North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 23 - MEDICAL ASSISTANCE ADMINISTRATION
Subchapter E - MEDICAID ELIGIBILITY REQUIREMENTS
Section .0200 - FINANCIAL REQUIREMENTS
Section 23E .0203 - COUNTABLE INCOME

Universal Citation: 10A NC Admin Code 23E .0203

Current through Register Vol. 39, No. 6, September 16, 2024

(a) For Family and Children's medically needy cases, income from the following sources shall be counted in the calculation of financial eligibility:

(1) Unearned.
(A) RSDI, as defined in 10A NCAC 23A .0102;

(B) Veteran's Administration;

(C) Railroad Retirement;

(D) Pensions or retirement benefits;

(E) Worker's Compensation;

(F) Unemployment Insurance Benefits;

(G) All support payments, including child and spousal support;

(H) Contributions;

(I) Dividends or interest from stocks, bonds, and other investments;

(J) Trust fund income;

(K) Private disability or employment compensation;

(L) The portion of educational loans, grants, and scholarships for maintenance;

(M) Work release;

(N) Lump sum payments;

(O) Military allotments;

(P) Brown Lung benefits

(Q) Black Lung benefits

(R) Trade Adjustment benefits;

(S) SSI when the client is in long-term care;

(T) VA Aid and Attendance when the client is in long-term care;

(U) Foster Care Board payments in excess of State maximum rates for M-AF clients who serve as foster parents;

(V) Income allocated from an institutionalized spouse to the client who is the community spouse as stated in 42 U.S.C. 1396r-5(d);

(W) Income allowed from an institutionalized spouse to the client who is a dependent family member as stated in 42 U.S.C. 1396r-5(d);

(X) Sheltered Workshop income;

(Y) Loans, if repayment of a loan and not counted in reserve; and

(Z) Income deemed to Family and Children's clients.

(2) Earned Income.
(A) Income from wages, salaries, and commissions;

(B) Farm income;

(C) Small business income including self-employment;

(D) Rental income for use of real or personal property;

(E) Income for room and board in the household;

(F) Earned income of a child client who is a part-time student and a full-time employee;

(G) Supplemental payments in excess of State maximum rates for Foster Care Board payments paid by the county to Family and Children's clients who serve as foster parents; and

(H) VA Aid and Attendance paid to a budget unit member who provides the aid and attendance.

(3) Additional sources of income not listed in Subparagraphs (a)(1) or (2) of this Rule shall be considered available unless specifically excluded by Paragraph (b) of this Rule, or by State or federal regulation or statute.

(b) For Family and Children's medically needy cases, income from the following sources shall not be counted in the calculation of financial eligibility:

(1) Earned income of a child who is a part-time student but is not a full-time employee;

(2) Earned income of a child who is a full-time student;

(3) Incentive payments and training allowances made to Work Incentives Network (WIN) training participants;

(4) Payments for supportive services or reimbursement of out-of-pocket expenses made to volunteers serving as VISTA volunteers, foster grandparents, senior health aides, senior companions, Service Corps of Retired Executives, Active Corps of Executives, Retired Senior Volunteer Programs, Action Cooperative Volunteer Program, University Year for Action Program, and other programs under Titles I, II, and III of Public Law 93-113;

(5) Foster Care Board payments equal to or below the State maximum rates for Family and Children's clients who serve as foster parents;

(6) Income that is unpredictable, such as unplanned and arising only from time to time. Examples include occasional yard work and sporadic babysitting;

(7) Relocation payments;

(8) Value of the coupon allotment under the Food and Nutrition Program (FNS);

(9) Food (vegetables, dairy products, and meat) grown by or given to a member of the household. The amount received from the sale of home grown produce is earned income;

(10) Benefits received from the Nutrition Program for the Elderly;

(11) Food Assistance under the Child Nutrition Act and National School Lunch Act;

(12) Assistance provided in cash or in kind under any governmental, civic, or charitable organization whose purpose is to provide social services or vocational rehabilitation. This includes V.R. incentive payments for training, education, and allowance for dependents, grants for tuition, chore services under Title XX of the Social Security Act, and VA aid and attendance or aid to the home bound if the individual is in a private living arrangement;

(13) Loans or grants such as the GI Bill, civic, honorary and fraternal club scholarships, loans, or scholarships granted from private donations to the college, except for any portion used or designated for maintenance;

(14) Loans, grants, or scholarships to undergraduates for educational purposes made or insured under any program administered by the U.S. Department of Education;

(15) Benefits received under Title VII of the Older Americans Act of 1965;

(16) Payments received under the Housing Choice Voucher (HCV) Program, formerly known as the Experimental Housing Allowance Program (EHAP);

(17) In-kind shelter and utility contributions paid directly to the supplier;

(18) Shelter, utilities, or household furnishings made available to the client at no cost;

(19) Food/clothing contributions (except for food allowance for persons temporarily absent in medical facilities up to 12 months);

(20) Income of a child under 21 in the budget unit who is participating in the Job Training Partnership Act and is receiving Medicaid as a child;

(21) Housing Improvement Grants approved by the N.C. Commission of Indian Affairs or funds distributed per capital or held in trust for Indian tribe members under P.L. 92-254, P.L. 93-134 or P.L. 94-540;

(22) Payments to Indian tribe members as permitted under P.L. 94-114;

(23) Payments made by Medicare to a home renal dialysis patient as medical benefits;

(24) SSI, except for individuals in long-term care;

(25) HUD Section 8 benefits when paid directly to the supplier or jointly to the supplier and client;

(26) Benefits received by a client who is a representative payee for another individual who is incompetent or incapable of handling his or her affairs. Such benefits shall be accounted for by the county department of social services separate from the payee's own income and resources;

(27) Special one time payments such as energy, weatherization assistance, or disaster assistance that is not designated as medical;

(28) The value of the U.S. Department of Agriculture donated foods (surplus commodities);

(29) Payments under the Alaska Native Claims Settlement Act, P.L. 92-203;

(30) Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(31) HUD Community Development Block Grant funds received to finance the renovation of a privately owned residence;

(32) Reimbursement for transportation expenses incurred as a result of participation in the Community Work Experience Program or for use of client's own vehicle to obtain medical care or treatment;

(33) Adoption assistance;

(34) Incentive payments made to a client participating in a vocational rehabilitation program;

(35) Title XX funds received to pay for services rendered by another individual or agency;

(36) Any amount received as a refund of taxes paid;

(37) The first fifty-dollars ($50) of each child support/spousal obligation or military allotment paid monthly to the budget unit in a private living arrangement; and

(38) Income from an Achieving a Better Life Experience (ABLE) program account, pursuant to Chapter 147, Article 6F of the North Carolina General Statutes.

(c) For aged, blind, and disabled cases, income counted in the determination of financial eligibility shall be based on standards and methodologies in Title XVI of the Social Security Act.

(d) For aged, blind, and disabled cases, income from the following sources shall not be counted:

(1) Any Cost of Living Allowance (COLA) increase or receipt of RSDI benefit, that resulted in the loss of SSI for those qualified disabled and working individuals described at 42 U.S.C. 1396d(s);

(2) Earnings for those individuals who have a plan for achieving self-support (PASS) that is approved by the Social Security Administration; and

(3) Income from an Achieving a Better Life Experience (ABLE) program account, pursuant to Chapter 147, Article 6F of the North Carolina General Statutes.

(e) Income levels for purposes of establishing eligibility are those amounts approved by the N.C. General Assembly and stated in the Appropriations Act for categorically needy and medically needy classifications, except for the following:

(1) The income level shall be reduced by one-third when an aged, blind, or disabled individual lives in the household of another person and does not pay his or her proportionate share of household expenses. The one-third reduction shall not apply to children under 19 years of age who live in the home of their parents;

(2) An individual living in a long-term care facility or other medical institution shall be allowed as income level deduction for personal needs described under the Medicaid State Plan; and

(3) The income level to be applied for Qualified Medicare Beneficiaries described in 42 U.S.C. 1396d and individuals described in 42 U.S.C. 1396e shall be based on the income level for one; or two for a married couple who live together and both receive Medicare.

(f) Income for Family and Children's categorically needy cases is determined pursuant to 42 C.F.R. 435.603.

Authority G.S. 108A-25(b); 108A-54; 108A-54.1B; 42 C.F.R. 435.135; 42 C.F.R. 435.603; 42 C.F.R. 435.733; 42 C.F.R. 435.811; 42 C.F.R. 435.831; 42 C.F.R. 435.832; 42 C.F.R. 435.1007; 45 C.F.R. 233.20; 42 U.S.C 1383c(b); 42 U.S.C 1383c(d); P.L. 99-272, Section 12202; Alexander v. Flaherty Consent Order filed February 14, 1992;
Eff. September 1, 1984;
Temporary Rule Effective July 1, 1987, for a period of 120 days to expire on October 31, 1987;
Amended Eff. January 1, 1996; January 1, 1995; September 1, 1994; September 1, 1993;
Temporary Amendment Eff. February 23, 1999;
Amended Eff. August 1, 2000;
Transferred from 10A NCAC 21B .0312 Eff. May 1, 2012;
Readopted Eff. June 1, 2019.

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