Current through September 24, 2024
A. Deeming is
defined as follow:
1. The term "deeming"
identifies the process of considering another person's income and resources to
be available for meeting a Medicaid client's basic needs.
2. Deemed income and resources are attributed
to an eligible individual whether or not they are actually made available, with
the following restrictions:
a) Deeming only
applies in household situations;
1) Deeming of
income is not applied in the eligibility determination for either an
institutional or community spouse and deemed income is never included in the
Medicaid Income computation post-eligibility.
b) Income is only deemed from an ineligible
spouse to an eligible spouse and from ineligible parent(s) to eligible child.
1) Deeming is based on the concept that a
husband and wife (including "holding out" couples) and/or parents and child who
live together have a responsibility for each other and share income and
resources.
2) Both SSI and Medicaid
regulations require deeming in household situations.
B. It would not be
equitable to deem the entire amount of an ineligible parent's or spouse's
income to the eligible individual without some provision to permit the deemor
to meet his own needs and those of ineligible children in the household.
1. An allocation is an amount deducted from
income subject to deeming which is considered to be set aside for the support
of certain individuals other than the eligible individual.
a) Based on this consideration, allocations
are applied for the following:
1) Ineligible
parent(s); and
2) Ineligible
children in the household.
2. Application of these allocations reduces
the amount of income available for deeming.
C. For deeming purposes, a child is someone
who is neither married nor the head of a household and is:
1. Under age 18 or
2. Under age 22 and a student.
D. For deeming purposes, an
eligible child is a natural or adopted child under age 18 who lives in the
household with one or both parents, is not married and is eligible for or
applying for Medicaid.
1. A child is eligible
if the child receives Medicaid from any source (SSI, DHS, etc.).
a) Deeming no longer applies beginning the
month following the month the eligible child attains age 18.
1) An individual attains a particular age on
the day preceding the anniversary of his/her birth.
2) Deeming applies in the month of attainment
of age 18 regardless of whether the application filed that month is filed
before or after the day of attainment.
E. For deeming purposes, an
ineligible child is either a natural or adopted child of an:
1. Eligible individual or the eligible
individual's spouse; or
2. An
ineligible parent or the ineligible parent's spouse.
F. In addition to the general definition of a
child, an ineligible child must also be unmarried and either:
1. Under age 18; or
2. Under age 22 and a student.
a) Prior to 06/16/08, an ineligible student
child could remain a "child" for deeming purposes only until age 21.
G. A parent whose
income and resources are subject to deeming is one who lives in the same
household with an eligible child and is:
1. A
natural parent of the child; or
2.
An adoptive parent of the child.
H. A parent's income and resources are deemed
to an eligible child beginning the month:
1.
After the month the child come home to live with the parent(s)(e.g., the month
following the month the child comes home from the hospital; or
2. Of birth when a child is born in the
parent's home; or
3. After the
month of adoption when the month, i.e., the month the adoption become
final.
I. Deeming is
applied from parent to child when they live together in the same household.
1. When the child lives with a stepparent,
the stepparent is not considered a parent or spouse of a parent of the eligible
child for deeming purposes.
2.
Other relatives or individuals who have legal custody of a child, but are not
natural or adoptive parents, are also not considered parents for deeming
purposes.
3. An individual whose
parental rights have been terminated due to adoption no longer meets the
definition of "parent" for Medicaid purposes.
a) This remains true if the adopted child
later lives in the same household as the former parent.
J. Parental deeming rules are
waived for the following coverage group:
1.
Effective July 1, 1998, a child in the Disabled Child Living at Home coverage
group is exempt from parental deeming of income and resources.
2. The eligible child's own income and
resources affect Medicaid eligibility in the usual manner.
K. For deeming purposes, a temporary absence
exists when an individual (eligible individual or child or ineligible spouse,
parent or child) leaves the household but intends to, and does, return in the
same month or the following month. If the absence is temporary, deeming
continues to apply.
1. A child, away at school
(vocational or educational training facility), who returns home on some
weekends, holidays, or vacations and is subject to parental control is
considered temporarily absent from the parents' household regardless of the
duration of the absence.
a) Evidence which may
indicate a child away at school is not subject to parental control includes an
existing agreement, court order or signed statements from parents or school
authorities. In the absence of such evidence, consider the child subject to
parental control.
L. Any item which is not income to an
eligible individual is also not income to an ineligible spouse or parent. In
addition, the following types of income are excluded from deeming:
1. Exclude income used by an ineligible
spouse or ineligible parent (or child) to make support court-ordered payments.
a) If an ineligible child receives child
support payments, do not disregard one-third of the payment as is done for an
eligible child.
2.
Exclude a stepparent's income from deeming.
a)
The case is treated as a one-parent household, deeming the legal parent's
income to the eligible child.
3. Exclude In-Home Supportive Services
Payments provided under Title XX or other federal, state or local governmental
programs to an eligible individual and paid by the individual to his ineligible
spouse, parent or child living in the same household in return for in-home
supportive services (chore, attendant, homemaker, etc.).
a) Such payments made directly to the
ineligible spouse, parent or child to provide services to the ineligible are
also excluded for deeming purposes.
b) Retroactive IHSS payments are not a
resource for one calendar month following month of receipt.
1) Any unspent portion becomes a resource if
retained into the second calendar month following receipt.
M. Public Income
Maintenance Payments (PIM) Received by a Deemor are treated as follows:
1. PIM payments are payments based on need
paid under the following:
a) Temporary
Assistance for Needy Families (TANF);
b) Supplemental Security Income
(SSI);
c) The Refugee Act of
1980;
d) The Disaster Relief Act of
1974;
e) General Assistance
programs of the Bureau of Indian Affairs;
f) State or local government assistance
programs based on need; and
g) VA
benefits based on need.
2. In the deeming computation, the PIM
payment and any income counted in determining the PIM payment are excluded when
received by an ineligible spouse or parent.
a)
Assume all of the income of the person who received the PIM payment was used
(counted or excluded) in determining the payment.
b) There is no deeming allocation given for
ineligible spouses, parents or children who receive PIM payments.
c) Resources continue to be deemed (or
combined) from the spouse or parent receiving Income Based on Need.
d) If the spouse or parent who receives the
PIM payments wishes to apply for Medicaid, the PIM payment is counted according
to the income rules regarding the specific payment.
e) As a result of these exclusions from the
deeming process, there may be situations advantageous to a couple if the
potentially eligible spouse who has non-deemable income does not file.
1) Example: One spouse has a VA pension of
$500. The pension (and any income used to determine the pension payment) is not
deemable. The other applicant spouse has no income and would be treated as an
individual with zero income. If the spouse who has the pension also files, the
$500 would result in a dollar for dollar reduction in the couple FBR or FPL
since income based on need is considered income to an eligible
individual.
Social Security Act
§1902 (r)(2); 42 CFR §435.601(b) (Rev
1994).
