New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter B - Public Assistance
Article 2 - Determination of Eligibility-Categorical
Part 360 - MEDICAL ASSISTANCE
Subpart 360-4 - Financial Eligibility
Section 360-4.3 - Available income
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 360-4.3
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Available income of an MA applicant/recipient will be determined as follows:
(1) All earned and unearned income received
during the month will be considered. In determining the amount of earned and
unearned income, allowable business expenses will be deducted, as described in
subdivisions (c) and (d) of this section.
(2) Certain types of in-kind income will be
deducted as described in subdivision (e) of this section.
(3) Income deemed available from legally
responsible relatives will be added, as described in subdivision (f) of this
section.
(4) Income allocated to
dependent family members will be deducted. The amount remaining after the
calculations in paragraphs (1) through (4) of this subdivision are made, is the
applicant's/recipient's available income.
(b) Types of income.
(1) Income means any payment from any source.
It includes payments of money, goods, or services. It includes payments made on
a one-time basis and on a recurring basis. It includes both earned and unearned
income. Income received by an MA applicant/recipient is counted in the month in
which it is received when determining MA eligibility. Resources, however, may
be retained from month to month up to the levels exempted in section
360-4.7(a)
of this Subpart.
(2) Earned income
is income received as a result of working. Earned income includes, but is not
limited to, wages, salaries, tips, commissions, bonuses and income from
self-employment or a small business.
(3) Unearned income is income that is not
received as compensation for work performed. Unearned income includes, but is
not limited to, pensions, benefits, dividends, interest, and insurance
compensation.
(4) In-kind income is
income received in goods or services rather than in money. In-kind income can
be earned or unearned.
(c) Income from self-employment or small business. Income from a person's self-employment or from a small business owned and operated by the person, after allowable business expenses are deducted, is considered available earned income. The following allowable business expenses may generally be deducted:
(1) rental of
quarters and equipment;
(2)
salaries and fringe benefits of employees;
(3) cost of goods for resale;
(4) business taxes, licenses and
permits;
(5) cost of tools,
supplies and raw materials;
(6)
insurance for the business;
(7)
lights, heat, water, sewage and telephone charges;
(8) advertising and travel;
(9) taxes and carrying charges on any
property used in the business (other than payments on the principal of a
mortgage);
(10) for aged, certified
blind, or certified disabled applicants/recipients, depreciation costs for
buildings, equipment and materials necessary for and directly related to the
operation of the business; and
(11)
any other expense necessary for and directly related to the operation of the
business.
(d) Income from rental of property.
(1) Income received
from the rental of a person's real or personal property, after allowable
business expenses are deducted, is considered available income of the person.
For persons under 21 years of age, pregnant women, persons ineligible for ADC
solely because their income and/or resources are above the amounts allowed for
ADC eligibility, and parents described in section 360- 3.3(b)(7) of this Part,
such income will be considered earned income. For persons 65 years of age or
older, certified blind, or certified disabled, such income will be considered
unearned income. The following business expenses are deductible:
(i) property, school, water and sewer
taxes;
(ii) the cost of utilities
if they are included in the rent;
(iii) interest payments on mortgages for the
property (but not payments on the principal of the mortgage);
(iv) the cost of essential repairs on the
property (but not the cost of improvements to the property);
(v) wages paid to employees for maintaining
the property; and
(vi) any other
expenses necessary for the maintenance of the property.
(2) A person renting out a portion of his/her
homestead, as defined in section
360-1.4(f)
of this Part, may deduct the business expenses listed in paragraph (1) of this
subdivision to the extent that they are attributable to the rented portion of
the property.
(3) When a person
lives in income-producing property that is not a homestead, a reasonable rental
allowance for the portion occupied by the person must be added to the total
rental income before deducting allowable business expenses.
(e) In-kind income.
(1) Earned or unearned in-kind income
received from legally responsible relatives living outside the MA household is
considered available income pursuant to subdivision (f) of this section.
In-kind income received from anyone other than a legally responsible relative
is considered available income only if it is earned income. Gifts and one- time
contributions are not considered available income, regardless of the source;
however, they can be counted against the resource standard.
(2) The value of in-kind income will be
determined based on the current market value of the goods or services received.
The current market value is the amount that would be received if the goods or
services were sold on the open market in the applicant' s/recipient's local
area. However, the value of housing provided as in-kind income will be the
current market value of the housing or the social services district's maximum
shelter allowance, whichever is less.
(f) Legally responsible relatives.
(1) This paragraph explains when the income
and resources of a legally responsible relative is considered available to an
MA applicant/recipient. Legally responsible relative is defined in section
360-1.4(h)
of this Part.
(i) Legally responsible relative
living with an MA applicant/recipient who is not an institutionalized spouse as
defined in section
360-4.10
of this Subpart. A portion of the legally responsible relative's income and
resources, if he/she is of sufficient financial ability, will be considered
available to the MA applicant/recipient. With respect to MA
applicants/recipients who are 65 years of age or older, certified blind, or
certified disabled, the amount of a legally responsible relative's income, if
any, to be deemed available to the applicant/recipient will be determined in
accordance with Federal supplemental security income program regulations
providing for the allocation of an amount of such relative's income to meet the
needs of certain family members living with the applicant/recipient. The
applicant/recipient will not be denied MA if the legally responsible relative
refuses or fails to contribute toward the applicant's/recipient's medical
support. However, the furnishing of MA will create an implied contract with the
legally responsible relative and the cost of any MA provided may be recovered
from such relative by the social services district pursuant to sections 101 and
366 (3)(a) of the Social
Services Law.
(ii) Legally
responsible relative living apart from a noninstitutionalized MA
applicant/recipient. The legally responsible relative, if of sufficient
financial ability, will be asked to contribute a portion of his/her income and
resources to the MA applicant/recipeint. Regardless of the amount of any
requested contribution, only the amount that the legally responsible relative
actually contributes to the noninstitutionalized MA applicant/recipient will be
considered available when determining MA eligibility. However, the social
services district may seek to recover the cost of any MA provided from the
legally responsible relative pursuant to sections 101 and
366 (3)(a) of the Social
Services Law.
(iii) Spouses living
apart due to institutionalization of one spouse. The ability of the community
spouse to contribute income to the institutionalized spouse's cost of care will
be determined in accordance with section
360-4.10(b)
of this Subpart. The availability of the community spouse's resources will be
determined in accordance with section
360-4.10(c)
of this Subpart.
(iv) Parents of a
child under the age of 21 who is certified blind or certified disabled and who
is expected to be living separately from the parental household for 30 days or
more, will not be requested to make their income and resources available to
meet the cost of the child's necessary care or assistance; or to provide
information concerning their income and resources.
(2)
(i) The
social services district must request a legally responsible relative, other
than a community spouse as defined in section 360.4 -10 of this Subpart, to
contribute any excess resources toward the support the MA
applicant/recipient.
(ii) In
determining the amount of contribution to be requested, legally responsible
relatives who are not aged, certified blind, or certified disabled will be
allowed the resource disregard in section
360-4.6(b)(1)
of this Subpart and the standard resource exemptions listed in section
360-4.7(a)
of this Subpart. Legally responsible relatives who are aged, certified blind,
or certified disabled will be allowed the resource disregards in section 360-
4.6(b) of this Subpart and the standard resource exemptions listed in section
360-4.7(a)
of this Subpart.
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