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UPDATED: JANUARY 2012

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OTHER ELIGIBILITY REQUIREMENTS

FINANCIAL MAINTENANCE

NOTE: When calculating the household income to be used in the financial maintenance assessment, ALL known income of the applying members’ household, including income of any non-applying legally responsible relatives must be counted, including income otherwise exempt from the Medicaid budget such as part-time wages of a 17 year old full-time student. Other means of aid or support received by the household must also be included when calculating financial maintenance. For example, Food Stamps although not counted when determining eligibility must be included in the assessment. A parent(s) total gross monthly income must be used for a child-only application in addition to the income of a non-applying child.

In situations where the A/R’s share of monthly housing expenses exceeds the 60/70% level, the LDSS must send the Financial Maintenance form (DOH-4443) to the A/R for completion. Failure to complete and return the form to the LDSS will result in a denial or discontinuation of benefits.

NOTE: An application cannot be denied for failure to provide a shelter expense.

NOTE: The DOH-4443 is never sent before a determination of financial maintenance is completed and it has been determined that the A/R’s share of monthly housing expenses is in excess of the allowable amount.

Disposition: The LDSS must compare the total reported expenses on the Financial Maintenance form to the A/R’s income and determine if the A/R provided a sufficient explanation of how he/she is meeting monthly living expenses. Such explanations may include that bills are not being paid, bills are being paid with a credit card, or that someone else is paying the bill. Further information may be needed to explain any discrepancies. Documentation to support the A/R’s explanation of how he/she is meeting monthly living expenses cannot be required. However, if the A/R cannot explain how he/she is paying for monthly expenses, the A/R’s application/renewal will be denied/discontinued for failure to provide the required information.

NOTE: If the LDSS has information that an SSI-related A/R had assets (income and resources) on a previous application or renewal, and the SSI-related A/R cannot document how assets (income and resources) were spent, the possibility of a transfer of assets for the purpose of qualifying for Medicaid is considered. (See RESOURCES TRANSFER OF ASSETS)

(MRG)