Page 1

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.