2. One spouse for another spouse.
001.01 Parent for Child Relative
Responsibility
24-001.01A
Child
Considered Part of Household: If a child is living in the same
household with his/her parent(s), the parent(s)'s income and resources must be
considered available to the child.
24-001.01A1
Exceptions: A parent(s)'s income and resources are not
considered available to
i. A pregnant minor
who, pursuant to Neb. Rev. Stat. section
71-6903,
is denied financial support by her parents, guardians, or custodians due to her
refusal to obtain an abortion, and is therefore considered emancipated for
purposes of public assistance;
ii.
A child receiving Home and Community-Based Waiver;
iii. A child receiving Developmental
Disability Waiver; or
iv. A child
approved for Katie Beckett Medicaid. See 477 NAC
24-001G2b(1) and 477
NAC 27-009.
24-001.01A2
Temporary Absence: If a child is temporarily absent
from the home (ninety (90) days or fewer) but is still considered part of the
household, the parent(s)'s income and resources must be considered available to
the child. Temporary absence includes, but is not limited to
1. School attendance where the child returns
to the home on a regular basis (weekends, vacations, or summers).
2. Residence in an institution for a
developmental disability or mental illness for 90 days or fewer may be
considered temporary absence if the child was living in his/her parent(s)'s
household before institutionalization and will return to the parent(s)'s
household upon discharge.
24-001.01B
Child No Longer
Considered Part of Household: If a child is permanently out of the
home and no longer considered part of the household, his/her parent(s)'s income
and resources shall not be considered available to the child.
24-001.01C
Determination of
Paternity: Paternity cannot be established unless an alleged
father has signed a birth certificate, written and notarized paternity
acknowledgment form or a court has determined him to be the father.
Note: Paternity cannot be
established for an unborn.
24-001.01C1
Unmarried Parents: When unmarried parents are living
together, the alleged father is not financially responsible unless he has
acknowledged paternity or a court has determined that he is the father of the
child after the birth.
24-001.01C2
Children of a Marriage: Married individuals are
considered the parents of any children who are conceived or born during a
marriage, even if the couple is separated, has filed for divorce or annulment,
or states that one individual is not the parent of the child, unless there is a
court order that states otherwise.
24-001.01D
Military
Service: If a parent is absent due to active duty in the uniformed
services of the United States, that parent is still considered part of the
assistance unit and his/her income is considered available to the unit.
Uniformed service is defined as the Army, Navy, Air Force, Marine Corps, Coast
Guard, Environmental Sciences Services Administration, and Public Health
Service of the United States. If the client states that separation is due to
reasons other than performance in military service, the client must provide
proof of bona fide separation.
If the parent in the military is incarcerated, s/he is no
longer considered part of the assistance unit.
24-001.01E
Joint Physical
Custody: In a household where both parents are present, though not
necessarily continuously, income and resources of each must be used in a
child's eligibility determination and the needs of both parents included in the
unit. This includes situations in which the non-custodial parent has
sufficiently frequent contact with the child(ren) so that the normal parental
roles of providing guidance, physical care, and maintenance have not been
interrupted.
This policy applies when there is joint physical (shared)
custody in which the physical custody of the child(ren) is split between both
parents. This can be either on a scheduled basis as included in a divorce
decree or on an informal basis as agreed to by both parents. The percentage of
time spent with each parent is irrelevant in a joint custody arrangement for
Non-MAGI cases.
24-001.01F
Special Provisions Pertaining to Minor Parents
24-001.01F1
Minor
Parent: If a minor parent has a legal guardian, according to
Nebraska law, the guardian has no financial responsibility for the
minor.
24-001.01F2
Medically Needy Minor's Parent(s): If a minor parent is living
with his/her medically needy parent(s) who is receiving Medicaid for another
child, the minor parent must be in his/her parent(s)'s unit.
If assistance is received for the minor's child, that child
must also be in the parent(s)'s unit.
When a minor parent becomes emancipated, graduates from
secondary school at age 18, or reaches age 19, s/he and his/her child become a
separate unit.
Note: The family is not required to
receive Medicaid for the minor's child.
24-001.01F3
Minor Living in
Parent(s)' Home: If a minor is living in his/her parent(s)' home,
s/he is considered emancipated if s/he has married. If the minor has married,
s/he may be a separate unit with his/her child. If the marriage is annulled,
the minor is not considered emancipated.
24-001.01F4
Minor Not Living with
Parent(s): If the parent(s) has been contributing to the support
of the minor, written verification from the parent(s) of his/her plans to
continue or not continue to support is required.
24-001.01F5
Minor Parent Living
with Specified Relative, Guardian, or Conservator: A minor parent
who is living with a specified relative, guardian, or conservator is considered
emancipated unless the minor parent is being supported from his/her parent(s),
guardian, or conservator.
Note: See 477 NAC 1-001 for a list
of specified relatives.
24-001.01G
Deeming Provisions for
ABD Children
24-001.01G1
Parent for Child: If an ABD child age 17 or younger is
living in the household of his/her parent(s), the income and resources of the
parent(s) shall be deemed (i.e., determined available).
See 477 NAC 24-002.03 for exceptions to this deeming
requirement.
24-001.01G2
Disabled Child Not Receiving SSI
24-001.01G2a
Deeming Income and
Resources of Responsible Persons: A parent(s)'s income and
resources are considered in determining the eligibility of a child age 17 or
younger who is part of the household when the disabled child does not receive
SSI.
When there is a self-supporting parent(s) for children in two
different program cases, the procedures for deeming found below are followed
and the resulting deemed income and resources are divided between the program
cases containing the children on ABD. A portion of the income and resources of
these individuals is deemed to the child using the following procedures.
24-001.01G2b
Neither
Parent nor Child is Receiving SSI: If neither a disabled child nor
his/her disabled parent(s) is receiving SSI, and the child is living in the
same household with his/her parent(s), the parent(s)'s income and resources
must be deemed, with the following exceptions.
24-001.01G2b(1)
Exceptions: x
1.
Home and Community-Based Waiver: If a child living in
his/her parent(s)'s home is receiving Medicaid services through a Home and
Community-Based Service waiver, the parent(s)'s income and resources are not
deemed when determining eligibility for Medicaid.
2.
Katie Beckett: If
a child is not receiving waiver services, the income and resources of a parent
are not deemed for Medicaid if the child is severely disabled and would require
the level of care provided in a medical institution as well as certain medical
services for special needs (a Katie Beckett child; see 477 NAC
27-009).
24-001.01G3
Child Receiving
SSI: If a child age 17 or younger leaves a nursing facility or
hospital where s/he was receiving an institutional personal needs amount SSI
payment and goes home under a waiver, SSI must be notified of the waiver
eligibility. Even though income and resources of the parent(s) may make the
child ineligible for SSI, if the child is waiver-eligible, SSI continues the
institutional personal needs amount payment without deeming income and
resources of the parent(s).
Note: If the parent(s) is receiving
SSI, none of the parent(s)'s income shall be deemed.
24-001.01G4
Child in an
IMD: If a child under age 19 is placed in an IMD and is a ward of
the Department or another public agency, or if the placement is court-ordered,
see 477 NAC
25-001. If the child who is placed in
an IMD is still considered part of the household, the parent(s)' income is
deemed. See Appendix 477-000-009 for calculation procedures.
001.02 Special
Provisions Pertaining to Spouse-for-Spouse Relative Responsibility for ABD
24-001.02A
Divorce and
Separation: A divorce dissolves the marriage of a couple and there
is no longer spouse-for-spouse responsibility. A legal separation does not
dissolve the marriage.
24-001.02B
Determining Financial Responsibility for a Married
Couple:
24-001.02B1
Living Together without Medicaid Waiver or Program of All-Inclusive
Care for the Elderly (PACE) Services: The income and resources of
spouses living together in the same household shall be considered available to
each other. The resource standard for two shall be used to determine
eligibility whether one spouse or both are eligible.
Exception: If one spouse is
receiving VA benefits, and is eligible for ABD Medicaid, then eligibility shall
be determined separately. This only applies if the couple would be ineligible
for SSI as a couple. If they would both be eligible for SSI, the non-SSI spouse
must apply.
24-001.02B2
Living Together with Medicaid Waiver or PACE Services:
If only one spouse is eligible for ABD Medicaid, then use the spousal
impoverishment treatment of resources and income. An assessment and designation
of resources must be completed. See 477 NAC 26-003.01B and 477 NAC 26-003.01F.
If both spouses are eligible for ABD Medicaid, then eligibility shall be
determined separately. The resource standard for one shall be used for each
spouse. The combined resources must be $8,000 or less.
24-001.02B3
Living Apart and
Neither in a Specified Living Arrangement: Eligibility shall be
determined separately beginning the first full month the couple ceases to live
together. Consider only the income and resources in the applicant spouse's
name. The spouse shall be allowed a resource standard for one, and eligibility
shall be determined separately. Total countable resources for each spouse must
not exceed $4,000. This guideline shall be followed whether one spouse or both
are eligible.
24-001.02B4
Living Apart and Both in a Specified Living
Arrangement: If both spouses are in a specified living arrangement
(see 477 NAC
26-001), eligibility is determined as
follows: Consider the income of each spouse separately.
Consider the resources that each spouse has in their own
name. Combined resources must be below $8,000. Each spouse shall be allowed a
resource standard for one. This guideline shall be followed whether one spouse
or both are eligible.
24-001.02B5
Living Apart with One
in a Specified Living Arrangement: If only one spouse is eligible
for ABD Medicaid, spousal impoverishment rules apply for treatment of income
and resources (see 477 NAC
26-004 and 477 NAC
26-003). An assessment and
designation of resources must be completed (see 477 NAC 26-003.01B and 477 NAC
26-003.01F). The spouse shall be allowed the resource standard for one. If both
spouses are eligible and one enters a specified living arrangement, income and
resources shall be considered separately beginning the first full month the
couple ceases to live together. Each spouse shall be allowed a resource
standard for one. Combined resources must be $8,000 or less.
Note: If one spouse is temporarily
absent from the home, the couple's income and resources shall continue to be
considered together. An absence of fewer than 90 days is considered temporary.
If the spouse will be absent more than 90 days, the spouse's plans or ability
to return home shall be evaluated.
24-001.02C
Spouse for Spouse
Hardship Exemption: A hardship exemption may be granted to enable
an eligibility determination using only the applicant's resources in cases
where it is not possible to verify the resources of the non-institutionalized
spouse due to inability to obtain complete information. This exemption can only
be granted by Central Office.
Note: If the community spouse is
assisting the applicant with the application process or was living with the
institutionalized spouse just prior to institutionalization, spouse for spouse
financial responsibility applies.
001.03 Blindness or Disability Determination
24-001.03A
Eligibility
Requirements Applicable Only to Blind or Disabled: All applicants
for Aid to the Blind or Aid to the Disabled after January 1, 1974, must meet
the medical definitions of blindness or disability of the RSDI/SSI Programs as
administered by the Social Security Administration (SSA). The determination by
SSA that an individual is disabled or blind must be accepted for eligibility
for AABD/MA. In some cases, the State Review Team (SRT) may make the
determination of blindness or disability.
24-001.03B
Determination of
Eligibility for the Blind or Disabled
24-001.03B1
Disability
Determination: In the determination of eligibility for aid to the
blind or disabled, all eligibility requirements except that of the disability
determination are the responsibilities of the SSA.
24-001.03B2
Direct Referral to
the State Review Team: In the following situations a referral may
be submitted directly to the SRT for a determination of disability and its
probable duration without waiting for an SSI determination if the individual is
not eligible for another assistance program, and during the initial intake it
is apparent that:
1. The individual has
income and/or resources in excess of the limit for the SSI Program. The
client's potential eligibility for SSI must be monitored. If income and/or
resources fall below the SSI limit, a referral must be made immediately. The
client is allowed 60 days to apply for this potential benefit;
2. The individual requires immediate long
term hospitalization and/or treatment for a severe impairment before SSI can
make a determination, or would be required to extend his/her hospital stay
solely because of a delay in processing the SSI application, i.e., due to SSI's
required waiting periods before a decision on certain types of disability can
be made such as cancer or stroke (this does not include diagnostic examinations
or tests, routine medications, or drug/alcohol treatment). An immediate
referral must be made to SSI;
The individual is institutionalized (e.g., nursing home or
public institution) and SSI will be unable to make a determination. An
individual is eligible for SSI benefits while institutionalized only if
Medicaid will pay 50 percent of his/hercare. Therefore, SSI may, in some cases,
wait for a determination of eligibility for Medicaid. An immediate referral
must be made to SSI;
3. The
individual is deceased and SSI will not make a disability determination;
or
4. The individual is a non-U.S.
citizen who SSI will not review.
24-001.03B3
Subsequent Referrals
to SSA: The agency shall continue to monitor the client's
potential eligibility for RSDI and SSI benefits even though the SRT has made
the determination of disability.
001.04 SSI Program
If a client has not applied for SSI, an application must be
filed immediately. A client must be referred to SSI if:
1. The client lives alone and has monthly
unearned income less than the referral amount for an individual;
2. An eligible couple are living together and
have monthly unearned income less than the referral amount for a couple (Note:
both must apply for SSI); or
3. An
individual is in a nursing home and has unearned income of less than $50 per
month.
Exception: If income is less than these amounts but resources
are less than levels for MA, an SSI referral is not made but must consider
eligibility for Medicaid.
001.05 Institutionalization
An individual may qualify for AABD/MA while living in an
institution only if the institution is subject to the licensing requirements of
the Nebraska Department of Health.
24-001.05A
Patients in a Medical
Institution and Convalescent Leave: Assistance may be provided for
a client who is a patient in a medical institution, i.e., hospital, nursing
home, etc., if all other eligibility factors are met. Psychiatric wards of
medical hospitals are considered part of the medical institution and are not
subject to the restriction on psychiatric care identified previously.
The Central Office is responsible for determining the public
or private nature of an institution, and whether a public institution is one in
which otherwise eligible individuals may receive assistance.
24-001.05B
Criteria for
Determining Public Nature of Institutions: Prisons, jails, etc.,
are designated in the law as public institutions whose inmates are ineligible
to receive assistance. Governmental participation in financial support of an
institution, in policy formulation, or in the application of policy to specific
situations, is evidence of the public control which makes it a public
institution. Payment from public funds to, or in support of, individuals in a
private institution is not considered governmental participation in support of
the institution.
001.06
Factors Relating to Eligibility of Clients in Institutions
24-001.06A
Private Institution
and Home: The private institution in which the client chooses to
reside may be a fraternal, benevolent, or charitable institution, or the client
may make plans for living in a home which is privately owned and operated and
which furnishes shelter, board, and care according to the client's needs. In
determining the eligibility of a person living in a private institution or
home, it is necessary to determine if s/he has entered into any agreement with
the institution that s/he is to receive shelter and care in return for a
transfer of property, insurance, or other assets.
In determining eligibility of an individual in a private
institution, it is necessary to determine what the institution is able to
furnish its guests from its own resources. The individual may be eligible to
receive assistance if residing in one of the facilities previously described if
the terms of his/her stay do not in any way restrict the use of his/her
personal assets or income and if the individual has a need.
001.07 Working Disabled Part A
Medicare Beneficiaries
Individuals who were receiving RSDI disability benefits and
return to work but remain disabled may continue to be entitled to Part A
Medicare at no cost for 48 months. The Omnibus Budget Reconciliation Act of
1989 allowed these individuals, at the end of 48 months, to enroll in Part A
Medicare and pay a premium. It also required state Medicaid programs to
purchase Medicare Part A premiums for these individuals.
24-001.07A
Age: To
be eligible for the payment of the Medicare premium, an individual must be age
64 or younger.
24-001.07B
Disability: To be eligible for the payment of the
Medicare premium, an individual must continue to have a disabling impairment as
determined by SSA. SSA has the responsibility to periodically verify that the
disability continues. If SSA determines through a continuing disability review
that the client is no longer disabled, SSA notifies the Department and
eligibility for AABD/MA cases. If the client voluntarily withdraws from
Medicare Part A premium, eligibility for AABD/MA cases.
24-001.07C
Receipt of Other
Assistance: Through the AABD/MA program an individual may choose
to receive either payment of the Medicare Part A premium or full Medicaid
benefits but not both at the same time. While receiving either form of
assistance, the client may request the other; however, the client is not
eligible for full Medicaid benefits for any month for which the Department has
paid the Medicare Part A premium.
If a client who is on AABD/MA with excess and is paying
his/her own Part A Medicare premium fails to meet his/her excess obligation,
the Department retroactively pays the Medicare Part A premium for the excess
cycle. At the end of this excess cycle, the client must decide whether to
continue with the state paying the Part A premium or to begin a new excess
cycle and assume payment of the Part A premium him/herself.
