Current through Register 1531, September 27, 2024
(A)
Overview.
(1) An
individual's and the spouse's gross earned and unearned income, less certain
business expenses and standard income deductions, is referred to as the
countable-income amount. In determining gross monthly income, the MassHealth
agency multiplies the average weekly income by 4.333, unless the income is
monthly.
(2) For community
residents, the countable-income amount is compared to the applicable income
standard to determine the individual's financial eligibility.
(3) For institutionalized individuals,
specific deductions described in
130
CMR 520.026 are applied against the
individual's countable-income amount to determine the patient-paid
amount.
(4) The types of income
that are considered in the determination of eligibility are described in
130
CMR 520.009,
520.018,
520.019, and
130
CMR 520.021 through
520.024. These include income
to which the applicant, member, or spouse would be entitled whether or not
actually received when failure to receive such income results from the action
or inaction of the applicant, member, spouse, or person acting on his or her
behalf. In determining whether or not failure to receive such income is
reasonably considered to result from such action or inaction, the MassHealth
agency will consider the specific circumstances involved.
(B)
MassHealth Income
Standards. Generally, financial eligibility is based on a
percentage of the federal poverty level. The monthly federal poverty level
standards are determined according to annual standards published in the
Federal Register. The MassHealth agency adjusts these
standards annually using the following formula.
(1) Divide the annual federal poverty level
income standard as it appears in the Federal Register by
12.
(2) Multiply the unrounded
monthly income standard by the applicable federal poverty level
percentage.
(3) Round up to the
next whole dollar to arrive at the monthly-income standards.
(C)
Types of Earned
Income. Earned income is the total amount of compensation received
for work or services performed. Earned income includes wages, self-employment
income, and payment from roomers and boarders.
(1)
Self-employment
Income. Gross income for the self-employed is the total amount of
income listed on the most recent tax return before adjustments to income are
made. A real-estate dealer, if engaged in the business of selling real estate
to customers for profit, is considered to have self-employment earned income.
Income from property that is owned by an individual who is not a real-estate
dealer or is owned by the individual's spouse is considered unearned
income.
(2)
Income from
Roomers and Boarders. Payment for room and meals received from
anyone other than the spouse of the applicant or member is countable earned
income. Gross income from roomers and boarders is the amount received for the
room and board, less business expenses as described at
130
CMR 520.010(B).
(3)
Verification of Earned
Income. The applicant or member must verify gross earned income.
However, if he or she is applying solely for MassHealth Senior Buy-in for
Qualified Medicare Beneficiaries (QMB) as described in
130
CMR 519.010:
MassHealth Buy-in (for
Qualified Medicare Beneficiaries (QMB)) or MassHealth Buy-in for
Specified Low Income Medicare Beneficiaries (SLMB), or MassHealth Buy-in for
Qualifying Individuals (QI), both as described in
130
CMR 519.011:
MassHealth
Buy-in, verification is required only upon the request of the
MassHeaIth agency. Verifications include
(a)
two recent pay stubs;
(b) a signed
statement from the employer;
(c)
the most recent U.S. tax return or self-employment income records;
(d) for room and board: a statement signed by
both parties stating the amount and frequency of payments; or
(e) other reliable evidence.
(D)
Unearned
Income. Income that does not directly result from an individual's
own labor or services is unearned. Unearned income includes, but is not limited
to, social security benefits, railroad retirement benefits, pensions,
annuities, federal veterans' benefits, rental income, interest, and dividend
income. Gross rental income is the countable rental-income amount received less
business expenses as described at
130 CMR
520.010(C). The applicant or
member must verify gross unearned income. However, if he or she is applying
solely for MassHealth Senior Buy-in for Qualified Medicare Beneficiaries (QMB)
as described in
130
CMR 519.010: MassHealth Senior Buy-in
(for Qualified Medicare Beneficiaries (QMB)) or MassHealth Buy-in for
Specified Low Income Medicare Beneficiaries (SLMB) or MassHealth Buy-in for
Qualifying Individuals (QI) or both as described in
130 CMR
519.011: MassHealth Buy-in,
verification is required only upon MassHealth agency request. Verifications
include
(1) a recent check stub showing gross
income;
(2) a statement from the
income source when matching is not available;
(3) for rental income: a written statement
from the tenant or a copy of the lease; or
(4) other reliable evidence.
(E)
Lump-sum
Payments. A lump-sum payment is a one-time-only payment that
represents either windfall payments such as inheritances or legacies, or the
accumulation of recurring countable income such as retroactive unemployment
compensation or federal veterans' retirement benefits. Generally, lump-sum
payments are counted as unearned income in the calendar month received and as
an asset in subsequent months, except as provided in 130 CMR 520.009(E)(1).
(1)
Exceptions. The
following lump-sum payments are noncountable:
(a) a retroactive RSDI and/or SSI benefit
payment, subject to the provisions of
130 CMR
520.007(H)(1);
(b) proceeds reserved for the replacement or
repair of an asset that is lost, damaged, or stolen and any interest earned on
such proceeds are exempt from consideration as assets for nine calendar months
after the month of receipt and may be exempt for an additional nine calendar
months where good cause exists;
(c)
proceeds from the sale of a home used as the principal place of residence
provided the proceeds are used to purchase another home to be used as the
principal place of residence. Such proceeds are exempt from considerations as
assets for three calendar months after the month of receipt;
(d) proceeds from the sale of real estate
other than a home subject to the provisions of
130 CMR
520.007(G); and
(e) proceeds from the sale of nonexempt
vehicles subject to the provisions of
130 CMR
520.007(F).
(2)
Verifications. The applicant or member must verify a
lump-sum payment. However, if he or she is applying solely for MassHealth
Senior Buy-in for Qualified Medicare Beneficiaries (QMB) as described in
130
CMR 519.010:
Mass Health Senior
Buy-in (for Qualified Medicare Beneficiaries (QMB)) or MassHealth
Buy-in for Specified Low Income Medicare Beneficiaries (SLMB) or MassHealth
Buy-in for Qualifying Individuals (QI) both as described in
130 CMR
519.011:
MassHealth Buy-in,
verification is required only at MassHealth agency request. Verifications
include
(a) a benefit or settlement award
letter;
(b) a retirement-fund
document indicating the amount of the lump-sum payment;
(c) a written statement from the agency,
company, or institution making the payment;
(d) a copy of the payment document;
or
(e) other reliable
evidence.
