Current through September 17, 2024
The individual who expects to file a tax return plus all
persons whom the individual expects to claim as a tax dependent. See Appendix
477-000-006 on how to construct a Medicaid household.
If an individual does not intend to file an income tax return
and do not expect to be claimed as a dependent for the tax year, non-filer
rules apply. If the tax filer cannot reasonably establish that another
individual is a tax dependent of the tax filer for the tax year in which
Medicaid is sought, the inclusion of the individual in the household of the tax
filer is determined by using non-filer rules.
001.01 MAGI Income
The sum of MAGI-based income for each member of the
individual's household, with the following exceptions (for examples, see
Appendix 477-000-006 and 477-000-011):
1. Income of an individual, who is included
in the household of his/her natural, adopted or step parent and is not expected
to file a tax return for the taxable year in which eligibility for Medicaid is
being determined, is not included in household income whether or not the
individual files a tax return.
2.
Income of a tax dependent, other than a spouse or biological, adopted, or
stepchild, who expect to be claimed as a tax dependent by another taxpayer
included in the household and is not expected to file a tax return, is not
included.
3. Cash support provided
by a tax filer, to a claimed tax dependent, other than a spouse or
biological/adopted/step-child, is not included.
15-001.01A
Excluded Income for
MAGI:
1. Income exclusions that
are allowed under the Internal Revenue Code (See Appendix 477-000-008 for
allowable deductions);
2. An amount
received as a lump sum is counted only in the month received;
3. Scholarships, awards, or fellowship grants
used for education, but not living expenses;
4. Child support;
5. Veterans benefits (this does not include
military retirement);
6. Workers'
Compensation;
7. Other excluded
income, see Appendix 477-000-007.
15-001.01B
Excluded Income for
Native American/Alaskan Native Applicant/Client:
1. Distributions from Alaska Native
Corporations and Settlement Trusts;
2. Distributions from any property held in
trust, subject to Federal restrictions, located within the most recent
boundaries of a prior Federal reservation, or otherwise under the supervision
of the Secretary of the Interior;
3. Distributions and payments from rents,
leases, rights of way, royalties, usage rights, or natural resource extraction
and harvest from:
a. Rights of ownership or
possession in any lands from any property held in trust, subject to Federal
restrictions, located within the most recent boundaries of a prior Federal
reservation, or otherwise under the supervision of the Secretary of the
Interior; or
b. Federally protected
rights regarding off-reservation hunting, fishing, gathering, or usage of
natural resources;
4.
Distributions resulting from real property ownership interests and related to
natural resources and improvements:
a.
Located on or near a reservation or within the most recent boundaries of a
prior Federal reservation; or
b.
Resulting from the exercise of federally-protected rights relating to such real
property ownership interests;
5. Payments resulting from ownership
interests in or usage rights to items that have unique religious, spiritual,
traditional, or cultural significance or rights that support subsistence or a
traditional lifestyle according to applicable Tribal Law or custom;
and
6. Student financial assistance
provided under the Bureau of Indian Affairs education programs.
001.02 Monthly Income
Current monthly household income and family size shall be
used for individuals who have been determined financially eligible for
Medicaid. For family size see 477 NAC 14.
001.03 Annualized Income
Annualized income shall be used when a predictable increase
or decrease of future income is evidenced by a signed contract for employment,
a clear history of predictable fluctuations in income, or other clear
indication of such future changes in income.
001.04 Five Percent Disregard
A five percent disregard shall be applied when determining
eligibility of an individual for medical assistance under the eligibility group
with the highest income standard under which the individual may be determined
eligible using MAGI-based methodologies.
001.05 Reasonably Compatible Regarding Income
Information obtained through an electronic data match must be
considered reasonably compatible with income information provided by or on
behalf of the individual if both are either above, at, or below the applicable
income standard. See verification plan at Appendix 477-000-004 for the
applicable income standard.
001.06 Reasonable Explanation
If information obtained from an electronic data source is not
reasonably compatible with the individual's self-attestation, the individual
would be asked for a reasonable explanation. See verification plan at Appendix
477-000-004.
001.07 Earned
Income
Earned income is money received from wages, tips, salary,
commissions, and profits from activities in which an individual is engaged as a
self-employed person or as an employee. See Appendix 477-000-007 for income
chart regarding taxable income.
15-001.07A
Contractual
Income:
1. Income paid on a
contractual basis is prorated over the number of months covered under the
contract, even if the client is paid in fewer months than the contract
covers.
2. Income received
intermittently is prorated over the period it is intended to cover if the
income is expected to continue.
15-001.07B
Disregards for
Self-Employment: All operating expenses related to producing the
goods or services and without which the goods or services could not be produced
are deducted from gross income.
15-001.07C
Operating Expenses -
Farm Income: All expenses related to farm income are considered
operating expenses and are allowable.
001.08 Unearned Income
Unearned income is any cash benefit that is not the direct
result of labor or services performed by the individual as an employee or a
self-employed person. See income chart at Appendix 477-000-007. For sponsor
deeming see 477 NAC 17-006.
15-001.08A
Spousal Support: Spousal support received is
considered unearned income. See Appendix 477-000-006 for budgeting.
15-001.08B
Delay in Counting RSDI
Increase: After the annual RSDI cost of living increase, if a
client would go from Medicaid only status to Medicaid excess because his/her
income exceeds the Federal Poverty Level, the current RSDI amount shall be
used. The month after the month that the new FPL figures are published, the
client's eligibility shall be determined by comparing the increased RSDI
benefit to the new FPL guidelines. The delayed COLA provision applies only if
the RSDI increase would cause the client to have excess income. If there is an
increase in other unearned income or the client starts receiving other unearned
income in the same month as the COLA in RSDI benefits, the delayed COLA
provisions do not apply.
001.09 Potential Income
Potential income is defined as income based on entitlement or
need which is usually determined by an administering agency as a result of an
application for benefits by the individual.
The client is required to apply for any benefits for which
s/he appears to be entitled within 60 days of the date the client is notified
of the requirement.
The responsible relative shall be referred for any potential
benefit, but there is no sanction to the child(ren) Medicaid case if the
responsible relative fails or refuses to apply.
Determination of eligibility for assistance and authorization
of payment pending determination of entitlement for benefits shall not be
delayed.
001.10 Refusal to
Apply
A client is expected to make application for and accept
benefits promptly after the client's apparent entitlement to the benefits have
been discussed.
If a client's benefit is terminated for noncompliance, s/he
should be given ten days to make contact to reestablish the benefit. If no
contact is made within ten days, eligibility cannot be determined.
Income of responsible relatives is still considered in
determining the eligibility of the client.
001.11 Intercepted, Withheld or Garnished
Income
If the client's wages or unearned income is being garnished
or intercepted, the gross amount of income before garnishment shall be
counted.
001.12 Verification
of Income
For verification of income see the Verification Plan listed
at 477-00-004. If paper documentation is required, verification of income
consists of at least the following:
1.
The source of the income;
2. The
date paid or received;
3. The
period covered by the payment or benefit; and
4. The gross amount of payment or
benefit.
001.13 If Paper
Documentation is Required for Income Verification
15-001.13A
Income
Verification
15-001.13A1
At Initial Application: One month of current income is
used to determine initial eligibility. Income is converted for weekly and
bi-weekly income.
Note: Once eligibility has been determined, no verification
is required during the continuous eligibility period.
15-001.13A2
At
Renewal: Income must be verified every 12 months.
1. Regular income must be verified using one
month's income at a minimum.
2.
Irregular income must be verified using the three most recent months, if
available.
15-001.13B
Income
Conversion: Income is converted for weekly and bi-weekly income.
This figure is used to project medical eligibility unless:
1. There was a significant change in the
income of the previous three months; or
2. A significant change is anticipated during
the projected 12-month period.
15-001.13C
Self-Employment and
Farming Income: If electronic data sources are not available, the
most recent 1040 or bookkeeping records shall be used. See verification plan at
Appendix 477-000-004 to determine when paper documentation is
required.
001.14 Changes
The client must report the following changes:
1. Change in unit composition, such as the
addition or loss of a unit member;
2. Changes in residence;
3. New employment;
4. Termination of employment;
5. Changes in the amount of monthly income,
including:
a. All changes in unearned income;
and
b. Changes in the source of
employment, in the wage rate and in employment status, i.e., part-time to
full-time or full-time to part-time. For reporting purposes, 30 hours per week
is considered full-time. The client must report new employment within ten days
of receipt of the first paycheck, and a change in wage rate or hours within ten
days of the change; and
6. Changes in allowable tax deductions. See
appendix 477-000-008.
001.15 Terminated Income
When an individual engages in different types of
self-employment, it is not considered a termination of income if the individual
stops one type of work.
001.16 Retroactive Medical Eligibility
To determine retroactive medical eligibility, each month's
actual income shall be used unless an electronic data source is available and
is reasonably compatible with the individual's attested
income.
