contributions and In-Kind Income: Verify any in-kind income and contributions to which a money value is given. Verify the source and the amount. Verification consists of the name and address of the source of payment. Contact the source to verify the amount and frequency of the payment.
Primary Sources a. Contribution check; b. Statement from the person making a contribution; c. Cancelled checks of the person making a contribution; or d. Receipt for the contribution. Secondary Sources a. Client's statement of receipt; or b. A signed statement from an individual(s) who has knowledge of the situation. 8. Deemed Income: Determine and document whether deeming is appropriate. Verify the amounts of earned and unearned income and allowable deductions. Primary Sources a. Receipts of unearned income, e.g., award letter or benefit check; b. Receipts of earned income, e.g., paystubs or employer records; c. Immigration and Naturalization Service records; d. Correspondence from INS; or e. Receipts verifying income deductions. Secondary Sources a. Statement from client; or b. A signed statement from an individual(s) who has knowledge of the situation. 9. Educational Grants, Scholarships, Loans: Verify - a. The contract or the originator of the grant, loan, or scholarship; b. If the grant, loan, or scholarship may be used for current living costs; and c. If the grant, loan, or scholarship is for educational purposes and insured under any program administered by the Department of Education. Primary Sources a. Statement from the client; or b. A signed statement from an individual(s) who has knowledge of the situation.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004
M. Student Status
Accept attestation. If information is conflicting for any reason, follow up with verifications. Primary Sources a. School class schedule; or b. Letter from the school registrar N. Maternity/Paternity Primary Sources State data interfaces available on N-FOCUS (Bureau of Vital Statistics, Child Support Enforcement). Secondary Sources a. Birth certificate; b. Adoption records; c. Court order records; d. Indian census records; e. Court records of parentage; f. Signed paternity acknowledgement; g. Hospital or clinical records; h. Social service and welfare records; or i. Child support orders.
477-000-005
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-005 – Standardized CSE Referrals for Medicaid Child Support Referral: As stated in 477 NAC 12-011, Medicaid recipients are required to cooperate with Child Support Enforcement (CSE). When there is an adult/parent (including pregnant women and minor parents) eligible for medical services, a Child Support (CS) referral is required after the date eligibility is approved. Absent Parents Can Include: • Step-parents. • Biological parents. • Adoptive parents. • Alleged fathers (even if the name is unknown). • Deceased parents when the deceased parent was a non-custodial parent at the time of death. o A CS referral is not made when the deceased parent was a member of the child’s household at the time of death. • Alleged parent who lives in the home, but paternity has not been established. Paternity Establishment: If the father’s name is not on the birth certificate and the couple is unmarried, in order to legally establish paternity, the parents can either complete a notarized acknowledgment of paternity, as provided in Neb. Rev. Stat. § 43-1408.01, or bring a civil proceeding to establish paternity in district court as provided in Neb. Rev. Stat. § 43-1411.
Standardized Child Support Referral: A CS referral is completed when: • There is an adult eligible for medical services (including during the postpartum period) and there is an absent parent. • There is an adult eligible for medical services (including during the postpartum period) and the alleged father is in the home, but paternity has not legally been established. A CS referral is not required if a program closes and re-opens; however, if new information is available, a new CS referral can be sent. • CSE staff will send a questionnaire to the client. Exceptions to Referral: A referral is not made to the CSE unit for / when: 1. Only the child(ren) is receiving Medicaid. 2. An unborn child (599 CHIP). 3. An emancipated minor. 4. A child(ren) receiving Home & Community Based Services in the home of both parents. 5. A deceased parent when the parent was a member of the child’s household at the time of death.
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-005 a. A CS referral is appropriate when the deceased parent was a noncustodial parent at the time of death. b. If a deceased parent was out of the child’s household at the time of death and the time of death has been more than 2 years ago, child support can only enforce an order up to 2 years past the date of death. 6. The parent cannot meet the Share of Cost (SOC). 7. Independent living programs.
Case Scenarios When a Referral Should Not Be Sent: 1. A Minor mother who is living with her parent(s), is in his/her own Master Case with a new child, the father is in the household, and paternity has been established. 2. Both biological parents in which paternity has been established who live in the home with the child. 3. A CS referral does need to be made during the postpartum period (this would not apply to 599 CHIP) for a newborn whose father is either absent from the home or who has not formally acknowledged paternity.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
477-000-006 – Determination of Medicaid Budgeting Procedures
Determining MAGI-Based Eligibility
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
A. Does the individual expect to file taxes? i. If no – continue to Step B. ii. If yes – does the individual expect to be claimed as a tax dependent by anyone else? 1. If no – the household consists of the taxpayer, a spouse living with the taxpayer or filing jointly, and all persons whom the taxpayer expects to claim as a tax dependent. If the individual is under the age of 19 and living with a parent(s), move to Step C. Is anyone in the household pregnant? If yes – the household also includes the total number of expected unborns. STOP HERE. 2. If yes – continue to Step B.
B. Does the individual expect to be claimed as a tax dependent? i. If no – continue to Step C. ii. If yes – does the individual meet any of the following tax dependent exceptions? The individual expects to be claimed as a tax dependent of someone other than a spouse or biological, adopted, or step parent. The individual is a child under 19, living with both parents, but the parents do not expect to file a joint tax return. The individual is a child under age 19, who expects to be claimed by a non-custodial parent. 1. If no – the household is the household of the taxpayer claiming him/her as a tax dependent. Is the individual married? If yes – the household also includes the individual’s spouse. Is anyone in the household pregnant? If yes – the household also includes the total number of expected unborns. STOP HERE. 2. If yes – continue to Step C.
C. For individuals who neither expect to file a tax return nor expect to be claimed as a tax dependent, as well as tax dependents who meet one of the exceptions in B. ii., the household consists of the individual and, if living with the individual— The individual’s spouse; The individual’s biological, adopted, and step children under age 19;
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
In the case of individuals under age under age 19, the individual’s biological, adopted, and step parents and biological, adopted, and step siblings under age 19; and In the case someone in the individual’s household is pregnant, the total number of expected unborns.
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
A. Is any household member the child or expected tax dependent of another member of the household? i. If yes – is the individual required to file a tax return? If yes – continue to Step B and include the child’s income in the total household income. If no – continue to Step B but do NOT include the child’s income in the total household income. ii. If no – continue to Step B.
B. Determine the MAGI-based income of each member of the individual’s household, unless the income of such member is flagged as not being counted in Step A. Recall that, for purposes of Medicaid and CHIP eligibility, the following rules apply, regardless of the rule applied for purposes of the Exchange/APTC eligibility: An amount received as a lump sum is counted as income only for the month received. Scholarships, awards, or fellowship grants used for education purposes and not for living expenses are excluded from income. Certain distributions, payments, and student financial assistance for American Indians and Alaska Natives are excluded from income. Actually available cash support, exceeding nominal amounts, provided by a person claiming an individual as a tax dependent but who is not the individual’s biological, adopted, or step parent is excluded from income.
C. Household income equals the sum of the MAGI of every member of the individual’s household determined in Step B.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Examples of How to Construct a Medicaid/CHIP Household
STEP-BY-STEP EXAMPLE – MARY & FAMILY
Mary is a 56-year-old working grandmother who claims her daughter Samantha, age 18 and a full-time student, and her granddaughter Joy (Samantha’s daughter), age 2, as tax dependents. No one in the household is blind or disabled. No one in the household is pregnant. No one in the household has health insurance.
Relevant Information: Mary earns $4,500/month ($54,000/year) Samantha earns $300/month ($3,600/year) There are no other sources of income Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes. Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL Nebraska’s CHIP income standard is 213% FPL Nebraska’s Parent/Caretaker Relative income maximum is:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
MARY expects to file taxes (A-ii) and she does not expect to be claimed as a tax dependent (A-ii-1), so her Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Mary’s household consists of the taxpayer (Mary) and all persons who the taxpayer expects to claim as a tax dependent. Mary expects to claim her daughter Samantha and her granddaughter Joy as tax dependents.
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
MARY’S MEDICAID HOUSEHOLD = Mary + Samantha + Joy Note: Because Mary is not a child she is ineligible for CHIP.
SAMANTHA is not expected to file taxes (A-i) and she expects to be claimed as a tax dependent by her mother Mary (B-ii), so her Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. If Samantha fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. We must consider whether any of the exceptions for tax dependents apply, as listed below: Is the individual (Samantha) the tax dependent of someone other than a spouse or a biological, adopted, or step parent? NO Is the individual (Samantha) a child living with both parents, but the parents do not expect to file a joint tax return? NO Is the individual (Samantha) a child who expects to be claimed by a non-custodial parent? NO Because none of the tax dependent exceptions apply, Samantha is not married, and no one in the household is pregnant, Samantha’s household is the same as the household of Mary, the taxpayer claiming her as a dependent (B-ii-1). SAMANTHA’S MEDICAID/CHIP HOUSEHOLD = Samantha + Mary + Joy
JOY is not expected to file taxes (A-i) and she is claimed as a tax dependent by her grandmother Mary (B-ii), so her Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5. If Joy fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. We must consider whether any of the exceptions for tax dependents apply, as listed below: Is the individual (Joy) the tax dependent of someone other than a spouse of a biological, adopted, or step parent? YES (her grandmother, Mary) Is the individual (Joy) a child living with both parents, but the parents do not expect to file a joint tax return? NO Is the individual (Joy) a child who expects to be claimed by a non- custodial parent? NO Because Joy falls into one of the exceptions, we look to the rules for non-filers (C) to determine Joy’s household. This includes Joy plus any of the following, if they live with her: A spouse NO The children of the individual NO A parent or siblings of the individual YES – mother (Samantha) The total number of expected unborns if a member of the household is pregnant NO JOY’S MEDICAID/CHIP HOUSEHOLD = Joy + Samantha
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
MARY’S MEDICAID HOUSEHOLD = Mary + Samantha + Joy
Mary is required to file taxes and is not the child or expected tax dependent of another member of her household (A-ii). Therefore her Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Samantha is the child and expected tax dependent of Mary, another member of the household (A-i). Samantha’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. If Samantha fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. Joy is also the expected tax dependent of Mary (A-i). Joy’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5. If Joy fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. Neither Samantha nor Joy are required to file a tax return (A-i), so we will continue to Step B, but we do NOT include the children’s incomes (Samantha - $300/month, Joy - $0) in the total household income. Mary earns $4,500/month, so her MAGI-based income = $4,500/month (B). The household’s income equals the sum of the MAGI of every member of Mary’s household (C), so Mary’s Medicaid household income = $4,500/month. This household income equates to $4,500 for a household size of 3 for purposes of Parent/Caretaker Relative eligibility determination. MARY’S MEDICAID HOUSEHOLD INCOME = $4,500/month.
SAMANTHA’S MEDICAID/CHIP HOUSEHOLD = Samantha + Mary + Joy Samantha’s Medicaid/CHIP household income determination is the same as Mary’s; however, because Samantha qualifies as a child, her income must be expressed in a percentage of FPL (see Step 3, below). This household income equates to 277% FPL* for a household size of 3 for purposes of either a Medicaid eligibility determination for children age 6 through 18 or a CHIP eligibility determination. SAMANTHA’S MEDICAID/CHIP HOUSEHOLD INCOME = 277% FPL.
JOY’S MEDICAID/CHIP HOUSEHOLD = Joy + Samantha Joy is the child of Samantha, another member of the household (A-i). Joy is not required to file a tax return (A-i), so we will continue to Step B. Although Joy is claimed as a tax dependent by Mary, she meets the first exception (B-ii) and Joy’s household consists of Joy and Samantha (her parent). Although Samantha is the child and expected tax dependent of Mary for purposes of determining Joy’s household, Samantha is NOT the child or expected tax dependent of another member of Joy’s household (= Joy + Samantha) (A-ii), so we will continue to Step B.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Although Samantha is not required to file a tax return, her income counts because neither of her parents is included in this household. Samantha earns $300/month, so her MAGI-based income = $300/month (B). The household’s income equals the sum of the MAGI of every member of Joy’s household (C), so Joy’s Medicaid/CHIP household income = $300/month. This household income equates to 23% FPL* for a household size of 2 for purposes of either a Medicaid eligibility determination for children age 1 through 5 or a CHIP eligibility determination. JOY’S MEDICAID/CHIP HOUSEHOLD INCOME = 23% FPL.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
MARY: Because Mary claims Samantha and Joy, both children, as tax dependents, we determine Mary’s eligibility under the Parent/Caretaker Relative group. Nebraska’s Parent/Caretaker Relative income maximum is*:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
Mary’s Medicaid household income of $4,500/month for a household size of 3 exceeds the maximum of $841/month, so Mary is not eligible for Medicaid based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace. The agency will electronically transfer the account, including all relevant information, to the Marketplace for further evaluation.
Note: If an applicant indicated they may qualify for Medicaid on a non-MAGI basis, such as being medically needy (share of cost), or having blindness or a disability, the Medicaid agency would pursue such evaluation at the same time as the Exchange completed determination of eligibility for Exchange/APTC. This would require the applicant to supply the Medicaid agency with information on a supplemental form.
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
SAMANTHA: Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL. Samantha’s Medicaid/CHIP household income of 277% FPL exceeds the FPL percentage for both Medicaid and CHIP, so Samantha is not eligible for Medicaid or CHIP based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace. The agency will electronically transfer the account, including all relevant information, to the Marketplace for further evaluation.
JOY: Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household of 23% FPL, Joy is eligible for Medicaid. If Joy had not been eligible for Medicaid, she may have been eligible for CHIP because she is uninsured and her FPL percentage is below the CHIP income standard.
SIMPLIFIED EXAMPLE 1 – BOB & FAMILY
Bob is a 58-year-old working grandfather. Bob’s daughter Sophia, age 18 and a full-time student, and Sophia’s daughter Emma, age 2, live with Bob. Bob claims Sophia as a tax dependent but Emma is claimed as a tax dependent by her non-custodial parent Harold, who does not live with Bob. Bob, Sophia, and Emma are not blind or disabled. No one in the household is pregnant. No one has health insurance
Relevant Information: Bob earns $4,500/month ($54,000/year) Sophia earns $300/month ($3,600/year) There are no other sources of income Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes. Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL Nebraska’s CHIP income standard is 213% FPL Nebraska’s Parent/Caretaker Relative income maximum is:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
BOB expects to file taxes and he does not expect to be claimed as a tax dependent, therefore his Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Bob’s household consists of the taxpayer and all persons who the taxpayer expects to claim as a tax dependent. BOB’S MEDICAID HOUSEHOLD = Bob + Sophia
SOPHIA is not expected to file taxes and she is claimed as a tax dependent by her father, Bob. Sophia’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. If Sophia fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. None of the exceptions for tax dependents listed at 1-B-ii apply to Sophia. Because Sophia is not married, and no one in the household is pregnant, Sophia's household is the same as the household of Bob, the taxpayer claiming her as a dependent. SOPHIA’S MEDICAID/CHIP HOUSEHOLD = Sophia + Bob
EMMA is not expected to file taxes and she is claimed as a tax dependent by her father Harold. Emma’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5. If Emma fails Medicaid eligibility, she may be eligible for CHIP because she is uninsured. One of the exceptions for tax dependents listed at 1-B-ii applies to Emma: she is a child who expects to be claimed by a non-custodial parent. Because Emma falls into one of the exceptions, we look to the rules for non-filers to determine Emma’s household. This includes Emma plus her mother, Sophia, because Sophia and Emma live together. EMMA’S MEDICAID/CHIP HOUSEHOLD = Emma + Sophia
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
BOB’S MEDICAID HOUSEHOLD = Bob + Sophia
Bob is required to file taxes and is not the child or expected tax dependent of another member of his household. Bob’s Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Sophia is the child and expected tax dependent of Bob, so her Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18 or, if necessary, CHIP. Sophia is not required to file a tax return, so we will NOT include Sophia’s income ($300/month) in the total household income. Bob earns $4,500/month, so his MAGI-based income = $4,500/month. Because Sophia’s income does not count, Bob’s Medicaid household income = $4,500/month. The household’s income equals the sum of the MAGI of every member of Bob’s household, so Bob’s Medicaid household income = $4,500/month.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
This household income equates to $4,500 for a household size of 2. BOB’S MEDICAID HOUSEHOLD INCOME = $4,500/month.
SOPHIA’S MEDICAID/CHIP HOUSEHOLD = Sophia + Bob Sophia’s Medicaid/CHIP household income determination is the same as her father Bob’s; however, because Sophia qualifies as a child, her income must be expressed in a percentage of FPL. This household income equates to 348% FPL* for a household size of 2. SOPHIA’S MEDICAID/CHIP HOUSEHOLD INCOME = 348% FPL.
EMMA’S MEDICAID/CHIP HOUSEHOLD = Emma + Sophia Emma is the child of Sophia, another member of the household, so Emma’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5 or, if necessary, CHIP. Emma is not required to file a tax return, so will NOT include Emma’s income ($0) in the total household income. Although Sophia is the child and expected tax dependent of Bob for purposes of determining Bob’s household, Sophia is NOT the child or expected tax dependent of another member of Emma’s household (= Emma + Sophia). Although Sophia is not required to file a tax return, her income counts because neither of her parents is included in this household. Sophia earns $300/month, so her MAGI-based income = $300/month. Sophia’s Medicaid/CHIP household income = $300/month. This household income equates to 23% FPL* for a household size of 2. EMMA’S MEDICAID/CHIP HOUSEHOLD INCOME = 23% FPL.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
BOB: Nebraska’s Parent/Caretaker Relative income maximum is*:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly. By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Bob’s Medicaid household income of $4,500/month for a household size of 2 exceeds the maximum of $704/month, so Bob is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
SOPHIA: Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL. Sophia’s Medicaid/CHIP household income of 348% FPL exceeds the FPL percentage for both Medicaid and CHIP, so Sophia is not eligible for Medicaid or CHIP based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
EMMA: Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household of 23% FPL, Emma is eligible for Medicaid. If Emma had not been eligible for Medicaid, she may have been eligible for CHIP because she is uninsured and her FPL percentage is below the CHIP income standard.
SIMPLIFIED EXAMPLE 2 – ALICE & BILL
Alice is a 66-year-old working grandmother who is applying for coverage for herself and her 12- year-old grandson Bill, who lives with Alice. Alice does not plan to claim Bill as a tax dependent. Bill receives Social Security Survivor benefits, which count as income. Bill is not expected to file taxes. Alice and Bill are not blind or disabled, but Alice is age 65 or older. No one in the household is pregnant. Alice receives Medicare benefits; Bill has no health insurance.
Relevant Information: Alice earns $850/month ($10,200/year) Bill receives $500/month in Social Security Survivor benefits There are no other sources of income Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes. Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL Nebraska’s CHIP income standard is 213% FPL
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
ALICE expects to file taxes and she does not expect to be claimed as a tax dependent. However, because Alice is 66 years old, her eligibility for Medicaid will be based on ABD standards, in which tax filing requirements do not apply and eligibility is determined using non-MAGI ABD based methodology. Thus, at this point, we will discontinue any efforts to determine MAGI-based eligibility for Alice. To determine if Alice is eligible for Medicaid, she will have to provide more information on a supplemental form for ABD benefits.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
BILL is not expected to file taxes, nor does he expect to be claimed as a tax dependent by his grandmother, Alice. Because Bill is not married, he has no children, he does not live with his parents, and no one in the household is pregnant, Bill's household consists of himself only. BILL’S MEDICAID/CHIP HOUSEHOLD = Bill
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
BILL’S MEDICAID/CHIP HOUSEHOLD = Bill
Bill is not the child or expected tax dependent of another member of his household. Although Bill is a child, his Social Security Survivor benefits DO count as income. Bill collects $500/month, so his MAGI-based income = $500/month. This household income equates to 52% FPL* for a household size of 1. BILL’S MEDICAID/CHIP HOUSEHOLD INCOME = 52% FPL.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
ALICE: Because Alice is age 65 or older, her eligibility for Medicaid will be based on ABD standards, in which tax filing requirements do not apply. Her eligibility will be determined using non-MAGI ABD based methodology, with necessary information gathered on an ABD supplemental form.
BILL: Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household income of 52% FPL, Bill is eligible for Medicaid. If Bill had not been eligible for Medicaid, he may have been eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard.
SIMPLIFIED EXAMPLE 3 – KELLY & STANLEY’S FAMILY
Kelly is a 45-year-old woman applying for coverage for herself, her 47-year-old partner Stanley, her 15-year-old son Isaac, Stanley’s 14-year-old son Trent, and Stanley and Kelly’s 2-year-old son Jacob. Kelly claims Isaac as a tax dependent. Stanley claims Trent and Jacob as tax dependents. No one in the household is blind or disabled. No one in the household is pregnant. No one in the household has health insurance.
Relevant Information: Kelly earns $1,500/month ($18,000/year) Stanley earns $2,500/month ($30,000/year) There are no other sources of income
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes. Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL Nebraska’s CHIP income standard is 213% FPL Nebraska’s Parent/Caretaker Relative income maximum is:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
KELLY expects to file taxes and she does not expect to be claimed as a tax dependent, therefore her Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Kelly’s household consists of the taxpayer and all persons who the taxpayer expects to claim as a tax dependent. Kelly and Stanley are not married, so Stanley is NOT included in Kelly’s household.
KELLY’S MEDICAID HOUSEHOLD = Kelly + Isaac (Kelly’s son)
ISAAC (Kelly’s son) is not expected to file taxes and he is claimed as a tax dependent by his mother Kelly. Isaac’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. If Isaac fails Medicaid eligibility, he may be eligible for CHIP because he is uninsured. None of the exceptions for tax dependents listed at 1-B-ii apply to Isaac. Isaac’s household is the same as Kelly’s, the taxpayer claiming him as a dependent. ISAAC’S MEDICAID/CHIP HOUSEHOLD = Isaac (Kelly’s son) + Kelly
STANLEY expects to file taxes and he does not expect to be claimed as a tax dependent, therefore his Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Stanley’s household consists of the taxpayer and all persons who the taxpayer expects to claim as a tax dependent. Stanley and Kelly are not married, so Kelly is NOT included in Stanley’s household. STANLEY’S MEDICAID HOUSEHOLD = Stanley + Trent (Stanley’s son) + Jacob (Stanley and Kelly’s son)
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
TRENT (Stanley’s son) is not expected to file taxes and he is claimed as a tax dependent by his father Stanley. Trent’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. If Trent fails Medicaid eligibility, he may be eligible for CHIP because he is uninsured. None of the exceptions for tax dependents listed at 1-B-ii apply to Trent. Trent’s household is the same as Stanley’s, the taxpayer claiming him as a dependent. TRENT’S MEDICAID/CHIP HOUSEHOLD = Trent (Stanley’s son) + Stanley + Jacob (Stanley and Kelly’s son)
JACOB (Stanley and Kelly’s son) is not expected to file taxes and he is claimed as a tax dependent by his father Stanley. Jacob’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5. If Jacob fails Medicaid eligibility, he may be eligible for CHIP because he is uninsured. One of the exceptions for tax dependents listed at 1-B-ii applies to Jacob: he is living with both of his parents and his siblings. Because Jacob falls into one of the exceptions, we look to the rules for non- filers to determine Jacob’s household. This includes Jacob plus his parents and his siblings because they all live together. JACOB’S MEDICAID/CHIP HOUSEHOLD = Jacob (Stanley and Kelly’s son) + Stanley + Kelly + Isaac (Kelly’s son) + Trent (Stanley’s son)
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
KELLY’S MEDICAID HOUSEHOLD = Kelly + Isaac (Kelly’s son) Kelly is required to file taxes and is not the child or expected tax dependent of another member of her household. Kelly’s Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Isaac is the child and expected tax dependent of Kelly. Kelly earns $1,500/month, so her MAGI-based income = $1,500/month. Kelly’s Medicaid household income = $1,500/month. This household income equates to $1,500 for a household size of 2. KELLY’S MEDICAID HOUSEHOLD INCOME = $1,500/month.
ISAAC’S MEDICAID/CHIP HOUSEHOLD = Isaac (Kelly’s son) + Kelly Isaac’s Medicaid/CHIP household income determination is the same as his mother Kelly’s. Isaac’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18 or, if necessary, CHIP. Because Isaac is a child, his income must be expressed in a percentage of FPL. This household income equates to 116% FPL* for a household size of 2. ISAAC’S MEDICAID/CHIP HOUSEHOLD INCOME = 116% FPL.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
STANLEY’S MEDICAID HOUSEHOLD = Stanley + Trent (Stanley’s son) + Jacob (Stanley and Kelly’s son)
Stanley is required to file taxes and is not the child or expected tax dependent of another member of his household. Stanley’s Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Trent is the child and expected tax dependent of Stanley. Jacob is the child and expected tax dependent of Stanley. Stanley earns $2,500/month, so his MAGI-based income = $2,500/month. Stanley’s Medicaid household income = $2,500/month This household income equates to $2,500 for a household size of 3. STANLEY’S MEDICAID HOUSEHOLD INCOME = $2,500/month.
TRENT’S MEDICAID/CHIP HOUSEHOLD = Trent (Stanley’s son) + Stanley + Jacob (Stanley and Kelly’s son) Trent’s Medicaid/CHIP household income determination is the same as his father Stanley’s. Trent’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18 or, if necessary, CHIP. Because Trent is a child, his income must be expressed in a percentage of FPL. This household income equates to 154% FPL* for a household size of 3. ISAAC’S MEDICAID/CHIP HOUSEHOLD INCOME = 154% FPL.
JACOB’S MEDICAID/CHIP HOUSEHOLD = Jacob (Stanley and Kelly’s son) + Stanley + Trent (Stanley’s son) Jacob’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5 or, if necessary, CHIP. Jacob’s Medicaid/CHIP household income determination is the sum of the MAGI of every member of his household. Kelly earns $1,500/month and Stanley earns $2,500/month, so the monthly MAGI-based income = $4,000/month. Jacobs’s Medicaid/CHIP household income = $4,000/month Because Jacob is a child, his income must be expressed in a percentage of FPL. This household income equates to 174% FPL* for a household size of 5. JACOB’S MEDICAID/CHIP HOUSEHOLD INCOME = 174% FPL.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
KELLY: Nebraska’s Parent/Caretaker Relative income maximum is*:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
Kelly’s Medicaid household income of $1,500/month for a household size of 2 exceeds the maximum of $704/month, so Kelly is not eligible for Medicaid based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
ISSAC (Kelly’s son): Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household income of 116% FPL, Isaac is eligible for Medicaid. Even if he was not eligible for Medicaid he may be eligible for CHIP. If Isaac had not been eligible for Medicaid, he may have been eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard.
STANLEY: Nebraska’s Parent/Caretaker Relative income maximum is*:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly. By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133 By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Stanley’s Medicaid household income of $2,500/month for a household size of 3 exceeds the maximum of $822/month, so Stanley is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
TRENT (Stanley’s son): Nebraska’s Medicaid income standard for children ages 6 to 18 is 133% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household income of 154% FPL, Trent is not eligible for Medicaid. However, he is eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard.
JACOB (Stanley and Kelly’s son): Nebraska’s Medicaid income standard for children ages 1 to 5 is 145% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household income of 174% FPL, Jacob is not eligible for Medicaid. However, he is eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard. Notes: If Kelly and Stanley were married and filing jointly, the tax household would include all family members – Kelly, Stanley, Isaac, Trent, and Jacob – and the Medicaid/CHIP household would be the same as the tax household. If Kelly and Stanley were married and filing separately, each would be included in the other’s household. Kelly’s Medicaid household would be her tax household + Stanley, and Stanley’s Medicaid household would be his tax household + Kelly.
SIMPLIFIED EXAMPLE 4 – DOUG’S FAMILY
Doug is a 50-year-old man applying for coverage for himself, his 18-year-old daughter Elizabeth, Elizabeth’s 19-year-old husband Andrew, and Andrew and Elizabeth’s 1-year-old son Samuel. Doug claims Elizabeth as a tax dependent, and Andrew claims Samuel as a tax dependent. All of the family members live together. No one in the household is blind or disabled. No one in the household has health insurance. Elizabeth is pregnant and is expecting twins. When the twins are born, Andrew expects to claim himself, Samuel, and the twins as tax dependents (Doug will continue to claim Elizabeth as a tax dependent, as she is still a minor).
Relevant Information: Doug earns $2,000/month ($24,000/year) Andrew earns $2,083/month ($25,000/year) There are no other sources of income Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes. Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL Nebraska’s CHIP income standard is 213% FPL Nebraska’s Medicaid income standard for pregnant women is 194% FPL
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Nebraska’s Parent/Caretaker Relative income maximum is:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.
DOUG expects to file taxes and he does not expect to be claimed as a tax dependent. Therefore his Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Doug’s household consists of the taxpayer, all persons who the taxpayer expects to claim as a tax dependent, and the number of expected unborns. DOUG’S MEDICAID HOUSEHOLD = Doug + Elizabeth + 2 Unborns
ELIZABETH is not expected to file taxes and she is claimed as a tax dependent by her father Doug. Elizabeth’s Medicaid eligibility will be determined under Nebraska’s standards for children age 6 through 18. However, if Elizabeth fails Medicaid eligibility under children’s standards, she may be eligible as a pregnant minor under pregnant women’s standards. None of the exceptions for tax dependents listed at 1-B-ii apply to Elizabeth. Elizabeth’s household is the same as Doug’s, the taxpayer claiming her as a dependent, and this includes the number of infants Elizabeth expects to deliver. And because Elizabeth is married and living with her spouse, her household also includes Andrew. ELIZABETH’S MEDICAID/CHIP HOUSEHOLD = Elizabeth + Doug + Andrew + 2 Unborns
ANDREW expects to file taxes and he does not expect to be claimed as a tax dependent. Therefore his Medicaid eligibility will be determined under Nebraska Parent/Caretaker Relative standards. Andrew’s household consists of the taxpayer, a spouse living with the taxpayer, and all persons who the taxpayer expects to claim as a tax dependent. ANDREW’S MEDICAID HOUSEHOLD = Andrew + Elizabeth + Samuel + 2 Unborns
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
SAMUEL is not expected to file taxes and he is claimed as a tax dependent by his father Andrew. Samuel’s Medicaid eligibility will be determined under Nebraska’s standards for children age 1 through 5. If Samuel fails Medicaid eligibility, he may be eligible for CHIP because he is uninsured. Samuel falls into one of the exceptions listed at 1-B-ii: he is living with both of his parents. Because Samuel falls into one of the exceptions, we look to the rules for non- filers to determine Samuel’s household. This includes Samuel plus both his parents and his expected number of unborn siblings because they all live together. SAMUEL’S MEDICAID/CHIP HOUSEHOLD = Samuel + Andrew + Elizabeth + 2 Unborns
2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.
DOUG’S MEDICAID HOUSEHOLD = Doug + Elizabeth + 2 Unborns Doug is required to file taxes and is not the child or expected tax dependent of another member of his household. Elizabeth is the child and expected tax dependent of Doug. Doug earns $2,000/month, so his MAGI-based income = $2,000/month. Doug’s household income = $2,000/month. This household income equates to $2,000 for a household size of 4. DOUG’S MEDICAID HOUSEHOLD INCOME = $2,000/month.
ELIZABETH’S MEDICAID/CHIP HOUSEHOLD = Elizabeth + Doug + Andrew + 2 Unborns Elizabeth is the expected tax dependent of Doug, but Elizabeth is not required to file a tax return. Doug earns $2,000/month, so his MAGI-based income = $2,000/month. Andrew earns $2,083/month, so his MAGI-based income = $2,083. Elizabeth’s household income equals the sum of the MAGI of every member of her household. Elizabeth’s household income = $4,083/month. This household income equates to 178% FPL* for a household size of 5. ELIZABETH’S MEDICAID/CHIP HOUSEHOLD INCOME = 178% FPL.
ANDREW’S MEDICAID HOUSEHOLD = Andrew + Elizabeth + Samuel + 2 Unborns
Andrew is expected to file taxes and is not the child or expected tax dependent of another member of his household. Samuel is the child and expected tax dependent of Andrew, and when the twins are born, Andrew expects to claim them as tax dependents. Andrew earns $2,083/month, so his MAGI-based income = $2,083/month
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
This household income equates to $2,083 for a household size of 5. ANDREW’S MEDICAID/CHIP HOUSEHOLD INCOME = $2,083/month.
Note: Although Elizabeth is a tax dependent of her father Doug, Doug is not included in Andrew’s household. Thus, if Elizabeth had any income, it would count, regardless of whether she had a filing requirement. This would also apply in Sam’s determination, below.
SAMUEL’S MEDICAID/CHIP HOUSEHOLD = Samuel + Andrew + Elizabeth + 2 Unborns Samuel’s Medicaid/CHIP household income determination is the same as Andrew’s; however, because Samuel is a child, his income must be expressed in a percentage of FPL. This household income equates to 90% FPL* for a household size of 5. SAMUEL’S MEDICAID/CHIP HOUSEHOLD INCOME = 90% FPL.
3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.
DOUG: Nebraska’s Parent/Caretaker Relative income maximum is:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
Doug’s Medicaid household income of $2,000/month for a household size of 4 exceeds the maximum of $976/month, so Doug is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
ELIZABETH: Nebraska’s Medicaid income standard for children ages 6 to 18 is 133% FPL, and the CHIP standard is 213% FPL. Nebraska’s Medicaid income standard for pregnant women is 194% FPL. With a Medicaid/CHIP household income of 194% FPL, Elizabeth is not eligible for Medicaid as a child age 6 through 18. However, when a pregnant minor does not qualify for Medicaid under children’s standards, she may qualify under pregnant women’s standards. With a Medicaid/CHIP household income of 194% FPL, Elizabeth is eligible for Medicaid as a pregnant woman. If Elizabeth had failed Medicaid eligibility under the pregnant women’s group, she may have been eligible for CHIP because she is uninsured. ANDREW: Nebraska’s Parent/Caretaker Relative income maximum is*:
* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.
Andrew’s Medicaid household income $2,083/month for a household size of 5 exceeds the maximum of $1,112/month, so Andrew is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.
SAMUEL: Nebraska’s Medicaid income standard for children ages 1 to 5 is 145% FPL, and the CHIP standard is 213% FPL. With a Medicaid/CHIP household of 90% FPL, Samuel is eligible for Medicaid. If Samuel had not been eligible for Medicaid, he may have been eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard. Joint Custody In situations where a child spends an equal number of nights with each parent, the income of each parent must be used to determine eligibility for the child.
By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
Determination of Medical Budgetary Units for Medically Needy and Non-Filers
1. Mom --------unmarried--------Dad Age 19
Age 19 Her child Alleged child in common
Has paternity for their child been established?
If No: ALLEGED CHILD IN COMMON/MOM/ MOM’S CHILD UNITS CONSIST OF – Mom Her child Alleged child in common *The unit remains this way unless paternity is established.
ALLEGED DAD’S UNIT CONSISTS OF- Dad
There are separate Medicaid units established for Mom and the alleged father. Only income of the Mom would be considered for Mom and the alleged child in common.
If Yes: CHILD IN COMMON’S UNIT- Mom Her child Dad Their child in common
MOM/ MOM’s CHILD UNITS CONSIST OF – Mom Her child Their child in common
DAD’S UNIT CONSISTS OF- Dad Their child in common
Note: If the family relationships are set correctly, the income will allocate correctly.
2. Mom--------unmarried--------Dad Age 17
Age 18
Alleged child together
Has paternity for their child been established?
If No: ALLEGED CHILD IN COMMON/MOM/ UNITS CONSIST OF – Mom Alleged child in common *The unit remains this way unless paternity is established.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006
ALLEGED DAD’S UNIT CONSISTS OF- Dad
There would be separate Medicaid units established for Mom and the alleged father. Only income of the Mom would be considered for Mom and the alleged child in common.
If Yes: CHILD IN COMMON’S UNIT- Mom Dad Their child in common
MOM’S UNIT CONSISTS OF – Mom Their child in common
DAD’S UNIT CONSISTS OF- Dad Their child in common
Paternity:
Unmarried Parents: When unmarried parents are living together as a family, the alleged father is not financially responsible unless he has acknowledged paternity or a court has determined that he is the father of the child after the birth.
Children of a Marriage: A woman's spouse is considered the father of any children who are conceived or born during a marriage even if the couple is separated and/or has filed for divorce or annulment unless there is a court order that states otherwise. If a woman states that her spouse is not the father of her child, establishment of paternity must be pursued, unless good cause exists.
Determination of Paternity: Paternity cannot be established unless an alleged father has signed a written and notarized paternity acknowledgment form or a court has determined him to be the father. Note: Paternity cannot be established for an unborn.
Military Service:
If a parent is absent due to active duty in the uniformed services of the United States, that parent is still considered part of the assistance unit and his/her income is considered available to the unit. Uniformed service is defined as the Army, Navy, Air Force, Marine Corps, Coast Guard, Environmental Sciences Services Administration, and Public Health Service of the United States. If the client states that separation is due to reasons other than performance in military service, the client must provide proof of bona fide separation.
If the parent in the military is incarcerated, s/he is no longer considered part of the assistance unit.
REV. JULY 14, 2023 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-007
477-000-007 –Taxable and Non-Taxable Income Examples
Examples of Taxable Income: 1. Income from earnings (employment and self-employment); 2. Bonuses and awards; 3. Severance pay; 4. Accrued leave pay; 5. Flexible spending contributions (such as a cafeteria plan); 6. Canceled debts; 7. Gambling winnings: 8. Jury pay; and 9. Rental income.
Examples of Non-Taxable Income: 1. Supplemental Security Income (SSI); 2. Temporary Assistance to Needy Families (TANF); 3. Veterans’ disability; 4. Workers’ Compensation; 5. Child Support; 6. Federal tax credits; and 7. Cash assistance.
Note: These lists are subject to change every time the IRS updates the Tax Code. Additional Taxable and Non-Taxable Income information can be found at: http://www.irs.gov/pub/irs-pdf/p525.pdf
Additional information on how the IRS views veteran’s income can be found at:
http://www.irs.gov/pub/irs-pdf/p17.pdf
If staff is unsure if income is taxable or non-taxable, contact Central Office for a determination.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-008
477-000-008 – Deductions using MAGI-Based Methodology
Deductions Allowable by the IRS
The items listed below are categorically subtracted from gross income to arrive at adjusted gross income, which, for an individual, is gross income minus the following deductions. If the MAGI income from the hub is not used and income verification is requested, these deductions would be applied to the earned income.
1. Trade and business deductions 2. Certain trade and business deductions of employees (i.e. reimbursed expenses of employees, certain expenses of performing arts, officials, elementary and secondary school teachers, and members of reserve components of the Armed forces of the United States.) 3. Losses from sale or exchange of property 4. Deductions attributable to rents and royalties 5. Certain deductions of life tenants and income beneficiaries of properties 6. Pension, profit-sharing, and annuity plans of self-employed individuals 7. Retirement savings 8. Penalties forfeited because of premature withdrawal of funds from time savings accounts or deposits 9. Alimony 10. Reforestation expenses 11. Certain required repayments of supplemental unemployment compensation benefits 12. Jury duty pay remitted to employer 13. Deduction for clean-fuel vehicles and certain refueling property 14. Moving expenses (military only) 15. Archer MSAs 16. Interest on education loans 17. Health savings accounts 18. Costs involving discrimination suits, etc. 19. Attorney’s fees relating to awards to whistleblowers.
Note: This list is subject to change every time the IRS updates the Tax Code.
477-000-009
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-009 – Examples: Budgeting Procedures Example 1 – Employed Single Parent and One Child: The household consists of Mom, a single parent with one 9-year-old child, Mom’s earned income is $800/month. The child passes at 133% FPL, so she is eligible. Mom fails Parent/Caretaker for a household size of 2, or $704. Mom has a medical need and is budgeted under the MNIL for two, or $392. Mom’s Share of Cost would be $308/month ($800 minus $100 earned income disregard minus $392). If insured, the child’s income standard would be 133% FPL for two. Because the earned income is less than 133% FPL for two, the child would still be eligible if insured. Example 2 – Ineligible Parents with Three Children: The family consists of two parents, both employed, and three children, ages 12, 5, and 6 months. The parents are requesting Medicaid only for their children. The earned income is $3,200/month. If the children are insured, the income level for the 12-year-old is 133% FPL for five, so this child is over his income level. The income level for the 5-year-old is 145% FPL for five, so this child and the 6-month-old (who would be budgeted at 162% FPL) are both eligible. If uninsured, the 12-year-old child would be eligible for CHIP at 213% FPL. If insured, the 12-year-old child is not reviewed for eligibility with a Share of Cost as a medical need does not exist. Example 3 – Disabled Dad, Mom and Three Children: The family consists of a disabled Dad who receives $1,200 SSA Disability/month, Mom who is unemployed and three children, ages 14, 6, and 3. Each of the children receives $275 SSA due to Dad’s disability.
The income for the father is $1,200 (Dad’s SSA) - $20 general ABD disregard = $1,180. The income for the other household members is $1,200 (Dad’s SSA). To determine Dad’s eligibility at 100% FPL for five, we’d only use Dad’s SSA of $1,180. Dad is therefore eligible as ABD/OMB. Note: A child’s income is never counted in a disabled parent’s budget. Mom’s eligibility is based on Parent/Caretaker relative (P/CR) guidelines plus the 5% FPL disregard. Mom’s income is $1,200. The P/CR income limit for a unit size of five is $1,375, so she is eligible for Medicaid.
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-009
Example 4 – Disabled Infant with Ineligible Parents: The family consists of a married couple with a newborn child. The child was premature and there were a number of complications related to the early birth. As a result, the child remained in neonatal intensive care for some six weeks and was hospitalized for over two months total. The child was approved presumptively for SSI. The child was also approved for Medicaid. When the child finally came home, the SSI stopped (due to parental income) but the child remained Medicaid-eligible and is still considered to be disabled for 12 months from the date of the last SSI payment (477 NAC 27-001.05A). Because the child was found eligible for Medicaid, the child would be continuously eligible for 12 months from their initial Medicaid eligibility determination. If the child was born to a Medicaid eligible mother, the child would be continuously eligible through the month of her first birthday. When the child’s eligibility was reviewed, the countable parental income was found to exceed 100% FPL for three, so the child is no longer Medicaid-eligible as ABD-OMB. However, before the child’s Medicaid coverage can be closed, the eligibility worker must determine if the child is eligible using 145% FPL for three or, if the child is uninsured, CHIP at 213% FPL for three. Example 5 – Disabled Single Parent and One Child: The household consists of a disabled father and a 7-year-old child. Dad receives $790 SSA disability. The child receives $395 SSA due to Dad’s disability. Dad’s countable income of $770 (SSA of $790- $20 general disregard) is less than 100% FPL for two, so Dad is eligible. Because Dad is disabled, we will not use the child’s SSA in determining Dad’s eligibility. If the child is insured or uninsured, the countable income of $1,185 (Dad’s SSA of $790 + child’s SSA of $395) does not exceed 133% FPL for two, the child is Medicaid eligible. The child’s income is counted as he is required to file an income tax return. Example 6- Medicaid Insurance for Workers with Disabilities (MIWD):
For calculation procedures for MIWD see 477-000-046. Example 7- Budgeting Reported Changes for ABD (Non-MAGI only) It must be determined if the reported change(s) affects Medicaid eligibility. If it does: 1.) Compare resources to the resource limit; 2.) Compare the income to the medically needy income level; 3.) Determine eligibility based on the household composition; 4.) Re-compute the budget; and 5.) Send an adequate and/or timely notice of change.
FEBRUARY 2, 2026 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY
HUMAN SERVICES MANUAL 477-000-010 477-000-010-- Requirement to File Income Taxes
Requirement to file Income Taxes: Per the Internal Revenue Service, if you are a U.S. citizen or resident alien, whether you must file a federal income tax return depends on your gross income, your filing status, your age, and whether you are a dependent. See table 1, 2, and 3. The filing requirements apply even if you owe no tax.
For additional tax filing requirement information: https://www.irs.gov/pub/irs-pdf/p17.pdf
FEBRUARY 2, 2026 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY
HUMAN SERVICES MANUAL 477-000-010
For additional tax filing information for dependents: http://www.irs.gov/pub/irs-pdf/p501.pdf
FEBRUARY 2, 2026 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY
HUMAN SERVICES MANUAL 477-000-010
MARCH 12, 2024 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY
HUMAN SERVICES MANUAL 477-000-010
Dependents. A person who is a dependent may still have to file a return. It depends on his or her earned income, unearned income, and gross income. For details, see Publication 501 Table 2. A dependent must also file if one of the situations described in Table 3 applies.
Responsibility of parent. If a dependent child must file an income tax return but cannot file due to age or any other reason, a parent, guardian, or other legally responsible person must file it for the child. If the child cannot sign the return, the parent or guardian must sign the child's name followed by the words “By (your signature), parent for minor child.”
Earned income. Earned income includes salaries, wages, professional fees, and other amounts received as pay for work you actually perform. Earned income (only for purposes of filing requirements and the standard deduction) also includes any part of a scholarship that you must include in your gross income. See chapter 1 of Publication 970, Tax Benefits for Education, for more information on taxable and nontaxable scholarships.
Child's earnings. Amounts a child earns by performing services are included in his or her gross income and not the gross income of the parent. This is true even if under local law the child's parent has the right to the earnings and may actually have received them. But if the child does not pay the tax due on this income, the parent is liable for the tax.
Unearned income. Unearned income includes income such as interest, dividends, and capital gains. Trust distributions of interest, dividends, capital gains, and survivor annuities are also considered unearned income.
Election to report child's unearned income on parent's return. You may be able to include your child's interest and dividend income on your tax return. If you do this, your child will not have to file a return. To make this election, all of the following conditions must be met. • Your child was under age 19 (or under age 24 if a student)* at the end of the year. • Your child had gross income only from interest and dividends (including capital gain distributions and Alaska Permanent Fund dividends). • The interest and dividend income was less than $11,000. • Your child is required to file a return unless you make this election. • Your child does not file a joint return. • No estimated tax payment was made for the year, and no overpayment was applied to from the previous year (or any amended return) was applied to this year under your child's name and social security number. • No federal income tax was withheld from your child's income under the backup withholding rules. • You are the parent whose return must be used when applying the special tax rules for children.
* A child born on January 1, 2001 is considered to be age 19 at the end of 2019; you cannot make the election for this child unless the child was a full-time student. Similarly, a child born on January 1, 1996, is considered to be age 24 at the end of 2019; you cannot make the election for this child.
For more information, see Form 8814 and Parent's Election to Report Child's Interest and Dividends in Publication 929.
Please note that the filing requirements are subject to change each year depending on the Internal Revenue Service.
477-000-011
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-011-- Examples: Income Treatment in Medicaid Example 1 This family consists of two parents and three children. The children were granted 12 months’ continuous eligibility in June. Dad was the only employed individual at the time of initial eligibility. In September, Mom goes to work. When her wages are combined with Dad’s, the income exceeds the children’s Medicaid income standards. The children must receive the remainder of their initial 12 months’ continuous eligibility. When the 12-month continuous eligibility period has ended, if the family income is still over the applicable income standard, the case is closed effective May 31st. Example 2 The children’s initial eligibility was established in December. The family’s income is from Dad’s self-employment so their most recent 1040 was used for income verification. At the annual renewal in late November, the family provides their new 1040 as verification of income. This 1040 indicates that there has been an increase in the countable income from self-employment and the income now exceeds the applicable income standard. The children are closed allowing for timely and adequate notice. If the children’s eligibility was based on self-employment or farming income as reported on a 1040, any new tax return filed by the family during the 12 months of continuous eligibility will be considered a significant change and must be reviewed at renewal. Example 3 The family’s income is Mom’s stable salaried employment. She earns the same amount each month and cannot earn overtime. When the initial application for Medicaid is filed, only one month’s income must be verified as electronic data sources were not available. At the point of the annual renewal, the staff must only verify a single month’s earnings because the income is regular and the electronic data sources are not available. Example 4 This family consists of Mom and two children. The children are eligible for Medicaid and have past their initial 12 months of continuous eligibility. At renewal, the children are found eligible for another 12 months of continuous eligibility.
After this renewal, Mom reports that she will be married next week. When the new stepfather’s income is considered the children are found to be over the applicable income standard (which is now based on a four-person household). However, the children are continuously eligible and cannot be closed until their next renewal. At the next renewal, if the household income puts the children over the their applicable income standard, they may be closed. Note: If Mom had gotten married during the initial 12 months’ continuous eligibility period, the children must remain eligible until the end of this period regardless of the stepfather’s income.
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-011
Example 5 (MAGI example only) The MAGI-based household submitted their annual renewal form with attested monthly income. VCI interface information is not available. The SEW interface report shows income from this employment, however the SEW report is not reasonably compatible. Paper verification is requested for current income and allowable expenses.
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-012
477-000-012 – Income Levels/Federal Poverty Levels and Resources
Program Standards, Federal Poverty Levels, and Maximum Income (Unless otherwise noted figures are effective 1/1/2026) Figures listed are representative of dollar amounts
Income Limits for MAGI Based Programs and Transitional Medical Assistance
F P L 23% 51% 58% 194% 185% 133% 162% 145% 133% 197% 213% HH SIZE SAGA FORMER WARD/ IMD PARENT/ CARETAKE R RELATIVE PREGNANT WOMEN TMA Heritage Health Adult (HHA) NEWBORN TO AGE 1 CHILDREN AGES 1-5 CHILDREN AGES 6-18 599 CHIP CHIP 1 306 679 772 2,581 2,461 1,769 2,155 1,929 1,769 2,621 2,833 2 415 920 1,046 3,499 3,337 2,399 2,922 2,615 2,399 3,553 3,842 3 524 1,162 1,321 4,417 4,212 3,028 3,689 3,302 3,028 4,486 4,850 4 633 1,403 1,595 5,335 5,088 3,658 4,455 3,988 3,658 5,418 5,858 5 742 1,644 1,870 6,254 5,964 4,288 5,222 4,674 4,288 6,350 6,866 6 851 1,886 2,145 7,172 6,839 4,917 5,989 5,361 4,917 7,283 7,874 7 960 2,127 2,419 8,090 7,715 5,547 6,756 6,047 5,547 8,215 8,883 8 1,068 2,369 2,694 9,009 8,591 6,176 7,523 6,733 6,176 9,148 9,891 9 1,177 2,610 2,968 9,927 9,466 6,806 8,290 7,420 6,806 10,080 10,899 10 1,286 2,851 3,243 10,845 10,342 7,435 9,056 8,106 7,435 11,013 11,907
Resource and Income Limits for Aged, Blind and Disabled Programs
MIWD and MIWD with Premium Income Limits
FPL 200% 250% HH MIWD MIWD PREMIUM 1 2,660 3,325 2 3,607 4,509
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-012
Medically Needy, ABD/OMB, MSP/QMB and ABD/QMB Income Limits
FPL - 100% HH SIZE MNIL MA ABD/OMB MSP/QMB 1 392 1,330 2 392 1,804 3 492 2,277 4 584 2,750 5 675 3,224 6 775 3,697 7 867 4,170 8 967 4,644 9 1,059 5,117 10 1,150 5,590
+91
SLMB and QI-1 Income Limits
FPL 120% 135% HH SLMB QI-1 1 1,596 1,796 2 2,164 2,435
Eligibility for the payment of the Part B by the State for QMB is effective the first of the month following the month that initial eligibility determination is processed. For example, if you determine an individual meets all eligibility requirements for QMB status on August 15th, the effective date of eligibility for payment of premiums, deductibles, and co-insurance is September 1. However, in no case are benefits effective prior to January 1, 1989, which is the effective date of this provision. Retroactive eligibility is precluded under this provision.
QI’s cannot be otherwise eligible for any other Nebraska Medicaid category. The individual must choose either medically needy/SOC or QI. Retroactive eligibility (up to 3 months prior to application) applies if: 1. The individual met all QI eligibility criteria in the retroactive period; and 2. The retroactive period is no earlier than January 1 of that calendar year.
QIs are eligible if their incomes are at least 120% of the FPL, but less than 135% of the FPL
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-012
Resource Limits HH SIZE RESOURCE LIMITS AABD/MA MSP/QMB SLMB/QI-1 1 4,000 9,950 2 6,000 14,910 Dependent Adult Child (DAC) Maximum for Burial Trust Effective 9/1/25 1 2,000 6,696
Spousal Impoverishment SPOUSAL IMPOVERISHMENT Reserved Amount (IM-73) Effective through 12/31/25 MIN 31,584 MAX 157,920 Reserved Amount (IM-73) Effective 1/1/26 MIN 32,532 MAX 162,660 Community Spouse 150% FPL *Effective 7/1/25 through 6/30/26 **Effective 7/1/26 2,644* 2,705** Excess Shelter Limit 794* *Effective 7/1/25 through 6/30/26 **Effective 7/1/26 812** Utility Standard *Effective through 12/31/25 **Effective 1/1/26 599* 615** Max Maintenance Allowance for Ineligible Spouse *Effective through 12/31/25 **Effective 1/1/26 3,948* 4,066**
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-012
Facility Standard of Need – Effective 1/1/24 FACILITY STANDARDS NURSING HOME SON Vets Personal Needs $90 (Excl.) $75 ASSISTED LIVING WAIVER SON $868 R&B + $75 Personal Needs $943 ASSISTED LIVING (NO WAIVER) SON $392 MNIL + $1004 Remedial Care $392*
Facility Standard of Need – Effective 1/1/25 FACILITY STANDARDS NURSING HOME SON Vets Personal Needs $90 (Excl.) $75 ASSISTED LIVING WAIVER SON $892 R&B + $75 Personal Needs $967 ASSISTED LIVING (NO WAIVER) SON $392 MNIL + $1,028 Remedial Care $1,420
Facility Standard of Need – Effective 1/1/26 FACILITY STANDARDS
NURSING HOME SON Vets Personal Needs $90 (Excl.)
$75
ASSISTED LIVING WAIVER SON $919 R&B + $75 Personal Needs
$994
ASSISTED LIVING (NO WAIVER) SON $392 MNIL + $1,055 Remedial Care
$1,447
Social Security Income (SSI)
HH SIZE SSI LEVELS Federal Benefit Rate (FBR) Referral Level
2025 Effective 1/1/26 2025 Effective 1/1/26 1 967 994 987 1,014 2 1,450 1,491 1,470 1,511
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY HEALTH AND HUMAN SERVICES 477-000-012
Medicare Premium
The premium amount for dual eligibles is assessed for those newly enrolled in Part B in 2021, not receiving social security, being directly billed for Part B, having Part B paid by Nebraska Medicaid, and whose modified adjusted gross income on IRS tax return from 2 years ago is below a certain amount.
Social security can tell the exact amount the individual is responsible for. See Medicare for more information on Part B costs at: https://www.medicare.gov/your-medicare-costs/part-b-costs/part- b-costs.html
Other Limits
Premium Charts for Medical Insurance for Workers with Disabilities (MIWD) and Transitional Medical Assistance (TMA)
MIWD Premium Payment Chart – Effective 1/1/26
HH Size - 1 Low High Monthly Premium Annual Premium $1,330 $2,659 $0 $0 $2,660 $2,792 $40 $480 $2,793 $2,925 $98 $1,176 $2,926 $3,058 $161 $1,932 $3,059 $3,191 $199 $2,388 $3,192 $3,325 $239 $2,868
Standard Medicare Part B Premium for 2025 Standard Medicare Part B Premium for dual eligible 2025 185.00 185.00 Standard Medicare Part B Premium Effective 1/1/26 Standard Medicare Part B Premium for dual eligible Effective 1/1/26 202.90 202.90 OTHER LIMITS Shelter Allowance 281 349
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-012
HH Size - 2 Low High Monthly Premium Annual Premium $1,804 $3,606 $0 $0 $3,607 $3,786 $54 $648 $3,787 $3,966 $133 $1,596 $3,967 $4,147 $218 $2,616 $4,148 $4,327 $270 $3,240 $4,328 $4,509 $325 $3,900 HH Size - 3 Low High Monthly Premium Annual Premium $2,277 $4,553 $0 $0 $4,554 $4,780 $68 $816 $4,781 $5,008 $167 $2,004 $5,009 $5,235 $275 $3,300 $5,236 $5,463 $340 $4,080 $5,464 $5,692 $410 $4,920 HH Size - 4 Low High Monthly Premium Annual Premium $2,750 $5,499 $0 $0 $5,500 $5,774 $83 $996 $5,775 $6,049 $202 $2,424 $6,050 $6,324 $333 $3,996 $6,325 $6,599 $411 $4,932 $6,600 $6,875 $495 $5,940 HH Size - 5 Low High Monthly Premium Annual Premium $3,224 $6,446 $0 $0 $6,447 $6,768 $97 $1,164 $6,769 $7,090 $237 $2,844 $7,091 $7,413 $390 $4,680 $7,414 $7,735 $482 $5,784 $7,736 $8,059 $580 $6,960 HH Size - 6 Low High Monthly Premium Annual Premium $3,697 $7,393 $0 $0 $7,394 $7,762 $111 $1,332 $7,763 $8,132 $272 $3,264 $8,133 $8,501 $447 $5,364 $8,502 $8,871 $553 $6,636 $8,872 $9,242 $665 $7,980
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-012
HH Size - 7 Low High Monthly Premium Annual Premium $4,170 $8,339 $0 $0 $8,340 $8,756 $125 $1,500 $8,757 $9,173 $306 $3,672 $9,174 $9,590 $505 $6,060 $9,591 $10,007 $623 $7,476 $10,008 $10,425 $751 $9,012 HH Size - 8 Low High Monthly Premium Annual Premium $4,644 $9,286 $0 $0 $9,287 $9,750 $139 $1,668 $9,751 $10,214 $341 $4,092 $10,215 $10,679 $562 $6,744 $10,680 $11,143 $694 $8,328 $11,144 $11,609 $836 $10,032 HH Size - 9 Low High Monthly Premium Annual Premium $5,117 $10,233 $0 $0 $10,234 $10,744 $153 $1,836 $10,745 $11,256 $376 $4,512 $11,257 $11,767 $619 $7,428 $11,768 $12,279 $765 $9,180 $12,280 $12,792 $921 $11,052 HH Size - 10 Low High Monthly Premium Annual Premium $5,590 $11,179 $0 $0 $11,180 $11,738 $168 $2,016 $11,739 $12,297 $411 $4,932 $12,298 $12,856 $676 $8,112 $12,857 $13,415 $836 $10,032 $13,416 $13,975 $1,006 $12,072
Premium Payment Process: Nebraska Medicaid Insurance for Workers with Disabilities will work much like TMA Premium Payments.
The client must pay the full premium no later than the 21st of the month following the month for which the payment is designated.
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-012
TMA Premium Payment Chart – Effective 1/1/26 FAMILY SIZE 1 FAMILY SIZE 2 FAMILY SIZE 3
ADJUSTED
ADJUSTED
ADJUSTED
MONTHLY
MONTHLY
MONTHLY
EARNED
EARNED
EARNED
INCOME
Fee INCOME
Fee INCOME
Fee
1330 - 1396.99 36 1804 - 1893.99 49 2277 - 2390.99 62 1397 - 1462.99 38 1894 - 1983.99 52 2391 - 2503.99 65 1463 - 1529.99 40 1984 - 2073.99 54 2504 - 2617.99 68 1530 - 1595.99 42 2074 - 2163.99 57 2618 - 2731.99 71 1596 - 1662.99 44 2164 - 2253.99 59 2732 - 2845.99 75 1663 - 1728.99 46 2254 - 2343.99 62 2846 - 2959.99 78 1729 - 1795.99 47 2344 - 2434.99 64 2960 - 3073.99 81 1796 - 1861.99 49 2435 - 2524.99 67 3074 - 3186.99 84 1862 - 1928.99 51 2525 - 2614.99 69 3187 - 3300.99 87 1929 - 1994.99 53 2615 - 2704.99 71 3301 - 3414.99 90 1995 - 2061.99 55 2705 - 2794.99 74 3415 - 3528.99 93 2062 - 2127.99 56 2795 - 2884.99 76 3529 - 3642.99 96 2128 - 2194.99 58 2885 - 2975.99 79 3643 - 3756.99 99 2195 - 2260.99 60 2976 - 3065.99 81 3757 - 3869.99 103 2261 - 2327.99 62 3066 - 3155.99 84 3870 - 3983.99 106 2328 - 2393.99 64 3156 - 3245.99 86 3984 - 4097.99 109 2394 - 2461.00 66 3246 - 3337.00 89 4098 - 4212.00 112
FAMILY SIZE 4 FAMILY SIZE 5 FAMILY SIZE 6
ADJUSTED
ADJUSTED
ADJUSTED
MONTHLY
MONTHLY
MONTHLY
EARNED
EARNED
EARNED
INCOME
Fee INCOME
Fee INCOME
Fee
2750 - 2887.99 75 3224 - 3384.99 88 3697 - 3881.99 101 2888 - 3024.99 79 3385 - 3545.99 92 3882 - 4065.99 106 3025 - 3162.99 83 3546 - 3706.99 97 4066 - 4250.99 111 3163 - 3299.99 86 3707 - 3867.99 101 4251 - 4435.99 116 3300 - 3437.99 90 3868 - 4028.99 105 4436 - 4620.99 121 3438 - 3574.99 94 4029 - 4189.99 110 4621 - 4805.99 126 3575 - 3712.99 98 4190 - 4351.99 114 4806 - 4990.99 131 3713 - 3849.99 101 4352 - 4512.99 119 4991 - 5174.99 136 3850 - 3987.99 105 4513 - 4673.99 123 5175 - 5359.99 141 3988 - 4124.99 109 4674 - 4834.99 127 5360 - 5544.99 146 4125 - 4262.99 113 4835 - 4995.99 132 5545 - 5729.99 151 4263 - 4399.99 116 4996 - 5156.99 136 5730 - 5914.99 156 4400 - 4537.99 120 5157 - 5318.99 141 5915 - 6099.99 161 4538 - 4674.99 124 5319 - 5479.99 145 6100 - 6283.99 166 4675 - 4812.99 128 5480 - 5640.99 149 6284 - 6468.99 171 4813 - 4949.99 131 5641 - 5801.99 154 6469 - 6653.99 176 4950 - 5088.00 135 5802 - 5964.00 158 6654 - 6839.00 181
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-012
FAMILY SIZE 7 FAMILY SIZE 8+
ADJUSTED
ADJUSTED
MONTHLY
MONTHLY
EARNED
EARNED
INCOME
Fee INCOME
Fee
4170 - 4378.99 114 4644 - 4875.99 126 4379 - 4586.99 119 4876 - 5107.99 133 4587 - 4795.99 125 5108 - 5339.99 139 4796 - 5003.99 131 5340 - 5571.99 145 5004 - 5212.99 136 5572 - 5803.99 152 5213 - 5420.99 142 5804 - 6035.99 158 5421 - 5629.99 148 6036 - 6268.99 164 5630 - 5837.99 153 6269 - 6500.99 171 5838 - 6046.99 159 6501 - 6732.99 177 6047 - 6254.99 165 6733 - 6964.99 183 6255 - 6463.99 170 6965 - 7196.99 190 6464 - 6671.99 176 7197 - 7428.99 196 6672 - 6880.99 182 7429 - 7661.99 202 6881 - 7088.99 187 7662 - 7893.99 209 7089 - 7297.99 193 7894 - 8125.99 215 7298 - 7505.99 199 8126 - 8357.99 221 7506 - 7715.00 204 8358 - 8591.00 228
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-013
477-000-013 – Mileage Allowance
Mileage may be allowed at the current state employee standard mileage rate for business miles driven established by the state’s Department of Administrative Services.
REV. DECEMBER 17, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-014
477-000-014 – Resource Provisions
The Specified maximum for funds set aside for burial increases by the Consumer Price Index every September.
When comparing the burial services (not including the excluded burial space items) to the burial trust limit, compare the burial services to the current burial trust limit regardless of what year the funds were set aside for burial. Burial Trust Limit Effective Date $6,696 September 1, 2025 $6,507 September 1, 2024 $6,346 September 1, 2023 $6,122 September 1, 2022 $5,654 September 1, 2021 $5,372 September 1, 2020 $5,303 September 1, 2019 $5,212 September 1, 2018 $5,031 September 1, 2017 $4,978 September 1, 2016 $4,926 September 1, 2015 $4,916 September 1, 2014 $4,834 September 1, 2013 $4,762 September 1, 2012 $4,683 September 1, 2011 $4,513 September 1, 2010 $4,462 September 1, 2009 $4,462 September 1, 2008 $4,235 September 1, 2007
For those who apply January 1, 2006, or later, the home equity value provision applies to the initial determination and redeterminations for long-term care services.
Home Equity Limits Effective Date $752,000 January 1, 2026 $730,000 January 1, 2025 $713,000 January 1, 2024 $688,000 January 1, 2023 $636,000 January 1, 2022 $603,000 January 1, 2021 $595,000 January 1, 2020 $585,000 January 1, 2019 $572,000 January 1, 2018 $560,000 January 1, 2017 $552,000 January 1, 2016 $552,000 January 1, 2015 $543,000 January 1, 2014 $536,000 January 1, 2013
REV. MARCH 24, 2016 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2016 HEALTH AND HUMAN SERVICES 477-000-015
477-000-015 – Third Party Liability
Refer all questions regarding third party payments received directly to DHHS.MedicaidCasualty@nebraska.gov.
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-016
477-000-016 – Health Insurance Premium Payment (HIPP) Program
Nebraska will pay the health insurance premium for Medicaid eligible clients in cases where it is cost-effective for the state. Payment of this premium does not replace Medicaid coverage. Instead, a third party (insurance company) would be the primary payer on claims and Medicaid would be secondary.
Workers should refer new or existing cases if the individual is Medicaid eligible, has health insurance, expects high medical expenses, and cannot afford to continue paying his or her health insurance premium.
Examples of Medical Conditions Generally Considered Cost-Effective for the State
Cancer (currently receiving chemotherapy or radiation) Pregnancy AIDS Infants born prematurely or with a serious medical condition Renal failure Upcoming surgery Any condition requiring hospitalization Any life-threatening illness An accident causing serious injury
This list is not comprehensive. There are many other conditions that could be considered cost- effective.
Examples in which HIPP Program will Not Pay Health Insurance Premium
The individual is aged The individual needs to pay his or her health insurance premium to stay Medicaid eligible (i.e., he or she needs the insurance as a deduction in their budget) The individual is eligible for Medicare The premium is for TMA The insurance policy is a CHIPS policy The individual’s share of cost obligation is higher than the monthly premium There is a court-issued medical support order that pays for the insurance policy
Note: When HIPP pays an individual’s health insurance premium, it may not be counted as a deduction in the budget. Please determine the impact of HIPP paying an individual’s insurance premium on the person’s budget before making a referral to the HIPP program.
HIPP referrals should be made to: DHHS Medicaid and Long-Term Care HIPP Program P.O. Box 95026 Lincoln, NE 68509; DHHS.MedicaidHIPP@nebraska.gov
MAY 3, 2018 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HUMAN SERVICES MANUAL 477-000-017
477-000-017-- Retroactive Medicaid
Retroactive Medicaid Retroactive Medicaid may be requested within six months of the initial application, even if there was no indication of a retro need on the initial application. Retroactive Medicaid requested on the initial application that was not acted on by the agency will be addressed despite the date the Retroactive Medicaid was initially requested. Example 1 Jan applied for Medicaid on 1/15/2017. On her application she marked No to the question that asks, “Do you want help paying for medical bills from the last 3 months”? Jan did not indicate anywhere on the application that she needed Medicaid for October, November and/or December 2016. Jan calls the Customer Service Center on 4/03/2017 and requests a Retroactive Medicaid eligibility determination for October, November and December 2016. Can we process Jan’s request? Answer: YES. Jan requested the Retroactive Medicaid eligibility determination within six months from the application date. Example 2: Same scenario as example 1; however, Jan sends a letter to DHHS on 8/30/2017 and requests that we look at her eligibility for Retroactive Medicaid for October, November and/or December 2016. Can we process Jan’s request? Answer: No. Jan requested Retroactive Medicaid more than six months after her application was received AND Retroactive Medicaid was never requested on her initial application. Example 3 Jeffrey applied for Medicaid on 2/1/2017. On his application he marked Yes to the question that asks, “Do you want help paying for medical bills from the last 3 months”? Retroactive Medicaid was not processed at initial application. Jeffrey calls the Customer Service Center on 6/30/2017 and asks to have Retroactive Medicaid eligibility determined for November, December 2016 and January 2017. Can Jeffrey’s request be processed? Answer: Yes. Jeffrey requested Retroactive Medicaid on his initial application. His Retroactive Medicaid request needs to be processed despite the date that it was initially requested.
MAY 3, 2018 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HUMAN SERVICES MANUAL 477-000-017
Example 4 Susie applied for Medicaid on 3/5/2017. On her application she marked Yes to the question that asks, “Do you want help paying for medical bills from the last 3 months”? Retroactive Medicaid was not processed at initial application. Susie sends a letter to DHHS on 12/5/2017 and asks to have Retroactive Medicaid eligibility determined for December 2016, January, February 2017. Can Susie’s request be processed? Answer: YES. Even though this is more than six months from the application date, exceptions may be allowed due to agency error.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-026
477-000-026 – Basic Budgetary Allowance for Non-MAGI
Medical Deductions: Verify medical insurance policies and document the following: 1. Name and address of insurance company; 2. Type of coverage; 3. Policy number; 4. Premium amount; 5. Effective dates of coverage; and 6. Policy owner and individual(s) covered.
Primary Sources
a. The insurance policy; b. Contact with the insurance company; c. Premium notice; d. Contact with the employer; e. Blue Cross Blue Shield TPL alert (the premium amount cannot be verified with this alert if it is employer sponsored health insurance); f. Contact with the policy owner, if other than the client; or g. Cancelled checks for health insurance premiums.
Examples: Considered Health Insurance
The following examples ARE considered health insurance. These policies provide or require specific medical or health service. Data should be entered on N-FOCUS/TPL and premium deductions allowed
Example 1: Physicians Mutual Insurance; hospital daily indemnity policy; monthly premium of $15; pays $25 per day for every day hospitalized.
Example 2: Amex Life Insurance; nursing home confinement policy; monthly premium of $52.20; pays $20 per day for every day of nursing home confinement for a maximum of twenty-four months.
Example 3: Bankers Life and Casualty Co.; cancer treatment policy; monthly premium of $5.60; pays for cancer surgery and chemotherapy.
NOTE: See 477 NAC 12-005 or 477 NAC 12-006 and 477 NAC 22-003.02F for treatment of Third Party Medical Payments received directly.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-026
Examples: Not Considered Health Insurance
The following examples are NOT considered health insurance. These are income replacement or accident policies and should NOT be entered on N-FOCUS/TPL. These policies can NOT be allowed as a medical deduction on a medical budget.
Example 4: GEM (University of Nebraska); school accident policy; pays for accidents related to school activities.
Example 5: Combined Insurance Co of America; accidental dismemberment policy; pays $5,000 for loss of any limb.
Example 6: Bankers Life and Casualty; accidental injury policy; pays $50 per day for any day unable to work due to injury while riding any public conveyance.
Example 7: Physicians Mutual Insurance; disability policy; pays $50 per day for any day of disability.
NOTE: If the health insurance premium verification submitted by the client has an amount specified for one of these, then do not allow that portion of the premium as a deduction. Do not send for additional verification requesting the premium break-out for health insurance.
The health insurance policy should be submitted to Central Office for consideration when it is questionable whether it meets the definition of creditable coverage.
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-029
477-000-029 – Calculation of Resources Reserved for Community Spouse
Effective 1/1/25
The assessment of resources is based on the value of resources owned during the month the alternate care spouse enters the specified living arrangement.
$31,584 is the minimum amount. $157,920 is the maximum amount. $63,168 is twice the minimum amount. $315,840 is twice the maximum amount.
The community spouse is entitled to reserve the greater of:
1. One-half of the combined equity value of all countable resources not to exceed $154,140 (the maximum amount); or 2. $30,828 in equity value of countable resources (the minimum amount).
Figures listed are representative of dollar amounts Previous Minimum and Maximum Amounts Year Minimum Maximum 2026 32,532 162,660 2025 31,584 157,920 2024 30,828 154,140 2023 29,724 148,620 2022 27,480 137,400 2021 26,076 130,380 2020 25,728 128,640 2019 25,284 126,420 2018 24,720 123,600 2017 24,180 120,900 2016 23,844 119,220 2015 23,844 119,220 2014 23,448 117,240 2013 23,184 115,920 2012 22,728 113,640 2011 21,912 109,560 2010 21,912 109,560 2009 21,912 109,560 2008 20,880 104,400 2007 20,328 101,640 2006 19,908 99,540 2005 19,020 95,100
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-029
Amounts Used for Budgeting Non-MAGI Couples (SIMP)
AMOUNTS USED FOR BUDGETING COUPLES Figures listed are representative of dollar amounts Income level (based on 150% of federal poverty level for two) *Effective 7/1/25 through 6/30/26 **Effective 7/1/26
2,644* 2,705** Excess shelter limit *Effective 7/1/25 through 6/30/26 **Effective 7/1/26 794* 812** Utility standard *effective through 12/31/25 **effective 1/1/26 599* 615** Maximum maintenance allowance for ineligible spouse *effective through 12/31/25 **effective 1/1/26 3,948* 4,067**
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-029
Examples- Assessment and Designation of Resources Example 1 Mr. and Mrs. Edwards have been living in their own home. On 10/15/2013 Mr. Edwards enters a nursing home. On 1/20/2014 Mrs. Edwards contacts the Department to request an assessment of their resources. The worker completes Form IM-73 and determines what total countable resources were at the time Mr. Edwards entered the nursing home. The total of all resources owned as of 1/20/2014 is $60,000. The minimum and maximum resource amounts are listed above. Mrs. Edwards provides the worker with verification that total resources owned in 10/2013 were $65,000. The spousal reserved amount is $32,500. On Form IM-73 the Edwards resources as of 10/2013 consisted of: Certificate of Deposit #1 $25,000 Certificate of Deposit #2 $25,000 Stocks ABC Company 100 shares worth $100 per share $10,000 Bond E $ 5,000 TOTAL $65,000 Form IM-73 is completed and signed by both Mr. and Mrs. Edwards, a copy is given to each, and a copy is retained for the Department's record. $32,500 is reserved for the community spouse (Mrs. Edwards). On 5/1/2014 Mrs. Edwards requests an application for ABD for Mr. Edwards, who is still residing in the nursing home. The worker completes Form IM-74. Resources owned at the time of application are $36,500, which include the $32,500 community spouse allowance plus $4,000 for the alternate care spouse. On Form IM-74 the Edwards resources as of 5/1/2014 consist of: Community Spouse Allowance Alternate Care Spouse Certificate #4 $10,000 Savings #6 $4,000 Bond E $ 5,000
Stocks ABC Company 100 shares worth $100 per share $10,000
Savings Account #5 $ 7,500
TOTAL $32,500
Mr. Edwards meets all other eligibility requirements. The ABD application for Mr. Edwards is approved with a medical effective date of 5/1/2014; Mr. Edwards’ nursing home care is paid for 4/1/2014 as are all other medical bills. Notice is sent advising him of the date of eligibility and also notifying him that he has 90 days from the date of the notice to complete the transfers of ownership so that only $4,000 in resources remain in his name. On 6/28/2014, Mrs. Edwards provides the worker with verification that Mr. Edwards’ name has been removed from the CD, bond, stocks, and savings account #5. They put his $4,000 into a new account, savings account #6.
REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-029
Example 2 Mr. and Mrs. Bird have been living in their own home. On 12/9/2013, Mrs. Bird is admitted to a nursing home. Mr. Bird contacts the Department on 4/5/2014 and requests an assessment of their resources. The worker completes Form IM-73. Total resources owned as of 12/2013 are $10,000. Since $10,000 is less than the minimum amount for 2013, the minimum amount is used. The amount reserved for the community spouse is at least the minimum. Form IM-73 is signed by Mr. Bird (Mrs. Bird is unable to sign). Two copies are given to Mr. Bird, and one is retained for the Department record. Since the client is already within resource limits, an application for ABD is completed on 4/5/2014. The worker also completes Form IM-74. The community spouse amount is $10,000 and the applicant's share is $0. Resources consist of: Community Spouse Allowance Alternate Care Spouse Savings Account #1 $ 8,500
Checking Account #2 $ 1,500
TOTAL $10,000
TOTAL $0.00
Example 3 Mr. and Mrs. Jones have been living in their own home. On 11/19/2012 Mr. Jones is admitted to a nursing home. On 3/26/2013 Mrs. Jones contacts the Department and requests an assessment of their resources. The worker completes Form IM-73 and determines what total countable resources were at the time Mr. Jones entered the nursing home. The total resources as of 11/2012 are $500,000. The maximum community spouse allowance in 2012 was $113,640. Form IM-73 is signed by both Mr. and Mrs. Jones. Each is given a copy, and a copy is retained for the Department record. On 6/5/2013 Mr. Jones returns to the home with his wife. The assessment completed for 11/2012 becomes invalid. On 1/24/2014 Mr. Jones is readmitted to the nursing home. The assessment completed on 11/2012 is again valid. Example 4 Mr. and Mrs. Brown have been living in a house they rent. Mr. Brown was admitted to the nursing home on 2/15/2014. Mrs. Brown gave notice to her landlord and moved to an assisted living facility near the nursing home. On 4/28/2014 Mrs. Brown requests assistance to help with her husband’s nursing home bills. Mrs. Brown does not need Medicaid for herself and requests an assessment of resources. Since Mrs. Brown does not reside in a hospital or nursing home or want assistance for herself, she may be a community spouse. The worker completes the IM-73 for 2/2014, the month of entry to the nursing home, and countable resources total $30,000. Half of $30,000 is less than the year 2014 minimum reserved amount. Since the community spouse retains at least the minimum, the minimum amount is entered on the IM-73.
MAY 3, 2018 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HUMAN SERVICES MANUAL 477-000-030 477-000-030-- Treatment of Life Estate Income Examples
Example 1 Client in a nursing home has a life estate interest in a farm and a house in town. The house in town is not being rented out, but a grandson is living there rent free. The farm is being rented out for an annual cash rent total of $8,000. There is a copy of this cash rent agreement in the case file. The real estate taxes on the farm are $1,500 per year. The insurance on the farm is $500 per year. We do not allow any expenses on the house in town because it is not producing any income. The farm net income is: $8,000 cash rent - $2,000 (taxes and insurance) = $6,000 divided by 12 = $500 per month. Total countable monthly unearned life estate income is $500 per month.
Example 2 Married couple on Medicaid as aged clients live together in a house in town. Six years ago they deeded their farm to the children and retained a life estate. Mr. drives out to the farm most weekdays and helps his son, who lives on the farm, with minor chores. The verbal agreement and actual income distribution with the son has been a 60/40 crop and expenses split. The couple files a self-employed tax return. This is not a self-employed situation for Medicaid. The self-employed tax return can be used to help verify the sale of product and the allowable related expenses. Since your clients are to receive 40% of product (grain, hay, livestock) sale and have 40% of cost (fertilizer, seed, fuel, repairs) + full responsibility for taxes and insurance, you will need to confirm with the client that the product income and expenses on the tax form are reflective of that arrangement. The result will be used as unearned income in the client's budget.
Example 3 Client in a nursing home that deeded the farm to the son many years ago and retained a life estate. The son, who farms the ground, has not been sharing any of the income produced with your client, but your client has been paying the taxes and insurance. There is no income being produced for your client and the taxes and insurance cannot be allowed as an expense from other income.
MAY 3, 2018 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HUMAN SERVICES MANUAL 477-000-030
Example 4 Client deeded the farm to the son several years ago and retained a life estate. The agreement with the son is a 60/40 crop and expense split. The son, who farms the land, drilled a new well and terraced the land. The son claims these expenses were charged against mom's share of the income and there is no remaining income to give her. Capital improvements such as new terracing, updating a home, new wells and irrigation for prior dry land farming, are not allowed as an expense for the life estate holder. These are capital improvements to real property that is owned by the remainderman.
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-031
477-000-031 – Real Property Sold on Contract
When real property is sold on contract rather than an outright full purchase, certain conditions of the contract must be met to verify adequate compensation and to avoid applicable deprivation of resources policy. These conditions are:
1. Current fair market value must be used for the sale/purchase agreement. 2. The contract period must not exceed the life expectancy of the participant. (See Life Expectancy Table and Deprivation of Resources reference.) 3. The contract must not include balloon payments. (See Deprivation of Resources reference regarding equal payments.) 4. Appropriate default language for recovery upon failure to make scheduled payment. 5. Contract balance/scheduled payments cannot be forgiven during the life of the contract, i.e., no exculpatory or cancellation terms. 6. Appropriate interest rate on unpaid balance. 7. Payments must commence immediately. 8. Amortization schedule to demonstrate #2, #6, and #7.
These are general guidelines that are used to verify adequate compensation to the participant for the contract sale. Central Office Public Assistance staff may assist the Local Office in making the determination.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-032
477-000-032 – Deprivation of Resources
Example 1: Mr. Smith applies for Medicaid on 8/20/18. He has been in a Nursing Home since 6/15. On 3/15/17 he gave $35,000 to his son. The transfer is within the 60-month period prior to the date of his Medicaid application and the penalty begins with the date of application which is 8/20/18. A denial Notice of Action will need to be sent for deprivation of resources stating the penalty period is 7 months. For a notice type, you will need to select “transfer of assets” under sanctions.
$35,000 amount of transfer $35,000 ÷ $5,000 current private pay rate = 7 number of months for penalty period
Example 2: Mr. Smith transferred his ranch with fair market value of $250,000 to his children on 3/15/17. He permanently entered a nursing home on 11/10/15. Mr. Smith applies for Medicaid on 5/14/18 which is within the 60-month period prior to the date of transfer. He is ineligible for 52.08 months beginning with 5/18.
Step A $250,000 amount of transfer $250,000 ÷ $4,800 current private pay rate = 52.08 number of months penalty period
Mr. Smith reapplies for Medicaid in the month a partial penalty of .08 applies. The partial month penalty is converted to a dollar amount and applied to the Share of Cost for that month.
Step B $4,800 private pay cost x 52 month penalty period $249,600 penalty period amount for 52 full months
Step C $250,000 transfer amount -249,600 penalty period amount for 51 full months $400 partial month penalty amount at private pay rate
For the month of application, the partial month penalty amount of $400 would be added to Mr. Smith’s Share of Cost amount as his responsibility for the cost of care. Medicaid will not pay the nursing home the difference between the Medicaid rate and partial month penalty amount.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-032
Example 3: Mr. Smith entered a nursing home on 12/1/2015, and applied for Medicaid on 6/25/18. On 2/25/17 he transferred a $20,000 CD to his son. On 12/10/17 he transferred a $10,000 CD to his grandchild. Since Mr. Smith is in a nursing home and has transferred resources for less than fair market value during the 60-month period before the date of his Medicaid application, he is subject to a period of ineligibility from the date of his application. Current actual monthly cost to a private pay patient is $5,000.
$20,000 amount of transfer on 2/25/17 $20,000 countable disposal ÷ $5,000 private pay cost = 4 months of ineligibility
$10,000 amount of transfer on 12/10/17. $10,000 ÷ $5,000 private pay cost = 2 months of ineligibility Total months of ineligibility are 6 beginning with 6/18 the month of Medicaid application.
Example 4: Mr. Smith lives at home and gave his son $12,000 on 3/25/18. Mr. Smith applied and was approved for Medicaid in 09/18. Deprivation regulations do not apply to current eligibility because he is not in a nursing home or receiving any type of nursing services.
On 10/2/18 Mr. Smith enters a nursing home and the monthly private pay rate is $4,800. A transfer of assets for less than fair market value has occurred within the 60-month look back period from the date of nursing home entry. Mr. Smith is ineligible for nursing home payment for a period of 2.5 months. Deprivation does not apply until Mr. Smith was residing in a specified living arrangement.
$12,000 amount of transfer on 3/25/18 $12,000 ÷ $4,800 private pay cost = 2.5 months of ineligibility from the month of entry to the nursing home.
Mr. Smith must be given ten-day notice that he is ineligible for 2.5 months effective 11/18 due to deprivation of resources.
Example 5: Mr. Smith applies for Medicaid on 8/10/18 and has lived in the nursing home for several years. There were 4 transfers of cash made as follows:
In 3/17 he transferred $4,000 to his daughter In 4/17 he transferred $3,500 to his daughter In 5/17 he transferred $3,000 to his son In 6/17 he transferred another $3,500 to his son
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-032
All the transfers are within the 60-month look back period. The total amount transferred is $14,000. The private pay rate at the nursing home is $4,600. The penalty periods are calculated as follows:
$14,000 cash transferred $14,000. ÷ $4,600 private pay cost = 3.04 Total months of ineligibility beginning with 8/18, the month of Medicaid application.
Example 6: Mr. Smith transferred his farm with a value of $300,000 to his son on 2/14/10 by recorded deed. He applied for Medicaid on 9/2/11 and his current resources consist of a savings account with $5,000 and a money market account with a balance of $20,000. Mr. Smith wants to get a period of ineligibility started because of the deprivation. This is not possible because he is currently over the permitted resource limit of $4,000. A period of ineligibility may not begin until the applicant is eligible for Medicaid except for the deprivation of resources.
Example 7: Mr. Smith transferred his house with a value of $485,000 to his daughter on 1/10/06 by recorded deed. He applied for Medicaid on 9/15/11 because he is out of funds to pay for his stay in the nursing home. There is no deprivation to consider because the transfers took place beyond the 60 month look back. Month one of the look back is the month prior to the month of application.
Share of Cost amount exceeds the Medicaid Per Diem If the partial month penalty amount added to the Share of Cost amount exceeds the Medicaid per diem for the entire period, you will enter the private pay rate per diem on N-FOCUS. There will be no Medicaid payment to the nursing home and the penalty has been met.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-033
477-000-033 – Deprivation of Resources Hardship Waiver Procedure
The individual may request in writing to the agency a hardship waiver exception when imposing a period of ineligibility for transfer of assets would deprive the individual of medical care so that his/her health or his/her life would be endangered. A notice of discharge from the facility is not necessary to demonstrate that health or life would be endangered. Undue hardship also exists when application of the transfer of assets provisions would deprive the individual of food, clothing, shelter, or other necessities of life.
Central Office will make a determination within 30 days from receipt of the hardship waiver request by the Central Office. If circumstances beyond the control of the agency prevent action within the required time, the Central Office will send a notice to the individual who filed the hardship waiver request. The guardian, conservator, or anyone acting on behalf of the client must attempt to recover transferred assets. Up to 30 days of nursing home services may be provided if the individual is cooperating to the fullest extent in attempting to recover transferred assets. If cooperation ceases, undue hardship no longer exists.
For deprivation transactions 2/8/2006 or later, the following procedure will be followed for a Hardship Waiver:
a. The Notice of Action for Medicaid denial or closure because of existing period of ineligibility for deprivation of resources will include a statement of the individual’s right to request a Hardship Waiver. b. The Hardship Waiver written request must be submitted to the Local Office. The facility may file this request with the written consent of the individual or his/her legal representative. c. The Local Office will then submit this request to Medicaid Policy Staff at Central Office with the following information attached: a. Living arrangement of the individual/spouse at time of transfer; b. Documentation of spouse and/or individual’s current resources; c. Documentation of transferred resource dates, signatory(s)/requester (person signing or requesting the transfer), amounts, and relationship of individual to whom the resource was transferred; d. Copies of any informal or legal action already initiated to recover resources d. If the client/spouse did not participate in the transfer, then Central Office will immediately notify the Local Office to open the case for 30 days/one month while the final decision on the Hardship Waiver is made. (1) This specific month will be determined in consultation with the worker. (Open for specified month and close for the following month.) (2) This will apply to nursing facility services (assisted living waiver, nursing home, acute care hospital, IMD). (3) If a Hardship Waiver decision cannot be made within the 30 days, then Central Office will notify the individual and Local Office that the decision remains pending. i. Note: If the client/spouse participated in the transfer, hardship will be denied. If it is demonstrated that the client/spouse had a guardian and/or conservator on the date of the client/spouse signature, then the signature of that client/spouse on a transfer action does not constitute participation and a fraud referral must be made. (4) Central Office will notify the Local Office of the Hardship Waiver decision.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-033
1. Hardship Waiver Denial 1. The client/representative may appeal the denial. Do not open the case for other than the notified 30 day/month temporary period if an appeal is filed. 2. Hardship Waiver Approval a. Local Office will open the case. b. Local Office will notify in comment section of the approval notice of action that the client is “required to immediately and continuously pursue recovery of the transferred resources, including, but not limited to, full cooperation with Adult Protective Services, Attorney General Fraud Unit, and any court proceedings. Failure to take action to recover or cooperate will immediately end Medicaid eligibility."
REV. MAY 3., 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-034
477-000-034 – Resource Spend Down
A client may reduce resources to the allowable limit and establish a medical effective date earlier than the month in which the resources are reduced if the excess resources are paid on outstanding medical bills incurred no earlier than the third month prior to the month of request. If the client reduces resources on outstanding medical bills, the medical effective date would be the first day of the month, retroactive or prospective, in which the last medical bill was paid which reduced the resources to the allowable limit.
Examples:
Excess Resources in Month of Application Outstanding Medical Bills Application Resources Reduced Jan 1-10, Feb 2, 5, 12, 25, Mar 1-31 March (excess resources) April (below limit)
If medical bills for Jan 1-10 and Feb 2 and 5 were used to reduce resources, medical eligibility would begin Feb 1 even though the bills were not actually paid until April. If resources were reduced in April on something other than the outstanding medical bills, e.g., purchase of a burial fund, medical eligibility would begin April 1.
Below Resource Limit in Month of Application Outstanding Medical Bills Application Jan 3-15, 25, (excess resources)($500) Feb 10, 18, 22, March 5, 8 April (below limit)
The client is eligible April 1 without a spenddown; however, if s/he wants medical eligibility established retroactively a resource spenddown must be done. Verify the resources in the oldest month in which there are outstanding medical bills, but no earlier than the third month prior to the month of request. In this situation the client has $500 excess resources in January.
If the client pays $500 on the medical bills and the last bill paid was incurred Feb 18, medical eligibility would begin Feb 1.
The client must pay the amount of the excess resources from January even though s/he is below resources in April.
Procedures: 1. Calculate the amount of excess resources in either the month of application or in a prior month if the client is below the resource limit in the month of application and there are outstanding medical bills. 2. Verify the dates and amounts of outstanding medical bills incurred within three months prior to the month of request for assistance. 3. Assist the client in identifying out-of-pocket medical costs which are to be paid by resource spenddown. If there is Medicare or private health insurance, you must have the Explanation of Benefits (EOB) to determine out-of-pocket costs.. 4. Obtain verification of paid medical bills used for resource spenddown. For any month there is Medicaid eligibility by payment of medical bills to reduce resources, there must be paid receipts for out-of-pocket medical expenses to verify the resource reduction.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-034
5. If there is a monthly Share of Cost, the amount of the resource reduction should be added to the SOC amount.
a. If there is no Share of Cost, proof of out-of-pocket payment on medical bills is all that is needed.
b. Example: Application for nursing home care made on 3/15 and resources are $4,450 at the time of application. Medical is being requested effective 2/1 as there are unpaid out-of-pocket pharmacy bills totaling $700. February’s budget as a SOC of $400 to which you would add $450 for the resource reduction. The total February SOC would be $850 and the notice would state that $450 of the amount was to reduce resources.
c. If this is a Share of Cost case, the first items on the Share of Cost form would be medical items paid to reduce the resource.
6. On the Notice of Action, state the amount of bills paid by the client from excess resources that are included in the Share of Cost amount.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-036
477-000-036 – Liquid/Non-Liquid Resources for Non-MAGI
Liquid Resources: Cash or other property that can be converted to cash within 20 days.
Examples of Liquid Resources:
1. Cash on hand; 2. Cash in savings or checking accounts; 3. Certificates of deposit; 4. Stocks; 5. Bonds; 6. Investments; 7. Mutual fund shares; 8. Collectable unpaid notes or loans; 9. Promissory notes; 10. Mortgages; 11. Land contracts; 12. Land leases; 13. Revocable burial funds; 14. Trust, guardianship or annuity funds; 15. Cash value of insurance policies; 16. Other similar properties; and 17. Medical savings accounts.
Excluded Liquid Resources:
Reverse Mortgage Monthly Income for ABD
Use the following method to determine counting or excluding monthly income from a reverse mortgage:
Do not count the reverse mortgage as monthly income to the Medicaid client if the monthly income for the reverse mortgage is NOT funded through an annuity.
Count reverse mortgage monthly income as unearned income to the Medicaid client if the monthly reverse mortgage income IS funded through an annuity. Annuity rules and not reverse mortgage rules apply in this instance. This does not need Central Office review.
Always count reverse mortgage monthly income paid to a community spouse because they are not a Medicaid client and the Medicaid exclusions of counting income do not apply to the community spouse.
Medicare Set-Aside Arrangement (MSA)
Medicare takes the position of a secondary payer in cases where there is another culpable party, such as an employer and/or its Workers’ Compensation Insurance carrier.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-036
The purpose of the Medicare Set-Aside Arrangement (MSA) is to provide funds to an injured worker to pay for future medical expenses that would otherwise be covered by Medicare, otherwise known as “qualified medical expenses”. If the injured worker incurs qualified medical expenses that exhaust the anticipated annual amount, Medicare will pay for any excess expenses. By establishing a Medicare Set-Aside Account, parties to a settlement are protecting Medicare’s interest and complying with the Medicare Secondary Payer Act.
Non-Liquid Resources: Property that is not cash and that cannot be converted to cash within 20 days.
Examples of Non-Liquid Resources:
1. A home; 2. Additional pieces of property; 3. Trailer houses; 4. Burial spaces; 5. Motor vehicles; 6. Life estates; 7. Farm and business equipment; 8. Livestock; 9. Poultry and crops; and 10. Household goods and other personal effects.
477-000-037
REV. JANUARY 21, 2020 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-037 – Medically Needy Standard Medically Needy Income Level The following figures are used for Medicaid or SIMP budgeting: (Figures listed are representative of dollar amounts) Number of Individuals One Month 1 392.00 2 392.00 Individual in long term care facility 60.00 Individual in Assisted Living with Waiver Services 783.00
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-038
477-000-038 – Life Estate and Remainder Interest Table
The life estate chart may be used whenever it is necessary to determine the value of a client's life estate interest in real property. For example, if a client gives away a life estate in real property, this may be considered a deprivation of a resource if the client is in a medical facility. To determine the value of the resource the client disposed of, use this chart.
Find the client's age in the Age column and then go to the column called Life Estate. Take the percentage listed here and multiply it by the TOTAL value of the real property. This will give you the value of the client's life estate interest.
For example, if a client has a life estate in real property and the life estate is deeded to the client's relatives within 60 months of the client entering a nursing home, this may be considered a deprivation of a resource. If the total value of the property is $40,000 and the client is 72 years old, you would take $40,000 x .57261 and the client's life estate interest was worth $22,904.40. The remainder amount to the relatives is $17,095.60 ($40,000 X .42739 in remainder column). The life estate tables may also be used if the owners wish to sell the property and need to know how much of the net proceeds the client should receive or if the owners wish to purchase the life estate interest from the client.
Life Estate Remainder Chart (rev. September 15, 2009) AGE LIFEESTATE REMAINDER 0 .97188 .02812 1 .98988 .01012 2 .99017 .00983 3 .99008 .00992 4 .98981 .01019 5 .98938 .01062 6 .98884 .01116 7 .98822 .01178 8 .98748 .01252 9 .98663 .01337 10 .98565 .01435 11 .98453 .01547 12 .98329 .01671 13 .98198 .01802 14 .98066 .01934 15 .97937 .02063 16 .97815 .02185 17 .97700 .02300
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-038
AGE LIFEESTATE REMAINDER 18 .97590 .02410 19 .97480 .02520 20 .97365 .02635 21 .97245 .02755 22 .97120 .02880 23 .96986 .03014 24 .96841 .03159 25 .96678 .03322 26 .96495 .03505 27 .96290 .03710 28 .96062 .03938 29 .95813 .04187
Life Estate Remainder Chart (rev. September 15, 2009) AGE LIFEESTATE REMAINDER 30 .95543 .04457 31 .95254 .04746 32 .94942 .05058 33 .94608 .05392 34 .94250 .05750 35 .93868 .06132 36 .93460 .06540 37 .93026 .06974 38 .92567 .07433 39 .92083 .07917 40 .91571 .08429 41 .91030 .08970 42 .90457 .09543 43 .89855 .10145 44 .89221 .10779 45 .88558 .11442 46 .87863 .12137 47 .87137 .12863 48 .86374 .13626 49 .85578 .14422 50 .84743 .15257 51 .83674 .16126
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-038
AGE LIFEESTATE REMAINDER 52 .82969 .17031 53 .82028 .17972 54 .81054 .18946 55 .80046 .19954 56 .79006 .20994 57 .77931 .22069 58 .76822 .23178 59 .75675 .24325 60 .74491 .25509 61 .73267 .26733 62 .72002 .27998 63 .70696 .29304
Life Estate Remainder Chart (rev. September 15, 2009) AGE LIFEESTATE REMAINDER 64 .69352 .30648 65 .67970 .32030 66 .66551 .33449 67 .65098 .34902 68 .63610 .36390 69 .62086 .37914 70 .60522 .39478 71 .58914 .41086 72 .57261 .42739 73 .55571 .44429 74 .53862 .46138 75 .52149 .47851 76 .50441 .49559 77 .48742 .51258 78 .47049 .52951 79 .45357 .54643 80 .43659 .56341 81 .41967 .58033 82 .40295 .59705 83 .38642 .61358 84 .36998 .63002 85 .35359 .64641
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-038
AGE LIFEESTATE REMAINDER 86 .33764 .66236 87 .32262 .67738 88 .30859 .69141 89 .29526 .70474 90 .28221 .71779 91 .26955 .73045 92 .25771 .74229 93 .24692 .75308 94 .23728 .76272 95 .22887 .77113 96 .22181 .77819 97 .21550 .78450
Life Estate Remainder Chart (rev. September 15, 2009) AGE LIFEESTATE REMAINDER 98 .21000 .79000 99 .20486 .79514 100 .19975 .80025 101 .19532 .80468 102 .19054 .80946 103 .18437 .81563 104 .17856 .82144 105 .16962 .83038 106 .15488 .84512 107 .13409 .86591 108 .10068 .89932 109 .04545 .95455
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
477-000-039 – Life Expectancy Tables
From Social Security’s Online Actuarial Publications “Period of Life Table.” A period life table is based on the mortality experience of a population during a relatively short period of time. Here we present the 2013 period of life table for the Social Security area population. For this table the period life expectancy at a given age represents the average number of years of life remaining if a group of persons at that age were to experience the mortality rates for 2013 over the course of their remaining life.
Period Life Table, 2013 Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 0 0.006519 100,000 76.28 0.005377 100,000 81.05 1 0.000462 99,348 75.78 0.000379 99,462 80.49 2 0.000291 99,302 74.82 0.000221 99,425 79.52 3 0.000209 99,273 73.84 0.000162 99,403 78.54 4 0.000176 99,252 72.85 0.000133 99,387 77.55 5 0.000159 99,235 71.87 0.000119 99,373 76.56 6 0.000146 99,219 70.88 0.000109 99,361 75.57 7 0.000133 99,205 69.89 0.000101 99,351 74.58 8 0.000118 99,192 68.90 0.000096 99,341 73.58 9 0.000102 99,180 67.90 0.000093 99,331 72.59 10 0.000091 99,170 66.91 0.000094 99,322 71.60 11 0.000096 99,161 65.92 0.000100 99,312 70.60 12 0.000128 99,151 64.92 0.000112 99,303 69.61 13 0.000195 99,138 63.93 0.000134 99,291 68.62
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 14 0.000288 99,119 62.94 0.000162 99,278 67.63 15 0.000389 99,091 61.96 0.000194 99,262 66.64 16 0.000492 99,052 60.99 0.000226 99,243 65.65 17 0.000607 99,003 60.02 0.000261 99,220 64.67 18 0.000735 98,943 59.05 0.000297 99,194 63.68 19 0.000869 98,870 58.09 0.000334 99,165 62.70 20 0.001011 98,785 57.14 0.000373 99,132 61.72 21 0.001145 98,685 56.20 0.000412 99,095 60.75 22 0.001246 98,572 55.27 0.000446 99,054 59.77 23 0.001301 98,449 54.33 0.000472 99,010 58.80 24 0.001321 98,321 53.40 0.000493 98,963 57.82 25 0.001330 98,191 52.47 0.000513 98,915 56.85 26 0.001345 98,060 51.54 0.000537 98,864 55.88 27 0.001363 97,928 50.61 0.000563 98,811 54.91 28 0.001391 97,795 49.68 0.000593 98,755 53.94 29 0.001427 97,659 48.75 0.000627 98,697 52.97 30 0.001467 97,519 47.82 0.000664 98,635 52.01 31 0.001505 97,376 46.89 0.000705 98,569 51.04 32 0.001541 97,230 45.96 0.000748 98,500 50.08
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 33 0.001573 97,080 45.03 0.000794 98,426 49.11 34 0.001606 96,927 44.10 0.000845 98,348 48.15 35 0.001648 96,772 43.17 0.000903 98,265 47.19 36 0.001704 96,612 42.24 0.000968 98,176 46.23 37 0.001774 96,448 41.31 0.001038 98,081 45.28 38 0.001861 96,277 40.38 0.001113 97,979 44.33 39 0.001967 96,097 39.46 0.001196 97,870 43.37 40 0.002092 95,908 38.53 0.001287 97,753 42.43 41 0.002240 95,708 37.61 0.001393 97,627 41.48 42 0.002418 95,493 36.70 0.001517 97,491 40.54 43 0.002629 95,262 35.78 0.001662 97,343 39.60 44 0.002873 95,012 34.88 0.001827 97,182 38.66 45 0.003146 94,739 33.98 0.002005 97,004 37.73 46 0.003447 94,441 33.08 0.002198 96,810 36.81 47 0.003787 94,115 32.19 0.002412 96,597 35.89 48 0.004167 93,759 31.32 0.002648 96,364 34.97 49 0.004586 93,368 30.44 0.002904 96,109 34.06 50 0.005038 92,940 29.58 0.003182 95,829 33.16 51 0.005520 92,472 28.73 0.003473 95,524 32.27
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 52 0.006036 91,961 27.89 0.003767 95,193 31.38 53 0.006587 91,406 27.05 0.004058 94,834 30.49 54 0.007170 90,804 26.23 0.004352 94,449 29.62 55 0.007801 90,153 25.41 0.004681 94,038 28.74 56 0.008466 89,450 24.61 0.005040 93,598 27.88 57 0.009133 88,693 23.82 0.005400 93,126 27.01 58 0.009792 87,883 23.03 0.005756 92,623 26.16 59 0.010462 87,022 22.25 0.006128 92,090 25.31 60 0.011197 86,112 21.48 0.006545 91,526 24.46 61 0.012009 85,147 20.72 0.007034 90,927 23.62 62 0.012867 84,125 19.97 0.007607 90,287 22.78 63 0.013772 83,042 19.22 0.008281 89,600 21.95 64 0.014749 81,899 18.48 0.009057 88,858 21.13 65 0.015852 80,691 17.75 0.009953 88,054 20.32 66 0.017097 79,412 17.03 0.010950 87,177 19.52 67 0.018463 78,054 16.32 0.012010 86,223 18.73 68 0.019959 76,613 15.61 0.013124 85,187 17.95 69 0.021616 75,084 14.92 0.014330 84,069 17.18 70 0.023528 73,461 14.24 0.015728 82,864 16.43
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 71 0.025693 71,732 13.57 0.017338 81,561 15.68 72 0.028041 69,889 12.92 0.019108 80,147 14.95 73 0.030567 67,930 12.27 0.021041 78,616 14.23 74 0.033347 65,853 11.65 0.023191 76,961 13.53 75 0.036572 63,657 11.03 0.025713 75,177 12.83 76 0.040276 61,329 10.43 0.028609 73,244 12.16 77 0.044348 58,859 9.85 0.031760 71,148 11.50 78 0.048797 56,249 9.28 0.035157 68,888 10.86 79 0.053739 53,504 8.73 0.038920 66,467 10.24 80 0.059403 50,629 8.20 0.043289 63,880 9.64 81 0.065873 47,621 7.68 0.048356 61,114 9.05 82 0.073082 44,484 7.19 0.054041 58,159 8.48 83 0.081070 41,233 6.72 0.060384 55,016 7.94 84 0.089947 37,890 6.27 0.067498 51,694 7.42 85 0.099842 34,482 5.84 0.075516 48,205 6.92 86 0.110863 31,040 5.43 0.084556 44,565 6.44 87 0.123088 27,598 5.04 0.094703 40,796 5.99 88 0.136563 24,201 4.68 0.106014 36,933 5.57 89 0.151299 20,896 4.34 0.118513 33,017 5.17
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 90 0.167291 17,735 4.03 0.132206 29,104 4.80 91 0.184520 14,768 3.74 0.147092 25,257 4.45 92 0.202954 12,043 3.47 0.163154 21,542 4.13 93 0.222555 9,599 3.23 0.180371 18,027 3.84 94 0.243272 7,463 3.01 0.198714 14,775 3.57 95 0.263821 5,647 2.82 0.217264 11,839 3.34 96 0.283833 4,157 2.64 0.235735 9,267 3.12 97 0.302916 2,977 2.49 0.253810 7,083 2.93 98 0.320672 2,075 2.36 0.271155 5,285 2.76 99 0.336706 1,410 2.24 0.287424 3,852 2.60 100 0.353541 935 2.12 0.304670 2,745 2.45 101 0.371218 605 2.01 0.322950 1,909 2.30 102 0.389779 380 1.90 0.342327 1,292 2.17 103 0.409268 232 1.80 0.362867 850 2.03 104 0.429732 137 1.70 0.384639 541 1.91 105 0.451218 78 1.60 0.407717 333 1.78 106 0.473779 43 1.51 0.432180 197 1.67 107 0.497468 23 1.42 0.458111 112 1.56 108 0.522341 11 1.34 0.485597 61 1.45
REV. APRIL 11, 2017 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #18-2017 HEALTH AND HUMAN SERVICES 477-000-039
Male Female Exact age Death probability a Number of lives b Life expectancy Death probability a Number of lives b Life expectancy 109 0.548458 5 1.26 0.514733 31 1.35 110 0.575881 2 1.18 0.545617 15 1.26 111 0.604675 1 1.11 0.578354 7 1.17 112 0.634909 0 1.04 0.613055 3 1.08 113 0.666655 0 0.97 0.649839 1 1.00 114 0.699987 0 0.90 0.688829 0 0.92 115 0.734987 0 0.84 0.730159 0 0.85 116 0.771736 0 0.78 0.771736 0 0.78 117 0.810323 0 0.72 0.810323 0 0.72 118 0.850839 0 0.67 0.850839 0 0.67 119 0.893381 0 0.61 0.893381 0 0.61
a Probability of dying within one year. b Number of survivors out of 100,000 born alive. Note: The period life expectancy at a given age for 2013 represents the average number of years of life remaining if a group of persons at that age were to experience the mortality rates for 2013 over the course of their remaining life. Source: Social Security Administration, Estimates from the 2016 Trustees Report.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-040
477-000-040 – State Review Team Information
Requirement of Medical Information Existence and permanence of an impairment must be determined from the findings reported by the physician following a diagnostic examination of the applicant. The report may also be made from information in existing medical records, such as those of the physician or of a clinic or hospital in which the applicant has been a patient if the treatment received was directly related to the disability impairment, and the applicant has been treated by the physician or had been a patient in the clinic or hospital within the year preceding the application or reapplication. The SRT will accept supporting medical documentation 12 months prior to the application date. However, there must be medical information for the time period being considered by the SRT and current information from an examination which occurred within three months of the application. If the applicant has requested consideration of an earlier onset of disability than the month of review by the SRT, medical information pertinent to that time period must be provided.
SRT Decision
The SRT considers the medical and social information submitted and determines if the applicant is disabled or blind. The SRT shall report their findings via Form MLTC-73.
Review of Disability Information for the review of disability must be submitted to the SRT before the date specified on Form MLTC-73. New medical and social information shall be provided and any additional medical information requested on the original Form MLTC-73 in order for the SRT to complete redetermination of disability. To continue Medicaid at the end of the 12-month period, a review of disability by SRT is needed.
Review When change occurs which may raise questions affecting the disability status and continued medical eligibility, SRT shall be notified.
Payment for Examination and Transportation: The cost of medical examinations to determine initial or continuing eligibility may not exceed the established fee. The cost of a medical examination to determine eligibility is an allowable Title XIX expenditure if the individual is eligible for medical benefits on the date of the examination. If the initial application is rejected, the cost of the examination must be paid from administrative funds. The cost of transportation necessary to secure the examination, and subsistence expense when it is necessary for the individual to secure the required services away from home are paid from administrative funds if the application is rejected. If the application is approved, the cost of transportation and subsistence expense is allowed in the budget as a special need.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-041
477-000-041 – RSDI Verification
Generally RSDI (Social Security) is verified by the Bendex for current recipients of ABD. Changes in benefits for current recipients are reported on N-FOCUS via the BDE interface and are used to determine the following month’s budget, taking into consideration the Request. This procedure does not apply to discrepancies with the buy-in. When a client is current pay SSI verification of other income or resources are not required.
The State Data Exchange (SDX) must be used to verify receipt of SSI benefits and determine the correct federal benefit rate. Changes in SSI benefits for current recipients are reported on N- FOCUS via the SDX interface. The ten-day notice requirement must be used. When there is a discrepancy in the verified amount of the check and the Bendex for the month of the check, a SVES SDX must be initiated to verify the amount of periodic extra earned income or periodic unearned income to be used in a client’s ABD budget if s/he is in non-pay status for SSI for one month due to the receipt of this periodic income.
This may be Net Countable Unearned Income, Deemed Income, or Net Countable Earned Income of the client. The amount of income from any of these fields may be used from the SDX and counted in the client’s budget, if it has been updated by SSI. No income disregards are allowed as they have already been allowed by SSI. If the client receives periodic unearned income, e.g., life estate income received annually or semi-annually, or deemed income from a spouse/parent, it is counted for medical budgeting. Approval of an application must not be delayed if all eligibility factors are met but is unable to obtain verification of the amount of any RSDI and/or SSI benefits due to SSA’s delay in determining the amount(s).
If a disabled client is not yet receiving RSDI, medical budgets must be computed without the RSDI income. At the time of approval, the client must be notified on a Notice of Action that s/he must report receipt of any RSDI and/or SSI benefits. The RSDI must be included in the budget in the first month possible considering the ten-day notice requirement.
477-000-042
REV. FEBRUARY 1, 2022 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-042 – SIMP Assessment for HCBS Waiver/PACE For definitions of institutionalized spouse, community spouse, institutional level of care, Assessment of Resources, and other SIMP components and processes, see 477 NAC Chapter 26. HCBS – Home and Community-Based Services PACE – Program of All-Inclusive Care for the Elderly A Spousal Impoverishment (SIMP) Assessment of Resources may be completed when it is likely that 30 days of nursing home level of care is necessary for an individual either in the home (e.g. HCBS waiver or PACE) or in a medical institution. The institutionalized spouse may receive HCBS waiver or PACE when a couple has spent down the community spouse’s reserved resource amount (based on the signed Assessment of Resources) plus the $4,000 resource maximum for the institutionalized spouse, or the community spouse has the minimum reserved resource amount or less (refer to 477-000-012 for the current amount). If the institutionalized spouse has not been residing in a medical institution for more than 30 days, then a level of care assessment is needed to verify that the 30-day requirement has been met in order to begin the Assessment of Resources process. • The completion of an HCBS waiver or PACE level of care assessment (when level of care is met) meets the criteria for the likely 30-day period. OR • If the institutionalized spouse has not already met the 30-day continuous stay, the facility may declare that the stay is likely to be at least 30 days. Examples: One Spouse is requesting Medicaid and HCBS Waiver or PACE: 1) It is verified that the spouse requesting HCBS Waiver or PACE has met the likely 30-day period requirement. 2) An Assessment of Resources is completed. a. Current resources must be no more than the reserved resource amount plus $4,000 in resources for the institutionalized spouse. 3) SIMP budgeting begins the month HCBS waiver or PACE services actually begin. 4) Medicaid eligibility for the community spouse is re-determined (when applicable).
REV. JULY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #37-2014 HEALTH AND HUMAN SERVICES 477-000-043
477-000-043 – Procedures for Assisted Living and Assisted Living Waiver Services
Points to remember about AL and ALW Services:
1. There is no Medicare certification for Assisted Living Waiver Services, so the SON will change the first full month of authorized Waiver services. 2. Always use the highest appropriate SON for the month of entry into Assisted Living. 3. There is no remedial care allowance for Assisted Living Waiver, only Assisted Living. 4. The client must be Waiver eligible (need nursing home level of care) and have an Aged and Disabled Waiver case established in order to be considered Assisted Living Waiver. 5. The SON for Assisted Living, as well as Assisted Living Waiver, includes the personal needs allowance. To arrive at the actual room and board payment, the client would pay the facility, You need to subtract the Personal Needs Allowance from the total SON. 6. Deprivation of resource rules do apply to Assisted Living Waiver, but not to Assisted Living except for grant. 7. Both Assisted Living and Assisted Living Waiver budgets get the $20 disregard. 8. The begin date for Waiver is the date payment for waiver services begins. This date is not necessarily the same as the Waiver assessment date. 9. If both spouses are in Assisted Living and only one needs Waiver services, the other spouse may be a community spouse.
See 477-000-042 for spousal procedures when there is Waiver at home. For N-FOCUS budgeting steps for Assisted Living and Assisted Living with Waiver, see the “How To” Help in N-FOCUS.
REV. DECEMBER 17, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-044
477-000-044 – ABD Standard of Need
The ABD Standard of Need is used to determine when a referral is needed for payment and for remedial care calculation for a Nebraska Medicaid budget.
Figures listed are representative of dollar amounts ABD Standard of Need
Number in Unit 2025 2026 (Effective 01/01/2026) 1 737 764 2 1,146 1,187 3 1,454 1,509 4 1,767 1,836 5 2,080 2,163 6 2,393 2,490 7 2,706 2,817 8 3,019 3,144 9 3,332 3,471 10 3,645 3,798 Each additional person 313 327
Standard of Need Nursing Home, Public Institution for the Treatment of Mental Diseases
Effective 9/1/23: 75 Effective 9/1/23: Personal Needs Allowance of $75 is included in the living arrangements listed:
Effective 1/1/25 Effective 1/1/26 Maximum Board and Room *Drug Treatment Centers are budgeted as Board and Room unless Medicaid is paying. If Medicaid is paying, use $64. 982 1,009 Maximum for Licensed or Non-Licensed Boarding Home (providing board and room) 982 1,009 Certified Adult Family Home 1,110 1,137 Licensed Assisted Living Facility 1,420 1,447 Assisted Living Waiver 967 994 Licensed Group Home for Children and/or Child Caring Agency 1,046 1,073 Licensed Center for the Developmentally Disabled 982 1,009 Licensed Mental Health Center 1,420 1,447
REV. DECEMBER 17, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-044
Maximum Shelter Allowance Single Shelter Amount 281 Multiple Shelter Amount 349
SSI Referral Amounts
2025 Effective 01/01/2026 Single Individual 987 1,014 Couple 1,470 1,511
477-000-045
REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-045 – Share of Cost If an applicant or recipient of Nebraska Medicaid does not meet the requirements for Nebraska Medicaid due to excess income, but can demonstrate a medical need, then a medically needy budget may be approved. Countable income for the month is reduced to the Medically Needy Income Level (MNIL) by spending the excess income on medical services or supplies. The amount that needs to be incurred is referred to as the Share of Cost (SOC). Nebraska Medicaid becomes active for the month after an individual has reduced their income below the MNIL. Each month is determined separately. An applicant may be determined eligible for medical assistance with a SOC if: 1. The applicant’s income and resources have been verified. The individual must meet a category of eligibility except for excess income; 2. A medical need exists or can reasonably be anticipated which meets or exceeds the SOC amount; 3. The individual has paid or obligated the SOC for medical care or services for anyone in the medical assistance unit. If the income of a parent in the home but not in the unit has been considered in the budget, the parent’s medical expenses (including insurance premiums) may be applied to meet the child's SOC obligation; and 4. Obligations or expenditures are substantiated on the Record of Health Cost – Share of Cost – Nebraska Medicaid Program form. The medical need will be re-evaluated at renewal. If it is determined that a medical need continues to exist, and the applicant remains eligible, then a SOC benefit may continue. If it is determined that a medical need no longer exists or the SOC has not been met in the prior months, then the benefit will end. Meeting the SOC Obligation When it is necessary to obligate income to meet the SOC, a form will be mailed each month. The individual will take the monthly SOC form to medical providers and medical services received for the month will be recorded on the form. The medical provider that provides the last service necessary to meet the SOC will submit the completed SOC form as directed on the form. Nebraska Medicaid coverage for medical bills not used to meet the SOC obligation is effective at the first of the month. If the individual does not meet the obligation, no medical bills are paid by Nebraska Medicaid for that month.
Allowable Share of Cost Obligations Medical Service or Supply: Any medically necessary service or supply is an allowable obligation of the SOC amount, whether or not the service or supply would be covered by Nebraska Medicaid. This includes the cost of: • Transportation to obtain necessary medical care. Mileage is allowed if the person travels by car. The actual cost of other forms of transportation is allowed.
REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-045
• Meals and lodging when necessary to obtain approved health services and only if the client is away from home for 12 hours or more per day. The allowance for cost of meals is $12 per day. The cost of lodging will be allowed if reasonable and the cost is verified. The allowance for meals and lodging may be allowed for an attendant if one is needed to accompany the recipient. • Actual fees for case management services provided by an Area Agency on Aging or a Nebraska Medicaid provider who is approved to provide case management services. Prior approval may be necessary if case management services are provided by another source. • The amount of medical premiums, including Medicare premiums, paid by an individual can be used as an obligation to the SOC amount. In most cases, this amount will be deducted before the SOC amount is calculated. • Remedial care services are an allowable obligation, whether or not they are covered by Nebraska Medicaid. Remedial care services are those services which assist in curing, alleviating, or easing a medical condition. This includes medically necessary over the counter drugs. • Medical expenses paid by another state, county, or city program may be used toward the individual’s obligation if no federal funds are used to pay the medical expense. This would include programs such as county general assistance, the Renal Disease Program or the Medically Handicapped Children's Program (MHCP). • Deductibles and co-pays from another insurance policy (including Medicare) may be used to meet an individual’s SOC. • Room and board expenses may NOT be used to meet the SOC obligation. Any expense incurred to meet the SOC obligation will not be paid by Nebraska Medicaid. Coordination of Benefits When an individual with a SOC obligation has medical insurance (including Medicare, worker's compensation, etc.), the following procedures apply: 1. A claim for payment is submitted to the insurance company before consideration of the SOC obligation. 2. The amount of the claim which is allowed or disallowed by the insurance company is verified (i.e., Medicare Explanation of Benefits (EOB’s), or other insurance benefit explanation forms). 3. The amount that the insurance company allowed must not be counted toward the individual's SOC obligation. 4. The amount of the claim which the individual incurs is counted toward the SOC obligation. This procedure applies to all persons whose medical expenses are being used to meet the SOC obligation.
REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-045
Procedures for Institutionalized Individuals Nebraska Medicaid recipients in medical institutions and certain recipients of Home and Community Based Services Waivers are considered institutionalized individuals. These recipients owe a portion of their income to the provider each month. This amount is also referred to as a SOC but is handled differently than for non-institutionalized individuals. • No form is sent each month because the need for ongoing medical services has been established in determining their eligibility for long-term care. • The amount that the recipient is responsible for is paid directly to the provider. • The amount of expected institutional expenses for the month are projected in order to establish that the person has a medical need. • An institutionalized individual may use additional medical expenses not covered by Nebraska Medicaid (e.g., health insurance premiums, incontinence supplies not provided by the facility) in order to meet their SOC obligation for the month. These expenses are the same as listed above. Change in Facilities If the Nebraska Medicaid recipient moves from one facility into another during the same month, the SOC is applied to the care received in the first facility. If the SOC amount is greater than the cost of care provided in the first facility, the SOC is split, and any remaining amount is applied to care in the second facility.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
477-000-047 – Examples: Transitional Medical Assistance
If a family qualifies for TMA (Transitional Medical Assistance), they are entitled to the first six months of eligibility without regard to income. However, beginning with Month 7 the family is subject to an income test. The family loses TMA eligibility if the countable earned income is greater than 185% FPL for the appropriate household size.
The countable income is determined by averaging the gross monthly earned income and subtracting the cost of child care (including that amount paid by Child Care Assistance). No other disregards are allowed. Unearned income is not considered in TMA budgeting.
In order to determine the household’s income, earnings and child care costs from the QRF report period (each three months) of TMA are reported via a QRF (Quarterly Report Form). Income from the QRFs are used to determine whether the family is eligible for TMA beyond Month 6. Assuming that the QRF and income verification are provided, there are four possible outcomes:
1. The countable income from the QRF is less than 58% FPL and is reflective of the current employment situation. Review all individuals for MAGI eligibility.
2. The countable income from Months 1 through 3 is greater than 185% FPL and is reflective of the current employment situation, TMA eligibility does not exist beyond Month 6 and the TMA case should be closed allowing for timely and adequate notice. Eligibility for Medicaid should be explored.
3. The countable income is less than 100% FPL and all TMA unit members remain eligible for TMA without any premium.
4. The countable income falls between 100% and 185% FPL. The premium, may apply to all TMA unit members or only to the adult(s). Since TMA is considered non-MAGI, we will run the budgets with the children as non-filers to place them in a MAGI child program (if applicable) and the adults would remain in the TMA premium. If the children are not eligible for the MAGI child program then the whole unit would be included in the TMA premium. TMA premium amounts are found in 477-000-012. The household must be notified of their premium.
WHO PAYS THE PREMIUM? The TMA premium may be required only for the adult(s) in the family; it may also be required for the child(ren). This will depend on the income, family size, composition of the family, and ages of the children. Another factor that must be considered is whether the child(ren) are covered by creditable health insurance. If the children pass eligibility for Medicaid or CHIP, they would not have a premium.
If the parent(s) choose to have a share of cost (SOC) in lieu of the TMA premium, all eligibility factors for medically needy must be met. For example, a medical need, resources, a valid application.
Before approving a TMA premium, review each individual for continuous eligibility.
Note: Please do not close the TMA case if the client has not paid their premium. The client will not receive Medicaid services for that month if the premium is not paid.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
Alaskan Natives and American Indians who provide verification of their tribal affiliation are not required to pay a premium. This determination is handled by Central Office.
Example 1: Household consists of Mom (age 23) and one child, age 4. The first QRF indicates that the countable monthly income is $1,300. Mom does carry health insurance on both herself and her child. One hundred percent FPL for a two-person household is $1,293, so this family may be subject to a TMA premium. The last eligibility review was completed five months ago.
Note FPL figures are updated annually.
Factors to Consider:
The child is under age 6 so would be budgeted at 145% FPL. CHIP is not an option due to the health insurance coverage. The last eligibility renewal was less than six months ago, but because it was not the initial determination, the child is not assured of any period of continued eligibility so may be subject to a premium along with Mom, if the child fails the applicable Medicaid category.
Result: The Mom in this case must make a decision. The income exceeds the guidelines for a household size of two, so she would be subject to a SOC if we were to close the TMA and run her through “regular” Medicaid budgeting. The income is less than 145% FPL for two, so the child would remain eligible without a SOC. Mom would remain on TMA with a premium while the child would be eligible for Medicaid.
Example 2: Household consists of a married couple with two children, ages 16 and 14. Both parents work and the QRF shows their combined gross earned income to be $2,900 per month. TMA is entering Month 7. The countable income exceeds 100% FPL for a four-person household, yet it is less than 213% FPL. The children are covered by creditable health insurance.
Factors to Consider: The family’s countable income exceeds the medically needy income level (MNIL) for four (the parent’s income standard) and also exceeds 133% FPL for four (the children’s income standard). Although the countable income is less than 213% FPL, we cannot close the parents and run the children in CHIP because the children are insured.
Result: In this case, all four family members are subject to the TMA premium. TMA premium amounts are found in 477-000-012.
Example 3: Single parent mother, age 28 with one child, age 9. Household has been on TMA for six months as Mom is employed full-time. The QRF shows that Mom earns $1,400 per month and pays no child care. Mom does not have health insurance coverage on herself or her child.
Factors to consider:
Mom’s countable income falls between 100% and 185% FPL, so she would appear to be subject to a TMA premium. Mom’s income clearly exceeds the MNIL for two, so the result would be a large SOC. There is no health insurance coverage and the income is below 213% FPL, so the child would be Medicaid eligible.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
Transitional Medical Timeline
The Medicaid client calls to report that she has found a job. The budget is updated and the client fails Parent/Caretaker Relative group. The client has received Medicaid (without a Share of Cost) in three of the previous six months.
The client is determined ineligible due to earnings. Staff sends notice advising the client that Transitional Medical begins effective 9/2013. N-FOCUS sets the TMA Begin Date as 09/2013.
Note: While earnings (and cost of child care as appropriate) must be reported on a quarterly basis completion and/or return of the Quarterly Report Form (QRF) is NOT an eligibility requirement. The client may only provide the requested information required on the form or unless there is a change indicated, current income known to the agency can be used as the attested amount and compared with electronic data sources to budget for the corresponding QRF period.
The following is a “timeline” example illustrating TMA notice and reporting requirements: ______________________________________________________________________ MONTH 1 - September; 1st month of TMA. No action necessary. ______________________________________________________________________ MONTH 2 - October; 2nd month of TMA. No action necessary. ______________________________________________________________________ MONTH 3 - November; 3rd month of TMA; the first QRF is mailed to the client at the end of this month. The first Quarterly Report Form is due by the 10th day of month 4 (December). ______________________________________________________________________ MONTH 4 - December; 4th month of TMA; the first QRF is due by the 10th. No action is REQUIRED at this point if the QRF is not received timely. ______________________________________________________________________ MONTH 5 - January; 5th month of TMA. No action necessary. ______________________________________________________________________ MONTH 6 - February; 6th month of TMA; the 2nd QRF is mailed to the client at the end of this month. Use income from months 1, 2, & 3 to calculate the budget for month 7.
1st quarter's report of earnings received 1st quarter's report NOT received Compute budget (income/child care costs) CLOSE CASE FOR MONTH 7 Compare result to 185% FPL Case manager must send timely notice Income < 185% FPL Income > 185% FPL
TMA continues. Subject to premium if income exceeds 100% FPL. Determine eligibility for MED (must send timely notice).
Note: If the first quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
MONTH 7 - March; 7th month of TMA; the 2nd QRF is due by the 10th. Use income from months 4, 5, and 6 to calculate budgets for months 8, 9 & 10.
2nd quarter's report of earnings received
2nd quarter's report NOT received Compute budget (income/child care costs) CLOSE CASE FOR MONTH 8 Compare result to 185% FPL
Case manager must send timely notice Income < 185% FPL Income > 185% FPL TMA continues. Subject to premium if income exceeds 100% FPL. Determine eligibility for MED (must send timely notice).
Note: If the second quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________ MONTH 8 - April; 8th month of TMA. No action necessary.
Note: If the second quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________ MONTH 9 - May; 9th month of TMA; the 3rd QRF is mailed to the client at the end of this month, and is due by 10th day of month 10. ______________________________________________________________________ MONTH 10 - June; 10th month of TMA; the 3rd QRF is due by the 10th. Use income from months 7, 8, & 9 to calculate budgets for months 11 and 12. If the income verification is not received, benefits should be closed for month 11. ______________________________________________________________________ MONTH 11 - July; 11th month of TMA. No action necessary.
NOTE: If the third quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. TMA should not continue past month 12.
Good Cause for Failing to Submit Information Required from the QRF: For later QRF reporting due to a client claiming good cause please send the case to Central Office for review. 477 NAC 27-006.07B4a ______________________________________________________________________ MONTH 12 - August; 12th month of TMA. At the end of month 12, the TMA case needs to be closed. Determine if a renewal form was sent to the client and what action is needed. Eligibility for Medicaid (but not TMA) shall be determined for all family members. The family cannot receive TMA again until they can meet the "3 out of 6" test again.
Note: Anytime TMA is terminated due to failure to provide verification of income or if the income is in excess of 185% FPL, the children and any medically needy individual must be reviewed for continuous eligibility and eligibility under other programs if all requirements are met (i.e. a current application/renewal form and income are on file, etc.)
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
Transitional Medical Assistance – Examples
TMA Example 1 Parent/caretaker relative (P/CR) Medicaid case becomes ineligible for Medicaid effective April due to increased earnings of the parent/caretaker relative. The unit has been eligible for Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is eligible for the first 6 months of the 12 months of TMA.
TMA Example 2 P/CR Medicaid case becomes ineligible for Medicaid effective April due to increased earnings of the parent/caretaker relative. The unit has NOT been eligible to receive Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is NOT eligible for TMA. A Medicaid budget would need to be computed to determine if medical eligibility exists for the unit. Review for continuous eligibility.
TMA Example 3 P/CR Medicaid case with no earned income becomes ineligible for Medicaid effective April due to increased collection of spousal support. Assuming the unit had received Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is not eligible for TMA since the loss of Medicaid was not due to increased earnings. 477 NAC 27-006.01
TMA Example 4 In May, the Medicaid case is in its 2nd month of the 12 months of TMA. The unit consists of Dad, Mom and a child. The child turns 19 in May and graduates from high school. The unit no longer contains a dependent child. Ten day notice is given and the TMA case is closed effective 6/1. 477 NAC 27-006.04C
TMA Example 5 The unit consists of Mom and 2 children. They are in their 3rd month of the 12 months of TMA. Mom either marries or the father of the children moves back home. Dad is added to the TMA unit. Mom, Dad and the 2 children would remain eligible for at least the first 6 months of the 12 months of TMA. Dad is added to the unit and his income would have to be counted beginning with month 7 of TMA to determine if the unit is under 185% FPL. 477 NAC 27-006.04 through 27-006.04C
TMA Example 6 Same situation as Example 5, however, the unit is in the 8th month of the 12 months of TMA when Dad returns to the household. Again, Dad is added to the TMA unit and his income is considered when the three month average income is computed in month 10 to determine if the unit is over 185% FPL for months 11 and 12. Dad is also added to the FPL level. If the unit's income remains under 185% FPL, the family remains eligible for TMA. If the unit's income is over the 185% FPL, the case is closed the end of month 10 and the children's eligibility for Medicaid is determined. Review for continuous eligibility.
Note: You would already have received Mom's report of her 3 months earnings in month 10. You would look prospectively at Dad's income for months 11 and 12.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
TMA Example 7 The unit consists of Mom and 2 children. They are in their 3rd month of the 12 months of TMA. Mom reports she is pregnant and the father of the unborn has moved in with her. The unborn is added to the unit size as an excluded sibling. Paternity cannot be established for an unborn. The alleged father of the unborn is not added to the unit size and his income would not be counted. Mom and the 2 children would remain in TMA. The alleged father would have no medical coverage unless he is age eligible or disabled and would be a unit size of 1.
TMA Example 8 The unit consists of Mom and 2 children. They are in their 8th month of the 12 months of TMA. One of the children becomes pregnant. Mom and the 2 children remain in TMA and the unborn is added to the unit size as an excluded sibling.
TMA Example 9 The unit consists of Dad, Mom, and 2 children. They are in their 7th month of the 12 months of TMA. Dad is determined disabled by SSA. If Dad would be eligible for ABD Medicaid OR if he is receiving SSI, he must be removed from the TMA unit and budgeted as ABD. If Dad would NOT be eligible for ABD Medicaid or is NOT receiving SSI, he would remain in the TMA unit.
Note: If Dad is eligible for an ABD Medicaid, but removing him from the TMA unit causes the TMA unit to be over the 185% FPL, eligibility for all household members is evaluated. Or, if removing him from the TMA unit to budget in an ABD program case results in a SOC, he can be added back into the TMA unit to eliminate his SOC.
TMA Example 10 The unit is in the 7th month of the 12 months of TMA. Mom reports an increase in her hourly wage that would put the unit over the 185% FPL. The budget would be computed in month 7 based on the new pay schedule to determine eligibility for months 8, 9, and 10.
TMA Example 11 The unit is in their 1st month of the 12 months of TMA. The case is closed at the end of the first month as the family moved to California. The family is only gone for 1 month and then moves back to Nebraska and reapplies for assistance. Mom is still working and the unit is not eligible for Medicaid because of earnings. The unit has been financially eligible to receive Medicaid in 3 of the last 6 months. They would be eligible for TMA, the original TMA cycle resumes.
TMA Example 12 The unit consists of Mom, 2 children ages 6 and 3, and an unborn. The unit is eligible for the first 6 months of TMA. They are not eligible for TMA beyond Month 6 because the earned income minus cost of child care exceeds 185% FPL. The TMA case is closed and a MED budget is run. Mom's eligibility is based on the Pregnant Women income standard for four, 194% FPL. If mom fails PW eligibility, she is continuously eligible through her post-partum eligibility. Eligibility of the three children, if uninsured, is based on the applicable income standard for each child.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047
TMA Example 13 The household has been in TMA since June. In November the employed parent is laid off and requests Medicaid. After the Medicaid eligibility is determined, the parent is recalled to work. There is no Medicaid eligibility for December due to earnings. Because the family was financially eligible to receive a grant or ADC related Medicaid only for November, they cannot begin a new TMA cycle starting with December. However, they may resume the original TMA cycle which began in June. December would be month 7 of the original TMA cycle. 477 NAC 27-006.05
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-048
477-000-048 – Real Property: Transfer on Death Deed
Ownership of real property must be verified by current recorded deed. A transfer on Death Deed is a revocable recorded deed which transfers real property ownership to another individual upon the death of the owner(s). When the current recorded deed is a transfer on death deed for our applicant/client, or his/her spouse, then the applicant/client is not eligible until that deed is revoked and recorded with the County Clerk or Register of Deeds. Below are the required steps: 1. Current Transfer on Death deed is verified and the copy is contained in the case record. 2. Send Notice of Action requiring revocation of transfer on death deed before Medicaid eligibility can be established. Manual reference 477 NAC 23-001.07A. 3. Client/spouse goes through the formal process for transfer on death deed revocation and records that revocation deed. 4. Client/spouse sends copy of revocation recorded deed to DHHS. 5. Eligibility determination proceeds.
REV. JULY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #37-2014 HEALTH AND HUMAN SERVICES 477-000-049
477-000-049 – Resource Review Verification
A renewal of eligibility is completed every 12 months. At the 12 month renewal, resources will be verified if applicable. Clients and/or beneficiaries are required to report changes within 10 days if it affects eligibility, which includes resources.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-050
477-000-050 – Property Excluded Regardless of Value
Property is excluded regardless of its value if a medical assistance client uses it in a trade or business. The client may be an employee who is required to use the property for his/her work or a self-employed individual who uses the property for his/her business.
EXAMPLE 1: Mr. Brown owns his own construction business. The net income from his business is his only source of income. He owns a garage and lot adjacent to his home in which he stores materials, supplies, and equipment used in his business. He maintains a checking account for the business with a current balance of $1,200. The garage, lot, checking account, and all materials, supplies, and equipment used for his business are an excluded resource.
EXAMPLE 2: Mr. Black owns his own hog confinement business. This includes several confinement buildings and the 10 acres they are situated on, 40 acres of farm land used to raise grain for feed, two tractors, a combine, many equipment and machinery items, other supplies for the business, and 50 hogs. He is engaged in the day-to-day business decisions for the operation, performs all the labor, and it is his only source of income. All land, buildings, livestock, machinery, and other equipment or supplies used for his business are an excluded resource.
Exception #1 for Example 2: If Mr. Black owned the operation but contracted out the labor, the resources would not be excluded because he is not performing a primary work effort.
Exception #2 for Example 2: If Mr. Black owned the operation/business, did all the labor, but the income received from the business was less than his Social Security income; then the business is not the primary source of income and the business resources are not excluded.
EXAMPLE 3: Mr. Green is employed by a local construction company as a carpenter. He is required by his employer to provide all his own tools and necessary equipment for carpentry. All tools and equipment required by the employer for work are an excluded resource.
EXAMPLE 4: Mr. Blue is employed by a Feed and Seed Sales company as a salesman. His office is in his home. He has a home computer and other office equipment which he uses for activities necessary to his employment as salesman. The home computer and other office equipment are excluded resources.
NONBUSINESS PROPERTY EXCLUDED UP TO $6,000 EQUITY Nonbusiness property that is used to produce goods or services essential to daily activities is an excluded resource up to $6,000 equity.
EXAMPLE 5: Mrs. Gray owns an extra lot adjacent to her home. The market value of this lot is $7,000 and there is a city lien against it for $2,000. Equity value of the lot is $5,000. Mrs. Gray uses the lot for a garden. The extra lot is an excluded resource because the equity value is less than $6,000 and it is used to produce goods for home consumption.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-050
EXAMPLE 6: Mrs. Mauve is buying two acres of pasture adjacent to her home with a market value of $8,000. She still owes $2,000 on the property so the equity value is $6,000. She uses the two acres of pasture to maintain livestock for food. She also has a tractor valued at $2,000 which is used to haul feed and water to the livestock.
The first $6,000 of equity value on the acreage and tractor is an excluded resource since they are used to produce goods for home consumption. $2,000 is a countable resource.
REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-051
477-000-051 – Partnership/S-Corporation Income
For MAGI:
S-Corporations and Partnership do not need to be reviewed by Central office as all business expenses are allowed per MAGI-based methodologies. If the Hub does not produce a match to verify the client’s attested income, the income amount reported on the client’s personal return (with all schedules and attachments) along with their schedule K-1 issued from the S-Corporation and/or Partnership should provide enough information to make a determination of the countable income.
For Non-MAGI:
S-Corporations and Partnership returns do need to be reviewed by Central Office.
Schedule E When a household’s Federal Income Tax return (1040) shows income or a loss on Line 17, the amount shown will also be reflected on their Schedule E (“Supplemental Income and Loss”). The Schedule E will indicate the type(s) of supplemental income or losses being reported. Part I of the Schedule E shows “Income or Loss from Rental Real Estate and Royalties,” and most expenses shown on Side 1, except for depreciation & depletion, are allowable. Part II of the Schedule E, “Income or Loss from Partnerships and S Corporations,” will indicate to the case manager if the household is involved in a Partnership or an “S” Corporation. If there is an entry in Part II of the Schedule E, the case manager must request tax documents in addition to the household’s Federal Income Tax return (1040) based on the type of income or a loss reported:
Partnerships: If Part II of the Schedule E shows a “P” in the area designated “Enter “P” for partnership; “S” for S Corporation,” the household is involved in a Partnership. o This means that the case manager will need to request certain IRS documents which are related to the status and income of the Partnership. The following IRS documents will be needed in order to determine the countable Partnership income: *IRS Form 1065 U.S. Partnership Return of Income – usually four pages in length, however, the “balance sheet” may not be included if it is not used; Schedule K-1 Form 1065 Partner’s Share of Income, Credits, Deductions, etc. – two pages in length, but sometimes the second page is not completed; (As Appropriate) – If the Partnership is involved in a farming operation, the Partnership must file a Schedule F.
*Each partner in the Partnership should either have or be able to obtain a copy of the Partnership return and appropriate schedules.
“S” Corporations If Part II of the Schedule E shows an “S” in the area designated “Enter “P” for partnership; “S” for S corporation,” the household is involved in an “S” Corporation.
REV. JANUARY 1, 2014 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #17-2014 HEALTH AND HUMAN SERVICES 477-000-051
o An “S” Corporation is a pass-thru small business. All income and expenses pass thru to the individual shareholders by their percentage of ownership. The following IRS documents will be needed in order to determine the countable “S” Corporation income:
*IRS Form 1120S U.S. Income Tax Return for an S Corporation– four pages in length; Schedule K-1 (Form 1120S) – Shareholder’s Share of Income, Deductions, Credits, etc. – two pages in length; (As Appropriate) – If the “S” Corporation is involved in a farming operation, the corporation must file a Schedule F.
*Each shareholder of an “S” Corporation should either have or be able to obtain a copy of the 1120S, their Schedule K-1, and other corporate schedules as appropriate.
Other information Part II of the Schedule E will also show if the involvement in the Partnership or “S” Corporation is passive or nonpassive. If the involvement is passive, the income is treated as unearned income. If the involvement is nonpassive, the income is treated as earned.
If a household member is an employee of a regular, or “C” Corporation, s/he will receive a W-2; income from this source is reported on Line 7 of their 1040 and is treated as regular wages. A copy of the Corporate tax return, IRS Form 1120, is not required, only verification of the income received from the Corporation.
As a general rule, when more documentation is initially provided, a more prompt determination of countable income can be made. When submitting documents to Medicaid Long-Term Care Policy for a determination of countable income, please include the household’s 1040, any schedules (such as the Schedule A, Schedule E, Schedule F, etc.) accompanying the household’s tax return and the business return (as appropriate).
477-000-052
REV. MARCH 12, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-052 – Non-MAGI Resource Verification Plan Nebraska’s Non-MAGI Resource Eligibility Verification Plan for Medicaid The Department will verify those resources declared by the client or appearing on electronic data sources. When verifying resources, the Department will also consider the possibility of ownership of resources that are not declared by the client, review past records, and, if there are resources listed, determine if they are still available. The ABD program follows SSI rules; Title 477 regulations continue to require verification of resources to determine initial and ongoing eligibility for clients with disabilities and aging adults and clients who are medically needy with a share of cost. When required, resource ownership must be verified (initially or when reported). The following information is needed for each resource that requires verification: Description (e.g., account number, policy number, or legal description), location, current value, ownership, and source of verification with the date verified. The Department can assist the client in obtaining requested information. The client should contact the Department if they are unable to obtain the requested verifications or if they wish to verify the information by phone via a conference call. The Department will review resources to determine if a deprivation has occurred. However, a deprivation penalty is only imposed if the client enters or receives institutionalized level of care such as: • Services received in a hospital; • Nursing facility; • Intermediate care facility; • Home and community-based services (HCBS) provided in the home or an assisted living facility; or • Program for all-inclusive care for the elderly (PACE) services provided in the home or in a facility. See the subsequent pages for definitions, verification sources when verification is required, and potential exemptions.
A. Accounts
Cash on Hand Bank Accounts Nursing Home Accounts Definition Funds not accounted for or deposited in any other resource.
Funds deposited and held by a financial institution. e.g., Checking, savings, online banks, credit union, (such as Ally, CHIME, Green Dot, NetSpend) ABLE (ENable), college savings (NEST 529), etc.
A special account for the residents personal funds. Verification Source Client declaration is acceptable. Bank Accounts will be verified electronically if available through the Asset Verification System (AVS).
The most recent monthly statement with ending monthly balance. Statement should include: • Client name. • Financial institution/bank name. • Date. • Account number (at least the last 3 digits), if applicable. • Account balance. • If needed, a conference call may be made to the financial institution to obtain the information.
Attestation is accepted unless there is questionable information that needs to be verified or the declared balance results in excess resources.
When required, the facility may provide verbal or paper verification to include: •Lowest daily balance; •Date of income deposit(s); and •Date facility payment was made.
When to Verify •At initial and renewal applications. •If client reports a change that affects eligibility. •At initial and renewal applications. •If client reports a change that affects eligibility.
•At initial and renewal applications. •If client reports a change that affects eligibility. Exemptions, Disregards and Comments N/A N/A N/A Questions to Consider N/A Do you have any shared accounts – If so with whom? •Do you have separate accounts for farming, self-employment, or student loans? •Do you have a debit card for the deposit of benefits? •Do you have a payee? • Why is there a different address on your statement? • Do you have any accounts with the facility that you reside in? • Is this account held at the nursing home or an outside financial institution? •Do you have any accounts in addition to your bank?
Accounts Continued
Direct Express Card and Relia Card Guardian or Conservator Funds Definition • Direct Express Cards are electronic benefits cards issued by Social Security for deposit of benefits. • Relia Cards are State of Nebraska issued US Bank electronic benefits cards for unemployment, child support or AABD/ADC grant payments. •Note: Social Security requires the electronic deposit of benefits into either a bank account or on a Direct Express card. It is rare that a client will receive funds on a paper check. Financial account that the guardian manages for the client; these are the clients funds. Verification Source Attestation is accepted unless there is questionable information that needs to be verified, or if the declared balance results in excess resources. The most recent monthly statement with transactions and balance. Statement should include: • Client name. • Financial institution/bank name. • Date. • Account number (at least the last 3 digits), if applicable. • Transaction history and account balance. • If needed, a conference call may be made to the financial institution to obtain the information. Guardian or Conservator Funds will be verified electronically if available through the Asset Verification System (AVS).
The most recent monthly statement with ending monthly balance. Statement should include: • Client name. • Financial institution/bank name • Date. • Account number (at least the last 3 digits), if applicable. • Account balance. • If needed, a conference call may be made to the financial institution to obtain the information. When to Verify •At initial and renewal applications. •If client reports a change that affects eligibility.
•At initial and renewal applications. •If client reports a change that affects eligibility. Exemptions, Disregards and Comments N/A • The Guardian/Conservator's Report to the Court can be accepted as verification of the account, if concurrent with the client’s Medicaid renewal (within 30 days). Questions to Consider • Do you have a debit card that your benefits are deposited onto? • Do you have a payee? • Do you have a debit card that you receive child support, unemployment, AABD or ADC grant payments deposited onto?
• Do you have any accounts in addition to your bank? • Does anyone manage your funds or assets for you?
B. Burial Funds
Pre-Need Burial Trust Burial Insurance Policy Burial Space Items Held in Contract Definition Funds in a trust fund created for the purpose of a prearranged funeral plan. Insurance whose terms specifically provide that the proceeds can be used only to pay the burial expenses of the insured. Contract that must state the individual has purchased particular burial space items for a specified price. The contract may be revocable or irrevocable as long as the agreement itself represents the individual’s ownership.
Verification Source A signed copy of the complete Burial Trust contract. A copy of the burial worksheet from the mortuary is needed if the amount is above the specified maximum. A copy of the Policy from the insurance company. A copy of the signed worksheet from the A copy of the Bill of Sale. A copy of the signed worksheet from the mortuary is needed if the amount is above the specified maximum.
mortuary is needed if the amount is above the specified maximum. When to Verify •At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility. •At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility.
•At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility. Exemptions, Disregards and Comments • A burial trust must be irrevocable if it is for paying non-excluded burial expenses. • If the irrevocable burial trust exceeds the specified maximum for non-excluded burial expenses, the excess is considered an available resource. •Once a policy is verified as irrevocable it does not need to be verified again.
• If the client has irrevocably assigned more than the specified maximum for non- excluded burial expenses in the burial insurance policy, the excess must be reviewed by the Department for deprivation of resources, if applicable. • If ownership of the burial insurance policy has been passed to the funeral home and the client is no longer the policy owner, then verification of an irrevocable beneficiary assignment is not needed.
•The contract may be funded by money set aside in a bank account or in a burial insurance policy.
Questions to Consider •Have you purchased any pre- arranged funeral plans? •Do you have any insurance policies designated for burial or that have been assigned to a funeral home?
•Have you pre-purchased any items for your burial or service? Sources for More Information 477 NAC 23-003.05(A)(iii)(1)(a)
477 NAC 23- 003.05(A)(iii)(5)
477 NAC 23-003.05(A)(iii)(8)
Money/Account Designated for Burial Burial Spaces (Plot) Definition An account, separated from all other funds, with up to $1,500 set aside for the sole purpose of paying for burial expenses. These accounts, and any interest earned, are excluded as a resource. Includes a crypt, mausoleum, urn, casket, marker, vault, or other repository for the remains of a deceased person. This also applies to markers, vaults, applicable sales tax, charges for opening and closing the grave. Does not include services, burial fees, etc.
Verification Source Money/Account Designated for Burial will be verified electronically if available through the Asset Verification System (AVS).
The most recent monthly statement with ending monthly balance.
If needed, a conference call may be made to the financial institution to obtain the information.
The individual’s declaration of a plot only may be accepted. If more than one plot is owned, then each plot must be designated for an immediate family member to be excluded.
When to Verify •At initial application. •At renewal. •If client reports change that affects eligibility. •At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility.
Exemptions, Disregards and Comments •These accounts are only allowed if there are no other irrevocable burial arrangements. •Changes include a new account designated for burial funds, updated balances in an existing designated account, and closed accounts (previously in budgets). •If retroactive Medicaid is requested, statements are needed for each month.
•Changes include: Newly purchased or sold spaces. •Once it is verified it does not need to be verified again.
Questions to Consider Do you have any funds set aside in a separate account for burial? Do you own any burial plots for yourself, spouse, or family members? Sources for More Information 477 NAC 23-003.05(A)(iii)(6)
477 NAC 23-003.(A)(iii)(7) and 003.05(A)(iii)(8)
3. Income Producing Resources
Land Contract Life Estate Annuity Definition Entered into when the seller of a property also finances the purchase. Real property in which a client or spouse has a “life interest.” It is a property that the client once owned and has now transferred the remaining interest to another party. A life estate is only a countable resource if sold. A revocable, assignable, or saleable annuity is countable as a resource and provides a right to receive periodic payments, either for life or a term of years.
Irrevocable, non-assignable annuities are not resources, but are a source of unearned income.
The verification pieces would be the same for all annuities.
Verification Source •A copy of the agreement to sell/purchase. •A copy of the trustee deed and/or promissory note (if available). •A copy of the recorded deed. •A life estate may be identified on the deed by the words: "life use" or "for use." •The Department sends Annuity verification form to be completed by the issuer. •The application for annuity, annuity issuance letter and related documents.
When to Verify •At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility. •At initial application. •At renewal applications if changes have occurred. •If client reports change that affects eligibility. •At initial and renewal applications. •If client reports a change that affects eligibility. Exemptions, Disregards and Comments A land contract is not counted as a resource. However, it must be verified, and payments are counted as unearned income. •The Department will review for deprivation if the client is in institutionalized care (Example: nursing home or waiver). •The Department will review for deprivation if the client is in institutionalized care (Example: nursing home or waiver). Questions to Consider •Do you own land in addition to the land your home is on? •Do you own any farmland or land not being used? •Are you owner financing the purchase of land that you own?
•Are you receiving income from a property you transferred or once owned? N/A Sources for More Information 477 NAC 23-003.05(A)(ii) 477-000-031
477 NAC 23-003.05(B)(vi) 477-000-038
477 NAC 23-003.05(A)(vi)(1) through 003.05(A)(vi)(1)(e)
Income Producing Resources Continued
Elective Share of a Spouse’s Augmented Estate Collectable Unpaid Notes or Loans Promissory Notes Definition This is the amount of the deceased spouse's estate that is available to the surviving Medicaid spouse as a potential benefit. An extended form of an IOU from one party to another that enables a payee to receive payments (possibly with interest) over a set period of time.
A financial instrument that contains a written promise by one party to pay another party a definite sum of money either on demand or at a specified future date. Verification Source •A copy of the of the court filing, when required.
•Proof of the client’s augmented share must be provided when the probate is final.
A copy of the signed note and any attached agreement or amendments, and any legal documents. A copy of the signed note and any attached agreement or amendments, and any legal documents. When to Verify •At initial application or renewal applications.
•At the death of a spouse.
•At initial application.
•At renewal applications if changes have occurred.
•If the client reports a change that affects eligibility.
•At initial application. •At renewal applications if changes have occurred. •If the client reports a change that affects eligibility. Exemptions, Disregards and Comments • The death of a community spouse may affect the surviving client’s Medicaid eligibility.
• If refused, payments that are owed to the client will be reviewed for deprivation. • The Department will review promissory notes for deprivation of resources. Questions to Consider N/A •Are you collecting on any debt owed to you? •Are you collecting on any debt owed to you?
4. Investments
Certificate of Deposit Publicly Traded Stocks and Mutual Funds Bonds Definition A time deposit that limits holders from withdrawing funds on demand without penalty. It is still possible to withdraw the money. •Stocks: Share of the value of a company which can be bought, sold or traded as an investment.
•Mutual Fund: Collection of stocks and/or bonds.
An investment in which an investor loans money to an entity (corporate or governmental) that borrows the funds for a defined period of time at a fixed interest rate. e.g., savings bonds. Verification Source Certificates of Deposit will be verified electronically if available through the Asset Verification System (AVS).
The most current quarterly or monthly (if available) statement. Statement should include: • Client name. • Financial institution name. • Date. • Account number (at least the last 3 digits). • Account balance. • If needed, a conference call may be made to the financial institution to obtain the information.
Most current quarterly or monthly (if available) statement. A copy of the bond(s). When to Verify •At initial and renewal applications. •If the client reports a change that affects eligibility.
•At initial and renewal applications. •If the client reports a change that affects eligibility. •At initial application and renewal applications. •If client reports change that affects eligibility. Exemptions, Disregards and Comments These funds are considered an available resource even though there is a penalty for withdrawal. Current stock exchange fair market value of the share(s) with verification of the amount of shares held by client may be used. N/A
Questions to Consider •Do you have any investments that have not been cashed in? •Do you have any investments that have not been cashed in? •Do you have any investments that have not been cashed in?
Investments Continued
IRA 401K / 403(b) Other Investments Definition Individual Retirement Account; There are four main types: Roth IRA- The client pays taxes during accumulation. o Traditional IRA- The client pays taxes upon withdrawal. o SIMPLE - Savings Incentive Match Plan for Employees. o SEP -Simplified Employee Pension IRAs for self-employed individuals or small business owners.
Established by employers for eligible employees to make salary deferral contributions on a post- tax and/or pretax basis. Employers offering a 401K or 403(b) plan may make matching or non- elective contributions to the plan on behalf of eligible employees.
An asset or item that is purchased with the hope that it will generate income or appreciate in the future. e.g., Shares of a business, oil and mineral rights. Verification Source IRAs will be verified electronically if available through the Asset Verification System (AVS).
A copy of the most current quarterly or monthly (if available) statement. Statement should include: • Client name. • Financial institution name. • Date. • Account number (at least the last 3 digits). • Account balance.
A copy of the most current quarterly or monthly (if available) statement. Statement should include: • Client name. • Financial institution name. • Date. • Account number (at least the last 3 digits) • Account balance. A copy of any legal documentation of the agreement.
Examples include, but are not limited to: partnership agreements, articles of incorporation, any other documents that pertain to the rights of the applicant to sell or control the business. When to Verify •At initial and renewal applications. •If the client reports a change that affects eligibility.
•At initial and renewal applications. •If the client reports a change that affects eligibility. •At initial and renewal applications. •If the client reports a change that affects eligibility. Exemptions, Disregards and Comments • These funds are considered an available resource even though there is a penalty for withdraw.
• If funds are not accessible in an employer-controlled 401K or 403(b) due to age, employment status restrictions etc., verification is needed from employer.
N/A
Questions to Consider •Do you have any investments that have not been cashed in? •Do you have any investments that have not been cashed in? •Are the funds accessible? •At what age are funds able to be accessed? •Is the fund employer controlled?
•Do you own shares in any business or corporation?
5. Property
A Home Real Property Trailer/Manufactured House Definition A property occupied now or previously by the client, spouse or other qualifying relative. Additional pieces of property. i.e., Farm, agricultural land, rental property, saleable time shares.
A housing unit constructed primarily off-site prior to being moved to a piece of property where it is set. Verification Source A Home will be verified electronically if available through the Asset Verification System (AVS).
A copy of the deed.
•Equity value may also need to be requested by the Department in certain situations.
Real Property will be verified electronically if available through the Asset Verification System (AVS).
A copy of the deed.
•Equity value may also need to be requested by the Department in certain situations. A Trailer or Manufactured House will be verified electronically if available through the Asset Verification System (AVS).
A copy of the title. •Equity value may also need to be requested by the Department in certain situations.
When to Verify •At initial application if the home is a countable asset. •If the client reports that they are no longer living in their home. •At initial application. •At renewal applications if changes have occurred. •If the client reports change that affects eligibility. •At initial application. •At renewal applications if changes have occurred. •If the client reports change that affects eligibility.
Exemptions, Disregards and Comments •Under certain circumstances, the client’s home is exempt from consideration as a countable resource. •Tax assessor records or receipt are not verification of ownership. •Moving from the home the client owns to an alternative living situation affects eligibility. •When an applicant or client has excess resources because of real property, he or she may receive Medicaid pending liquidation of the resource. •Tax assessor records or receipt are not verification of ownership. •When an applicant or client has excess resources because of real property, he or she may receive Medicaid pending liquidation of the resource. •Under certain circumstances, the client’s home is exempt from consideration as a countable resource. •Tax assessor records or receipt are not verification of ownership. •Moving from a home the client owns to an alternative living situation effects eligibility. •When an applicant or client has excess resources because of real property, he or she may receive Medicaid pending liquidation of the resource. Questions to Consider •Who is residing in the home? •Has the home been placed for sale? •Where were you living prior to applying for Medicaid? •Do you own properties other than the home you live in/own? •Do you own any farmland or land not being used? •Who is residing in the home? •Has the home been placed for sale? •Where were you living prior to applying for Medicaid?
Sources for More Information NAC 477 23-005(B)(iii)(4) through 003.05(B)(iii)(6)(a) 477 NAC 23- 003.05(B)(iv) 477 NAC 23-003.05(B)(iii)(4) through 003.05(B)(iii)(6)(a)
Countable Motor Vehicles. Farm and Business Equipment. Land Leases. Definition Classic vehicles, watercraft (boats, jet skis, etc.) recreational vehicles, off-road vehicles (ATVs, dirt bikes, etc.), aircraft, trailers, etc.
Equipment used for the client's trade or business to produce goods for the client's own use or consumption. Applicant-owned land being rented out. Verification Source •Countable Motor Vehicles will be verified electronically if available through the DMV. •If unable to verify, ownership of a countable motor vehicle is verified by the title or loan document.
Provide an estimate from dealer, loan statement, or auctioneer. •A copy of the recorded deed. •Equity value may also need to be requested by the Department in certain situations. When to Verify •Verify at initial application and renewal applications. •Verify if client reports change that affects eligibility. •Only countable vehicles require verification. •At initial and renewal applications. •If the client reports a change that affects eligibility.
•At initial application. •At renewal applications if changes have occurred. •If the client reports change that affects eligibility. Exemptions, Disregards and Comments •Classic Vehicle Definition: A classic vehicle is defined as a vehicle that may not be used for normal transportation to and from work, driven on a daily basis, or used for hire or used for a commercial business. This vehicle may be used for test drives, parades, or hobby- related activities. •Recreational Vehicle Definition: A motor vehicle that is designed to be used as living quarters, but is not currently being used as the primary residence. • Classic or restored vehicles fair market value is determined by retail value in NADA. If the vehicle is not listed or if the client disputes the value, an estimate of the value from a car dealer may be used. • For other vehicles values (ATV, boat etc.) if not available on Kelley Blue Book or other online sources, the value may be obtained by a dealer statement. • If the vehicle is leased the client does not own the vehicle.
•Under certain circumstances, the client’s farm and business equipment may be exempt from consideration as a countable resource.
The equity value of the land is a countable resource. Follow-up Questions •Do you have any classic cars or motorcycles, boats, jet skis, campers, RVs, trailers, or aircraft? •Do you have any vehicles in storage? •Do you have any leased vehicles or payments? Do you own any machinery or farm equipment? •Do you own land in addition to the land your home is on? •Are you leasing or renting land that you own to anyone?
•Do you have any vehicles licensed in another state? •Are any vehicles used as your residence?
Sources for More Information • Kelley Blue Book • NADA Guide for classic or restored vehicles
477 NAC 23- 003.05(B)(vii) N/A
6. Misc. Resources
Trust Life Insurance Livestock/Poultry and Crops Definition An arrangement in which a client's property or money is legally held or managed by another party.
There are several types of trusts that a client may have: irrevocable, revocable, special needs, guardianship, testamentary, and pooled. Whole life: Insurance with level premiums that has both an insurance and an investment component. The insurance pays a stated amount upon death of the insured. The investment accumulates a cash value that the policyholder can withdraw or borrow against.
Term Life: A form of life insurance that generally furnishes insurance protection for only a specified or limited period of time. May still accrue a cash value.
Livestock/Poultry: Domesticated animals raised to produce food, labor or profit. e.g., Cows, chickens, pigs etc.
Crops: Products that can be grown and harvested extensively for profit. Verification Source •A copy of all legal documents for the trust, including all amendments, attachments, and schedules. •A copy of the most recent financial statement or current accounting record.
•A copy of the most recent statement that verifies ownership, name and address of the insurance company, the policy number, beneficiary, date of purchase, original face value, cash surrender value, and value of any loans against the policy(s) and dividend information. • If needed, a conference call may be made to the financial institution to obtain the information.
Livestock/Poultry: A copy of an estimate from the operating loan, sale barn, or auctioneer.
Crops: Market price from grain elevator.
When to Verify •At initial application. •At renewal applications if changes have occurred. •If the client reports change that affects eligibility. Whole Life policies: •At initial and renewal applications. •If the client reports a change that affects eligibility.
Term Life policies: •At initial application. •At renewal unless original documentation from the insurance company verifies that the insurance policy will not accrue a cash value. •If the client reports a change that affects eligibility.
•At initial and renewal applications. •If the client reports a change that affects eligibility. Exemptions, Disregards and Comments N/A •If the client is unable to provide the needed information the Department can send a Life Insurance Verification Request form to the insurance company. Cash surrender value tables cannot be used as verification.
•Under certain circumstances, the client’s livestock, poultry, and crops may be exempt from consideration as a countable resource.
Questions to Consider N/A N/A N/A Sources for More Information 477 NAC 23- 003.05(A)(vi)(2)(a) • 477 NAC 23- 003.05(A)(iv) • 477 NAC 23-003.05(B)(vii)
Misc. Resources Continued
Household Goods and other Personal Effects Contents of Safe Deposit Box Tax Refund Definition Household goods and personal effects of moderate value used in the home. e.g. Furnishings and equipment used in the operation, maintenance and occupancy of the home. Items for comfort and accommodation; personal belongings, clothing, jewelry, items for personal care, etc.
Usually located inside a bank to store valuables. Items such as documents and jewelry are often stored. The return of excess amounts of income tax a taxpayer paid to the state or federal government.
Verification Source N/A Client declaration is accepted. •A copy of bank statements.
When to Verify N/A •At initial and renewal applications. •If the client reports a change that affects eligibility. •At initial and renewal applications. •Verify if client reports a change that affects eligibility. Exemptions, Disregards and Comments Excluded while the home is occupied, counted if items are sold or auctioned. •Some items may already be listed as a resource and verified per their resource category. •If items included are part of a collection and have substantial value then a written appraisal is required. e.g., coin collection.
Any balance retained after 12 months of receipt must be verified and counted as available.
Questions to Consider N/A •Do you have any items stored at the bank? N/A
REV. AUGUST 28, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-061 477-000-061 – Voter Registration Requirements The Nebraska Department of Health and Human Services (DHHS) is required to offer individuals the opportunity to register to vote when they contact a local DHHS office. The Department will also routinely offer this opportunity to clients when they apply for or have an eligibility review of their case. I. When an individual contacts DHHS and requests to register to vote but does not request or apply for services, staff will offer the individual the voter registration form. The individual may complete and - 1. Return the signed voter registration form to DHHS for mailing; or 2. Mail or take the voter registration form themself to the county clerk or election commissioner in the county where they live. Individuals in households applying for services are offered the opportunity to register to vote each time they complete or update an application for assistance. When the client indicates on the application that they wish to register to vote or if they do not answer the question – DHHS shall give the individual the voter registration form. If more than one individual listed on the application is a potential voter, the worker shall provide as many forms as are needed or requested by the household. If the individual requests help in completing the form, staff may assist to the extent that assistance is given on completing the DHHS application. If the individual cannot read and requests assistance, staff will ask all the questions on the voter registration form, but will not probe if the person does not answer a question. Staff must NOT in any way influence the individual in completing the voter registration form. DHHS is not responsible for the form being complete or the accuracy of the information on the form. When the client answers the voter registration question on the application "No", they are considered to have declined the opportunity to register to vote at that time. The signing and dating of the application by the client will verify that the applicant has been given the opportunity to register to vote and has declined.