29.14 Determination of countable income

In general The earned and unearned income of the members of the financial responsibility group is counted. Income is considered available and counted in the month it is received or credited to the member. The general approach AHS follows when it determines countable income for MABD is set forth below. These general rules apply to all individuals. (i) Determine income of the financial responsibility group. (ii) The income of all members of the financial responsibility group is combined, and the appropriate exclusions (see § 29.13) and standard deductions applied (see § 29.15). (iii) Compare countable income to the applicable income standard. (iv) An individual passes the income test when their Medicaid group’s income does not exceed the 29 32 VSA § 5830f. Financial Methodologies Part 5 – Page 49 (Sec.29.00, Sub.29.14) appropriate PIL, or the applicable income maximum, whichever is higher. An individual with income greater than the applicable income standard may establish financial eligibility by incurring eligible medical expenses that at least equal the difference between their countable income and the applicable PIL. The following subsections specify how income is allocated and deemed based on the type of coverage sought and the size of the financial responsibility group. Financial responsibility group of one individual seeking MABD other than Medicaid coverage of long-term care services and supports under MABD. Common financial responsibility groups of one include a single adult, an individual residing in a residential care home, and a child seeking Katie Beckett coverage. AHS determines countable income for an individual seeking MABD, other than Medicaid coverage of long-term care services and supports under MABD, with a financial responsibility group of one as follows: Determine and combine the total countable unearned income of the individual. Subtract a $20 disregard (pursuant to § 29.13(b)(4)), if applicable. Deduct an allocation for each ineligible child in the household for whom the individual is financially responsible. The amount of each allocation is equal to the maximum allocation amount minus any countable income of the child. If the unearned income is not at least equal to the applicable allocation amount, any remaining allocation may be deducted from earned income. Deduct from unearned income amounts used to comply with the terms of court-ordered support or Title IV-D support payments (pursuant to § 29.15(b)), if applicable. If unearned income is insufficient, any remaining amounts may be deducted from earned income. Determine and combine the individual’s countable earned income. Deduct any remaining amount of the $20 disregard, allocations for children and child support payments from the earned income. Deduct $65 from the remaining earned income. Deduct allowable work expenses for the disabled (§ 29.15(a)(3)). Deduct one-half of the remaining earned income. Deduct any allowable work expenses for the blind (§ 29.15(a)(2)). Combine the remaining earned income with any remaining unearned income. Deduct the amount of any income of a blind or disabled individual that is necessary for them to carry out a Plan to Achieve Self-Support (PASS), if applicable. The result is the individual’s countable income for the month. For a child seeking Katie Beckett coverage, compare it to the institutional income standard (IIS). For all others, compare it to the protected income level (PIL) or the SSI/AABD payment standard for one, whichever is higher. Financial Methodologies Part 5 – Page 50 (Sec.29.00, Sub.29.14) Financial responsibility group of two seeking MABD other than Medicaid coverage of long-term care services and supports under MABD. Countable income for MABD for any individual with a financial responsibility group of two is determined according to the rules under paragraph (b) above, as well as the following additional rules: Deem income at step (1). Earned and unearned income is deemed to the individual at step (1) from their ineligible spouse or ineligible parent, except no income is deemed to an individual from their ineligible children. Allocate income at step (3). Income is allocated from the financial responsibility group to each member of the financial responsibility group who is not applying for MABD at step (3) in the following amounts: (i) For a child, the difference between the SSI federal payment rate for one and the SSI federal payment rate for a couple is allocated. The allocation is reduced for ineligible children if they have income, unless the ineligible children are students with earned income. No allocation is made to children receiving public assistance. (ii) For a parent in a one-parent financial responsibility group, the SSI federal payment for one is allocated. (iii) For parents in two-parent financial responsibility groups, the SSI federal payment for two is allocated. Count income at step (13) for an individual requesting MABD who has a spouse. Countable income for an individual whose spouse is not requesting MABD is determined, according to the rules under paragraph (b) above, except at step (13) the countable income of the Medicaid group is compared to the PIL or the SSI/AABD payment standard for two, whichever is higher. Parent and child living together seeking MABD, other than Medicaid coverage of long-term care services and supports under MABD. These groups include a parent who is aged, blind, or disabled and a child who is blind or disabled. When a parent and a child in the same household both request MABD, countable income is determined as a financial responsibility group of two as follows: Determine the net income available to the parent following the steps under paragraph (b) if the parent is single, or under paragraph (c) if the parent has a spouse, except do not allocate any income to the eligible child. Compare the parent’s income to the PIL for one or, if married, the SSI/AABD payment standard for two. If the parent’s countable income is below the highest applicable income standard, the parent has passed the income test for eligibility. If the parent’s income exceeds the highest applicable income standard, deem the amount of income in excess of the highest applicable income standard to the eligible child as unearned income. Determine the child’s countable income by deeming any income from (1) above and then following the steps in paragraphs (e)(3)(iv) through (xiv). If the child’s income is less than the PIL, both the parent and the child pass the income test for MABD eligibility. When both a parent and child have a spenddown requirement, the parent and child will pass the income test once the child’s spenddown requirement has been met because the parent’s excess income was deemed to the child. If the parent’s spenddown requirement is less than the child’s and the parent meets Financial Methodologies Part 5 – Page 51 (Sec.29.00, Sub.29.14) their spenddown requirement, the parent will become eligible. The child, however, will remain ineligible until the remainder of the child’s spenddown is met. The parent’s incurred eligible medical expenses are deducted from the spenddown requirements of both the parent and child because the parent’s income was included in both income computations. Children seeking MABD, other than Medicaid coverage of long-term care services and supports under MABD (excluding Katie Beckett) The provisions of this paragraph generally apply when countable income for an eligible child is determined as a financial responsibility group of one. They do not apply in the following contexts: (i) Katie Beckett (see paragraph (b) above); (ii) A child whose parent also requests Medicaid (see paragraph (d) above); or (iii) Medicaid coverage of long-term care services and supports under MABD (see paragraph (f) below). Since parents are financially responsible for their children, their income must be considered available to their child requesting MABD, until the child reaches the age of 18. AHS determines countable income in applicable cases as follows: (i) Determine the total countable income, both earned and unearned, of the parents living with the child. (ii) Deduct an allocation specified in paragraph (c)(2)(ii)(B) of (C) for the needs of the parents living in the household from the total countable income of the parents. (iii) Deem the remaining amount to the child. If there is more than one blind or disabled child in the household, divide the remainder by the number of blind or disabled children and deem an equal portion to each. Do not deem more income to a child than the amount which, when combined with the child’s own income, would bring their countable income to the PIL. If the share of parental income that would be deemed to a child makes that child ineligible because that child has other countable income, deem parental income to other blind and disabled children under age 18 in the household and no portion to the child. (iv) Add the child’s own unearned income. This is the total unearned income. (v) Deduct the $20 disregard. This is the total countable unearned income. (vi) Determine the earned income of the child. (vii) Deduct the balance of the $20 disregard. (viii) Deduct the $65 earned income exclusion from any earned income. (ix) Deduct any allowable work expenses of a disabled child (§ 29.15(a)(3). (x) Deduct one-half of the remaining earned income. (xi) Deduct any allowable work expenses of a blind child (§ 29.15(a)(2). Financial Methodologies Part 5 – Page 52 (Sec.29.00, Sub.29.14) (xii) Combine the remaining earned and unearned income. (xiii) Deduct the amount of any income that is necessary to carry out a Plan to Achieve Self-Support (PASS), if applicable. (xiv) The result is the child’s countable income. Compare it to the PIL for one. A child with income below the PIL passes the income test. Individuals seeking Medicaid coverage of long-term care services and supports under MABD. Countable income for an individual requesting Medicaid coverage of long-term care services and supports under MABD is determined as follows: The countable income of the individual is compared to the applicable income standard for their coverage group beginning with the date of admission to long-term care. The institutional income standard (IIS) for an individual equals 300 percent of the maximum SSI federal payment to an individual living independently in the community. The IIS for a couple equals twice the IIS for an individual. When an individual is in a nursing facility and AHS has an indication that they will need long-term care for fewer than 30 days, AHS uses the PIL for the month of admission, and applies the rules for MABD other than the rules for Medicaid coverage of long-term care services and supports under MABD. Long-term care individuals in an institution Countable income for an individual seeking Medicaid coverage of long-term care services and supports under MABD in an institution is determined according to the rules under paragraph (b) above, except AHS: (i) Allocates income to the individual’s community spouse, other family members and for home upkeep, according to the rules in § 24.04; (ii) Allocates a personal needs allowance to the individual; and (iii) Compares the countable income of the Medicaid group to the IIS beginning with the date of admission to long-term care. For an individual whose gross income exceeds the IIS, AHS determines whether they may spend down their excess income to the PIL to establish their financial eligibility as medically needy, according to the rules at § 30.00. AHS determines whether the individual has incurred eligible medical expenses that equal the difference between their countable income and the PIL. Long-term care individuals seeking services in a home and community-based setting Countable income for an individual seeking Medicaid coverage of long-term care services and supports under MABD in a home and community-based setting is determined according to the rules under paragraph (b) above, except AHS: (i) Allocates income to the individual’s community spouse and other family members according to the Financial Methodologies Part 5 – Page 53 (Sec.29.00, Sub.29.15) rules in § 24.04; and (ii) Allocates a community maintenance allowance to the individual; and (iii) Approves income eligibility if the individual: Has gross income that does not exceed the IIS; or Passes the net income test for an individual working with disabilities (see § 8.05(d)). For an individual whose gross income exceeds the IIS, AHS determines whether they may spend down their excess income to the PIL to establish their income eligibility as medically needy using the rules at § 30.00. AHS determines whether the individual has incurred eligible medical expenses that equal the difference between their countable income and the PIL.