907 KAR 20:020 - Income standards for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals
RELATES TO: KRS 205.520, 42 C.F.R. Part 130, Section 4735 of Pub.L. 105-33, 42 U.S.C. 1382a, 1383c(b), 1396-1396v, 1396p(d)(4), 1397jj(b)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
Family Services,
Section 1. Income Limitations.
(1)
(a)
Income shall be determined by comparing adjusted income as required by Section
2 of this administrative regulation, of the applicant , applicant and spouse , or
applicant , spouse , and minor dependent children with the following scale of
income protected for basic maintenance :
|
Size of Family |
Annual |
Monthly |
|
1 |
$2,820 |
$235 |
|
2 |
3,492 |
291 |
|
3 |
4,056 |
338 |
|
4 |
5,028 |
419 |
|
5 |
5,904 |
492 |
|
6 |
6,672 |
556 |
|
7 |
7,452 |
621 |
(b) For
each additional family member, $720 annually or sixty (60) dollars monthly
shall be added to the scale.
(2) For a pregnant woman or child eligible
pursuant to 42 U.S.C.
1396a(e), a change of income
that occurs after the determination of eligibility of a pregnant woman shall
not affect the pregnant woman's eligibility through the remainder of the
pregnancy including the postpartum period, which ends at the end of the month
containing the 365th day of a period beginning on the last day of her
pregnancy.
(3) The special income
limits and provisions established in this subsection shall apply for a
determination of eligibility of a qualified Medicare beneficiary, specified
low-income Medicare beneficiary , qualified disabled and working individual, or
Medicare qualified individual group 1 (QI-1) .
(a) A qualified Medicare beneficiary shall
have income not exceeding 100 percent of the official poverty income
guidelines.
(b) A specified
low-income Medicare beneficiary shall have income greater than 100 percent of
the official poverty income guidelines but not to exceed 120 percent of the
official poverty income guidelines.
(c) A Medicare qualified individual group 1
(QI-1) shall have income greater than 120 percent of the official poverty
income guidelines but less than or equal to 135 percent of the official poverty
income guidelines.
(d) A qualified
disabled and working individual shall have income not exceeding 200 percent of
the official poverty income guidelines.
(4) Income shall be limited to the allowable
amounts for the SSI program for a:
(a) Child
who lost eligibility for SSI benefits due to the change in the definition of
childhood disability as established in
42 U.S.C.
1396a(a)(10); or
(b) Person with hemophilia who received a
class action settlement as established in 42 C.F.R. Part 130.
(5) Income shall be limited to the
allowable amounts for the mandatory or optional state supplement program for an
individual established in 42
C.F.R. 435.135.
Section 2. Income Disregards. In comparing
income with the scale established in Section 1 of this administrative
regulation, gross income shall be adjusted as established in this section.
(1) In a TANF or family related Medicaid
case:
(a) The standard work expense of an
adult member or out-of-school child shall be deducted from gross
earnings;
(b) For a person with
either full-time or part-time employment, the standard work expense deduction
shall be ninety (90) dollars per month; and
(c) Earnings of an individual attending
school who is a child or parent under age nineteen (19) or a child under age
eighteen (18) who is a high school graduate shall be disregarded.
(2) For an ABD Medicaid case, the
applicable federal SSI disregards pursuant to
42 U.S.C.
1382a(b) shall
apply.
(3) For an individual in a
Medicaid eligibility group subject to
42 U.S.C.
1396a(a)(10)(E)(i), (ii), or
(iv) or
42 U.S.C.
1396d(p), if an annual
Social Security cost-of-living adjustment, Railroad Retirement cost-of-living
adjustment, or federal poverty level cost-of-living adjustment causes an
individual to be ineligible for Medicaid benefits:
(a) The individual's most recent Social
Security cost-of-living adjustment, Railroad Retirement cost-of-living
adjustment, or federal poverty level cost-of-living adjustment shall be
disregarded; and
(b) The disregard
established in paragraph (a) of this subsection shall continue until the
individual loses Medicaid eligibility for any other reason for three (3)
consecutive months.
(4)
An ABD Medicaid case shall be the applicable federal SSI disregards pursuant to
42 U.S.C.
1382a(b).
Section 3. Lump Sum Income . Except as
established in Section 8 of this administrative regulation, for a Medicaid
case, lump sum income shall be considered as income in the month
received.
Section 4. Income
Exclusions.
(1) Income of a person who is
blind or disabled necessary to fulfill a plan approved by the United States
Social Security Administration to achieve self support, IRWE deduction, or BWE
deduction shall be excluded from consideration.
(2) A payment or benefit from a federal
statute, other than SSI benefits, shall be excluded from consideration as
income if precluded from consideration in SSI determinations of eligibility by
the specific terms of the statute.
(3) A cash payment intended specifically to
enable an applicant or recipient to pay for medical or social services shall
not be considered as available income in the month of receipt.
(4) A Federal Republic of Germany reparation
payment shall not be considered available in the eligibility or post
eligibility treatment of income of an individual in a nursing facility or
hospital or who is receiving home and community based services under a waiver
program.
(5) A Social Security cost
of living adjustment on January 1 of each year shall not be considered as
available income for a qualified Medicare beneficiary, specified low-income
Medicare beneficiary , qualified disabled and working individual, or Medicare
qualified individual group 1 (QI-1) until after the month following the month
in which the official poverty income guidelines promulgated by the United
States Department of Health and Human Services are published.
(6) Any amount received from a victim's
compensation fund established by a state to aid victims of crime shall be
excluded as income .
(7) A veteran
or the spouse of a veteran residing in a nursing facility who is receiving a
Veterans Administration (VA) pension benefit shall have ninety (90) dollars
excluded as income in the:
(a) Medicaid
eligibility determination; and
(b)
Post eligibility determination process.
(8) Veterans Administration payments for
unmet medical expenses and aid and attendance shall be excluded in a Medicaid
eligibility determination for a veteran or the spouse of a veteran residing in
a nursing facility .
(a) Veterans
Administration payments for unmet medical expenses and aid and attendance shall
be excluded in the post eligibility determination for a veteran or the spouse
of a veteran residing in a nonstate-operated nursing facility .
(b) Veterans Administration payments for
unmet medical expenses and aid and attendance shall not be excluded in the post
eligibility determination process for a veteran or the spouse of a veteran
residing in a state-operated nursing facility .
(9) An Austrian Social Insurance payment
based, in whole or in part, on a wage credit granted under Sections 500-506 of
the Austrian General Social Insurance Act shall be excluded from income
consideration.
(10) An individual
retirement account, KEOGH plan , or other tax deferred asset shall be excluded
as income until withdrawn.
(11)
Disaster relief assistance shall be excluded as income .
(12) Income that is exempted from
consideration for purposes of computing eligibility for the comparable money
payment program (AFDC or SSI) shall be excluded.
(13) In accordance with
42 C.F.R.
435.122 and
Section
4735 of
Pub.L.
105-33 , a payment made from a fund established by
a settlement in the case of Susan Walker v. Bayer Corporation or payment made
for release of claims in this action shall be excluded as income .
(14) In accordance with 42 C.F.R. Part 130 ,
any payment received by a person with hemophilia from a class action lawsuit
entitled "Factor VIII or IX Concentrate Blood Products Litigation" shall be
excluded as income .
(15) Family
alternatives diversion payments shall be excluded as income .
(16) All monies received by an individual
from the Tobacco Master Settlement Agreement shall be excluded.
(17) Income placed in a qualifying income
trust established in accordance with
42 U.S.C.
1396p(d)(4) and
907 KAR 20:030, Section 3(5),
shall be excluded.
Section
5. Consideration of Mandatory or Optional State Supplements. For
an individual receiving a mandatory or optional state supplement, that portion
of the individual's income that is in excess of the basic maintenance standard,
established in Section 1(1) of this administrative regulation, shall be applied
to the special need that results in the supplement.
Section 6. Pass -through Cases.
(1)
(a) An
increase in a Social Security payment shall be disregarded in determining
eligibility for Medicaid benefits if:
1. The
increase is a cost of living increase; and
2. The individual would otherwise be eligible
for an SSI benefit, mandatory state supplement, or optional state
supplement.
(b) An
individual who would otherwise be eligible for an SSI benefit, mandatory state
supplement, or optional state supplement shall remain eligible for the full
scope of program benefits with no spend-down requirements, as established in
Section 7 of this administrative regulation.
(2) For an individual who applied by July 1,
1988, the additional amount established in
42 U.S.C.
1383c(b) shall be
disregarded, meaning that amount of Social Security benefits to which a
specified widow or widower was entitled as a result of the recomputation of
benefits effective January 1, 1984, and except for which (and subsequent cost
of living increases) an individual would be eligible for federal SSI
benefits.
Section 7.
Spend-down Provisions.
(1) A technically
eligible individual or family shall not be required to utilize protected income
for medical expenses before qualifying for Medicaid.
(2)
(a) An
individual with income in excess of the basic maintenance scale established in
Section 1(1) of this administrative regulation shall qualify for Medicaid in
any part of a three (3) month period in which medical expenses incurred have
utilized all excess income anticipated to be in hand during that
period.
(b) Medical expenses
incurred in a period prior to the quarter for which spend-down eligibility is
being determined shall be used to offset excess income if the medical expenses:
1. Remain unpaid at the beginning of the
quarter; and
2. Have not previously
been used as spend-down expenses.
Section 8. Individual Retirement Account.
(1)
(a) If
an individual reaches the point at which the individual is eligible to begin
withdrawing from an IRA without suffering a penalty, the individual shall begin
withdrawing from the IRA at least the minimum amount determined by the
financial institution holding the IRA.
(b) If an individual does not begin
withdrawing from an IRA pursuant to paragraph (a) of this subsection, the
individual shall be ineligible for Medicaid benefits.
(2) If an individual withdraws funds from an
IRA prior to reaching the point at which the individual would suffer no penalty
for withdrawing funds, the withdrawal shall be considered non-recurring lump
sum income .
(3) If an individual
withdraws income pursuant to subsection (1)(a) of this section, the income
shall be prorated over the period of time the income covers (for example
monthly, quarterly, or annually).
Section 9. Applicability. The provisions and
requirements of this administrative regulation shall:
(1) Apply to:
(a) A child in foster care;
(b) An aged, blind, or disabled individual;
and
(c) An individual who receives
supplemental security income benefits; and
(2) Not apply to an individual whose Medicaid
eligibility is determined:
(b) Pursuant to
907 KAR
20:075.
Notes
STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 C.F.R. 435, 42 U.S.C. 1396a, 1396b, 1396d, 1397aa, 1382a(b)
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