Current through September 17, 2024
001.01
MAGI Income
The sum of MAGI-based income for each member of the
applicant's/client'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
step-child, who expects 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.
16-001.01A
Income Counted for
Children Who Expect to File but Who Do Not Expect to Be Claimed:
When a child under nineteen (19) years old resides with his/her parent(s) and
expects to file a tax return but does not expect to be claimed as a tax
dependent by his/her parents(s), non-filer rules shall be applied when
constructing the child's household size. The income of the child's parents and
siblings living with him/her counts in the child's budget.
16-001.01B
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; and
7. Other excluded
income, see Appendix 477-000-007.
16-001.01C
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 15-000
001.03
Reasonably Predictable
Change in Future Income and Family Size
In determining current monthly or projected annual household
income and family size, the Department shall include a prorated portion of
reasonably predictable future income, to account for a reasonably predictable
increase or decrease in future income, or both, as evidenced by a signed
contract for employment, a clear history of predictable fluctuations in income,
or other clear indicia of such future changes in income or family
size
001.04
Five
Percent Federal Poverty Level Disregard
A disregard of five percent (5%) of the Federal Poverty Level
(FPL) 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 an 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 an applicant's/client's self-attestation, the
applicant/client shall 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
16-001.07A
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.
16-001.07B Disregards for Self-Employment:
All operating expenses related to producing goods or services and without which
such goods or services could not be produced are deducted from gross
income.
16-001.07C Operating
Expenses - Farm Income: All expenses related to farm income are considered
operating expenses and are allowable deductions.
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
16-001.08A.
Spousal
Support. Spousal support (alimony) received is considered unearned
income. See Appendix 477-000-006 for budgeting.
16-001.08B
Delay in Counting RSDI
Increase: After the annual Retirement, Survivors, and Disability
Insurance (RSDI) cost of living adjustment (COLA), 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 begins receiving other unearned income in the
same month as the COLA in RSDI benefits, the delayed COLA provisions do not
apply.
16-001.08C
Intercepted, Withheld or Garnished Income: If a
client's wages or unearned income is being garnished or intercepted, the gross
amount of income before garnishment shall be counted.
001.09 Deeming Income for Sponsors of Aliens
16-001.09A
Sponsors for
Aliens: One hundred percent (100%) of the income of a sponsor (and
sponsor's spouse, if living with the sponsor) shall be considered when
determining the eligibility of an alien who applies for Medicaid if the sponsor
has signed an affidavit of support under Section 213A of the Immigration and
Nationality Act. The sponsor's income will be considered available to the alien
until one or more of the following circumstances apply:
1. The individual becomes a U.S.
citizen;
2. The individuals has
worked forty (40) qualifying quarters of coverage as defined under Title II of
the Social Security Act, or can be credited with the qualifying quarters as
provided under Section 435 and the alien did not receive any federal means
tested public benefit during that time period. This provision does not apply to
restricted medical assistance;
3.
The individual is pregnant (including 60 days post-partum); or
4. The individual is under age
19.
16-001.09B
Sponsor of More than One Alien: When an individual is
a sponsor for two or more aliens who are living in the same home, the amount of
deemed income of the sponsor (and the sponsor's spouse, if living with the
sponsor) is divided equally among the aliens. When an individual sponsors
several aliens but not all apply for Medicaid, the sponsor's total deemable
income is applied to the needs of the aliens who apply for Medicaid.
16-001.09C
Deeming
Exception: If a sponsored immigrant demonstrates that s/he or
his/her child(ren) have been battered or subjected to extreme cruelty by a
spouse, a parent, or by a member of the spouse's or parent's family who is
residing in the same household as the alien, deeming may be waived if a judge,
an administrative law judge, or the U.S. Citizenship and Immigration Services
(USCIS) recognizes the battery or cruelty.
16-001.09D
Alien
Duties: As an eligibility requirement, an alien is responsible for
1. Providing income information from the
sponsor; and
2. Obtaining the
necessary cooperation from the sponsor.
If an alien does not provide the necessary information, s/he
is not eligible for Medicaid.
001.10
Potential
Income
As a condition of Medicaid eligibility, the Department shall
require clients to take all necessary steps to obtain any annuities, pensions,
retirement, and disability benefits to which they are entitled.
Annuities, pensions, retirement, and disability benefits
include, but are not limited to, veterans' compensation and pensions, Social
Security benefits, railroad retirement benefits, and unemployment
compensation.
A client and/or any responsible relative, such as a spouse or
parent, is required to apply for any non-Medicaid benefits for which s/he
appears to be entitled within 60 days of the date the client is notified of the
requirement.
A responsible relative shall be referred for any potential
benefit, but there is no sanction applied to the child(ren)'s Medicaid case if
the responsible relative fails or refuses to apply.
Determination of eligibility shall not be delayed pending
determination of entitlement for potential benefits, so long as the
client/responsible relative has applied for such benefits within the 60-day
timeframe.
001.10A
Refusal
to Apply for Potential Income:
A client is expected to apply for and accept non-Medicaid
benefits promptly after the client's apparent entitlement to such benefits have
been discussed.
If a client's non-Medicaid benefit is terminated for
noncompliance, s/he shall be given ten days to make contact to reestablish the
benefit. If no contact is made within ten days, Medicaid eligibility cannot be
determined.
Income of responsible relatives is still considered in
determining the Medicaid eligibility of the client.
001.11
Verification of
Income
For verification of income see the Verification Plan listed
at Appendix 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.
001.12 If Paper Documentation is Required for
Income Verification
001.12A Income
Verification
001.12A1
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.
001.12A2
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.
001.12B Income Conversion: Income is
converted for weekly and bi-weekly income. This figure is used to project
Medicaid 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.
001.12C 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.
001.13
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. See Appendix 477-000-004
001.14
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.
