Revision 19-1; Effective March 1, 2019

 

G-2100 Eligibility Exceptions

Revision 09-4; Effective December 1, 2009

 

For the income eligibility budget, treatment of the following income exceptions is the same whether the person is in a noninstitutional or an institutional setting.

When calculating the total income for the income eligibility budget, do not consider receipt of those items detailed in Section E-1700, Things That Are Not Income. Some examples of things that are not income are:

  • medical care and services that are not income;
  • social services that are not income;
  • sale of a resource;
  • proceeds of a loan;
  • mandatory payroll deductions; and
  • cafeteria plan.

When calculating the total income for the income eligibility budget, do not consider receipt of those items detailed in Section E-2000, Exempt Income. Some examples of exempt income are:

  • income exempt under federal laws;
  • exempt income for Native Americans;
  • earned income tax credits; and
  • certain educational assistance.

When calculating the total income for the income eligibility budget, do not consider receipt of income that meets the definition of irregular or infrequent detailed in Section E-9000, Infrequent or Irregular Income. Take special note of interest and dividend treatment detailed in:

 

G-2200 Variable Income

Revision 09-4; Effective December 1, 2009

 

For the income eligibility budget, treatment of variable income is the same whether the person is in a noninstitutional or an institutional setting.

Average monthly income that is predictable but varies in amounts from month to month as detailed in Section E-5000, Variable Income.

 

G-2300 Special Income for Noninstitutional Budgets

Revision 09-4; Effective December 1, 2009

 

When the living arrangement is noninstitutional, income from support and maintenance and from deeming are considered in the eligibility budget. Refer to information in:

 

G-2310 Noninstitutional Deeming

Revision 09-4; Effective December 1, 2009

 

The term "deeming" identifies the process of considering another person's income and resources to determine available funds for meeting a person's basic needs of food and shelter.

 

G-2311 Spouse-to-Spouse Noninstitutional Deeming

Revision 09-4; Effective December 1, 2009

 

Use the following steps to prepare a budget for an individual when the person lives with an ineligible spouse in a non-institutional living arrangement.

 

G-2311.1 Pretest to Deeming

Revision 11-4; Effective December 1, 2011

 

For spouse-to-spouse deeming policy to apply, the person must first be eligible based on the person's own income in the pretest. To determine if the person meets the pretest, use the steps in Section G-5000, Noninstitutional Budget Steps, to determine the person's countable income and compare the person's countable income to the program's income limit for an individual.

If the individual is eligible in the pretest, Appendix XXIX, Special Deeming Eligibility Test for Spouse to Spouse, provides the manual steps used to calculate eligibility with deeming.

  • Allocations — An allocation is an amount deducted from income that is subject to deeming, which is considered to be set aside for the support of certain individuals other than the eligible individual. Normally, the allocation amounts are based on the difference between the eligible couple and individual income limits for the program being tested.

    Example: The allocation for a Medicaid program that uses the SSI federal benefit rate (FBR) limit is the difference between the SSI FBR couple and SSI FBR individual income limits. See Appendix XXXI, Budget Reference Chart.
  • The allocation for Qualified Medicare Beneficiaries (QMB) is the difference between the QMB couple and QMB individual income limits.
  • The allocation amount when the Special Income Limit is used is the difference between the SSI FBR couple and SSI FBR individual income limits.
  • When the Special Income Limit is used, the general income exclusion and the earned income exclusion are not allowed.

 

G-2311.2 Examples of Spouse-to-Spouse Deeming

Revision 19-1; Effective March 1, 2019

 

  1. A couple lives together in their own home. Only one spouse is applying for Community Attendant Services (CAS). The applicant’s only income is gross monthly Retirement, Survivors, and Disability Insurance (RSDI) benefits of $675. The non-applicant spouse is working and earns $800 gross monthly wages. The non-applicant spouse also gets RSDI of $200, and their 16-year-old son gets RSDI of $211.

Deeming Pretest — Person must be eligible as an individual first.

Step Description Amount
Step 1: Appropriate income limit =

$2,313

Step 2: Gross earned income =

$0

Step 3: Monthly unearned income =

$675

Step 4: Earned/unearned income exclusions =

NA

Step 5: Pickle RSDI COLA disregards =

NA

Step 6: Disabled Adult Child (DAC) RSDI exclusions =

NA

Step 7: Early Age Widow/Widower (W/W) RSDI exclusions =

NA

Step 8: Disabled W/W RSDI exclusions =

NA

Step 9: Remainder =

$675

Remainder is less than the individual income limit for CAS. Continue with the deeming process.

Determining the ineligible spouse's income (this section and Appendix XXIX, Special Deeming Eligibility Test for Spouse to Spouse)

Step 1:

Appropriate income limit for couple =

$4,626

Step 2:

Gross earned income =

$800

 

Gross unearned income =

$200

Step 3:

$386 Allocation for ineligible child

$211 Son's RSDI

 
 

$175 Allocation for ineligible child

 
 

$200 Unearned income

 

$175 Allocation for ineligible child

 
 

$25 Remaining unearned

 

Step 4:

Remaining unearned =

$25

   
 

Remaining earned =

+$800

   
   

$825

> $386 Deeming allowance

      Proceed to Step 5  

Step 5:

Non-applicant spouse's remaining unearned =

$25

   
 

Applicant's unearned =

+$675

   
 

Combined unearned =

$700

   
     
 

Non-applicant spouse's earned income =

$800

   
 

Applicant's earned income =

+$0

   
 

Combined earned =

$800

   

Step 6:

No $20 general exclusion since the applicant is applying for CAS.

   

Step 7:

No earned income exclusions since the applicant is applying for CAS.

   

Step 8:

Remaining income =

$700

Unearned

   

+ $800

Earned

 
   

$1,500

< $4,626

 
      Eligible for CAS  
  1. A couple lives together in their own home. Only one spouse is applying for QMB and only has gross monthly RSDI of $780. The non-applicant spouse's gross monthly wages are $800. They have no children.

Deeming Pretest — Person must be eligible as an individual first.

Step Description Amount
Step 1:

Appropriate income limit =

$1,041

Step 2:

Gross earned income =

$0

Step 3:

Monthly unearned income =

$780

Step 4:

Earned/unearned exclusions =

− $20

Step 5:

Pickle RSDI COLA disregards =

NA

Step 6:

DAC RSDI disregards =

NA

Step 7:

Early Age W/W RSDI exclusions =

NA

Step 8:

Disabled W/W RSDI disregards =

NA

Step 9:

Remainder =

$760

Remainder is less than the individual income limit for QMB. Continue with the deeming process.

Determining the ineligible spouse's income (this section and Appendix XXIX, Special Deeming Eligibility Test for Spouse to Spouse)

Step 1:

Appropriate income limit for couple =

$1,410

Step 2:

Earned =

$800

 

Unearned =

+ $0

 

Total =

$800

Step 3:

No ineligible children.

 

$800 Earned –

$0 Allocation for ineligible children =

   

$800 Remaining earned

Step 4: $800 Remaining income (earned and unearned) > $369 Deeming allowance
      Proceed to Step 5

Step 5:

Non-applicant spouse's remaining unearned =

$0

 
 

Applicant's remaining unearned =

+$780

 
 

Combined remaining unearned =

$780

 
 

Non-applicant spouse's remaining earned =

$800

 
 

Applicant's remaining earned =

+$0

 
 

Combined remaining earned =

$800

 

Step 6:

Combined unearned = $780 − $20 general exclusion = $760

Step 7:

Combined earned = $800 − $65 = $735 divided by 2 = $367.50

Step 8:

Remaining unearned =

 

$760

   
 

Remaining earned =

+

$367.50

   
 

Total =

 

$1,127.50 < $1,410

      Eligible for QMB

 

G-2312 Parent-to-Child Noninstitutional Deeming

Revision 11-3; Effective September 1, 2011

 

The term deeming identifies the process of considering another person's income and resources to be available for meeting a person's basic needs of food and shelter.

Allocations — To consider that a portion of an ineligible parent's income is used to provide for the ineligible parent's own living expenses and those of any ineligible child/children living in the household. Based on this consideration, apply allocations for:

  • ineligible parents; and
  • ineligible children in the household.

Application of these allocations reduces the amount of income available for deeming.

Deem a parent's income to an eligible child beginning the month:

  • after the month the child comes home to live with the parent(s) (for example, the month following the month the child comes home from the hospital); or
  • of birth when a child is born in the parent's home; or
  • after the month of adoption (the month of adoption is the month the adoption becomes final); or
  • after the month of marriage (for example, when a natural or adoptive parent marries) or the month after the month a parent begins living in a relationship in which they hold themselves out as married.

Deeming applies from a parent to a child when they live together in the same household.

Exceptions:

An ineligible spouse or parent who is absent from a deeming household due solely to a duty assignment as a member of the Armed Forces on active duty will, in the absence of evidence to the contrary, be considered to be living in the same household as the Supplemental Security Income (SSI) claimant/recipient for income and resources deeming purposes.

This policy applies regardless of how long the deemor is absent from the household due to a duty assignment and regardless of when such absence began.

If a natural or adoptive parent is deceased or is divorced from the stepparent, and the child is living with the stepparent, the stepparent is not considered a parent or spouse of a parent of the eligible child for deeming purposes.

Deeming does not apply if one or both of the parents are eligible for Medicaid.

This deeming process does not apply to the Medicaid Buy-In for Children (MBIC) program. See Section N-6000, Budgeting, for consideration of parents' income in the eligibility budget for MBIC.

To determine the amount of a parent's (and the parent's spouse's, if any) income to be deemed to a disabled child under 18, use the following steps.

 

Step Procedure

1

Determine the gross earned and unearned nonexempt and nonexcludable income of the parent(s).

2

Determine the total amount of allocations for ineligible children under 21 who live in the same household. The amount of a child's allocation is the difference between the couple and the individual limits for the program being tested, except when the Special Income Limit is used, less the amount of the child's own nonexempt income. When the Special Income Limit is used, the allocation equals the difference between the SSI federal benefit rate (FBR) couple and SSI FBR individual income limits, less the child's own nonexempt income.

3

Subtract the total amount of allocations for ineligible children in the household from the unearned income of the parent(s). Any unmet remainder of the allocation is deducted from the earned income of the parent(s).

4

If remaining income includes both earned and unearned income, deduct $20 from unearned income and then from earned income if unearned income is less than $20. From the remaining earned income, deduct $65 plus one-half of the remainder. Then, from the sum of remaining earned and unearned income, subtract an amount equal to the SSI FBR for an individual or a couple, as appropriate.

5

Divide any remaining income from the calculation in Step 4 equally among all eligible children in the household to establish each child's deemed income.

 

G-2312.1 Examples of Parent-to-Child Deeming

Revision 19-1; Effective March 1, 2019

 

  1. A child is 14 years old and is applying for Prior Medical for SSI (ME-SSI Prior). He lives with his ineligible parents. He has one ineligible sibling, age 16. Neither child has any income. The parents' gross monthly earnings total $1,500; their gross unearned income is $100.

Parent-to-Child Deeming

Step 1:

Parents' gross earned =

$1,500

 

Parents' gross unearned =

$100

 

Step 2:

$386

Allocation for ineligible child

 
 

− $0

Sibling's income

 
 

$386

Allocation for ineligible child

 
   

Step 3:

$100

Parents' unearned income

 

− $386

Allocation for ineligible child

 

− $286

Unmet remainder of the allocation

 

$1,500

Parents’ earned income

 

− $286

Unmet remainder of the allocation

 

$1,214

Remaining earned

 

Step 4:

$1,214 Remaining earned − $20 general exclusion =

 

$1,194 − $65 = $1,129 divided by 2 =

 

$564.50 Remaining earned

 
 
 

$564.50

Remaining earned

 

+ $0

Remaining unearned

 

$564.50

Total

 

− $1,157

SSI FBR for couple

 

$0

Income deemed to applicant

Determining the Applicant's Income

Step 1:

Appropriate income limit =

$771

 

Step 2:

Gross earned income =

$0

 

Step 3:

Monthly unearned income =

$0

 

Step 4:

$20 general exclusion =

− $20

 

Step 5:

Pickle RSDI COLA disregards =

NA

 

Step 6:

DAC RSDI disregards =

NA

 

Step 7:

Early Age W/W RSDI exclusions =

NA

 

Step 8:

Disabled W/W RSDI disregards =

NA

 

Step 9:

Remainder =

$751

< $771

 

Eligible for Prior Medical for SSI (ME-SSI Prior)

  1. A different child is 13 years old and is applying for Community Attendant Services (CAS). She lives with her ineligible parents. She has two ineligible brothers, ages 15 and 16. She gets $700 per month in RSDI disability benefits. Her brothers have no income. The parents' gross monthly earned income is $2,000 and their gross monthly unearned income is $200.

 

Parent-to-Child Deeming

Step 1:

Parents' gross earned = $2,000

 

Parents' gross unearned = $200

Step 2:

$386

Allocation for ineligible child

 

− $0

First brother's income

 

$386

Allocation for first brother

 
 

$386

Allocation for ineligible child

 

− $0

Second brother's income

 

$386

Allocation for second brother

Total allocation for ineligible children = $386 x 2 = $771

Step 3:

Parents’ unearned income =

$200

   
 

Allocation for ineligible children =

− $771

   
 

 

− $571

Unmet remainder

 
 

Parents’ earned income =

$2,000

   
 

Unmet remainder of allocation =

− $571

   
   

$1,429

Remaining earned

   

Step 4:

$0

Remaining unearned

 

$1,429

Remaining earned

 

− $20

General exclusion

 

$1,409

 
 

− $65

 
 

$1,344

divided by 2 = $672

 
 

$672

Remaining earned and unearned

 

− $1,157

SSI FBR for couple

 

$0

Remainder

 

Step 5:

$0 Income deemed to applicant

When parent-to-child deeming occurs for CAS, the $20 and the $65 plus one-half earnings exclusions are given to the parents in determining the amount to be deemed to the child. CAS does not allow these exclusions for the child who is the applicant/recipient.

 

Determining the Applicant's Income

Step 1:

Appropriate income limit =

$2,313

Step 2:

Gross earned income =

$0

Step 3:

$700

RSDI

 

 

+ $0

Deemed income

 
 

$700

Total unearned income

$700

Step 4:

No $20 general exclusion since applicant is applying for CAS

NA

Step 5:

Pickle RSDI COLA disregards =

NA

Step 6:

DAC RSDI exclusions =

NA

Step 7:

Early Age W/W RSDI exclusions =

NA

Step 8:

Disabled W/W RSDI exclusions =

NA

Step 9:

Remainder =

$700

 

$700 < $2,313

  Eligible for CAS