Revision 19-1; Effective March 1, 2019

 

G-4100 Income Exclusions

Revision 09-4; Effective December 1, 2009

 

After granting the applicable exemptions, apply appropriate exclusions to the remaining income of the person, including any income that is deemed as unearned income. See Section G-2000, Income Treatment, for exempt, variable and deemed income treatment.

An exclusion is not an exemption. An exclusion is applied to a type of income that would otherwise be counted in the eligibility determination. Income that is excluded in the eligibility test generally is considered when determining the amount that the person must pay for his care in a medical facility (see Chapter H, Co-Payment Budget.

 

G-4110 Twenty-Dollar General Exclusion

Revision 11-3; Effective September 1, 2011

 

For each month, the first $20 of unearned or earned income is excluded. This exclusion is applied first to unearned income, then to earned income if the unearned income is less than $20.

If no unearned income exists, the entire $20-exclusion is applied to the earned income.

See Section E-3000, Earned and Unearned Income.

Exceptions are as follows:

  • Although this exclusion does not apply to VA pensions and parents' dependency and indemnity compensation (DIC), it does apply to VA compensation and insurance. If, however, a person receives income from a VA pension and another source, he retains the general exclusion.
  • In the case of an eligible couple, only one $20-general exclusion is applied to the couple's combined income.
  • The $20-general exclusion does not apply when determining eligibility for Community Attendant Services.
  • The $20-general exclusion does not apply when determining eligibility for Medicaid Buy-In for Children (MBIC). See Section N-6320, MBIC Income Exclusion.

Example: The person receives $15 a month as a contribution from a relative. He also has $80 a month as gross earned income. The entire amount of the contribution is excluded because it is less than $20. The remaining $5 is then subtracted from the $80 gross earned income.

See Section E-4315, VA Aid and Attendance and Housebound Payments. Do not consider these payments in the eligibility budget.

 

G-4120 Earned Income Exclusion

Revision 18-4; Effective December 1, 2018

 

After applying the $20 general exclusion, exclude $65 of the remaining earned income plus one-half of the remaining earnings. In the case of an eligible couple, allow only one earned income exclusion for the couple's combined earned income.

Exceptions:

  • The earned income exclusion does not apply when determining eligibility for Community Attendant Services.
  • The earned income exclusion does not apply when determining eligibility for the Medicaid Buy-In for Children (MBIC) program.

Note: Do not apply the earned income exclusion when eligibility is determined using the special income limit.

Related Policy
MBIC Income Exclusion, N-6320
Institutional Eligibility Budget Steps, G-6300

 

G-4121 Examples of the Earned Income Exclusion

Revision 09-4; Effective December 1, 2009

 

  • Bob Evans' monthly income is $350 in wages and $100 in pension payments.

 

Description Amount

Unearned income

$100.00

General income exclusion

– 20.00

Remaining unearned income

$ 80.00

Earned income exclusion:

 

Gross earned income

$350.00

First $65.00

– 65.00

Remaining

$285.00

One-half of remaining

$142.50

Countable unearned income

$ 80.00

Countable earned income

+142.50

Total countable income

$222.50

  • Ralph and Mary Teague are both receiving disability Social Security and SSI benefits. They were in an automobile accident in June, the month before they applied for SSI. Mr. and Mrs. Teague have applied for retroactive Medicaid to help with the payment of their hospital bills in June. In the month under consideration, Ralph received wages from the Senior Citizens' Center for preparing meals. Mary did part-time piecework sewing by hand at home for a local clothing manufacturer. She had no work-related expenses because the company supplied the materials.

Unearned income:

 

Ralph's Social Security benefits

$200.00

Mary's Social Security benefits

+100.00

Gross unearned benefits for the couple

$300.00

General income exclusion (only one allowed)

– 20.00

Remaining unearned income

$280.00

Earned income:

 

Ralph's wages

$306.40

Mary's wages

+109.90

Total gross earned income

$416.30

Earned income exclusion (only one allowed):

 

First $65.00

65.00

Remaining

$351.30

One-half of remaining

$175.65

Countable unearned income

$280.00

Countable earned income

+175.65

Total countable income for the couple

$455.65

 

G-4200 Special Exclusion for Medicare Savings Plans – Census Bureau Wages

Revision 09-4; Effective December 1, 2009

 

The census is a count of everyone living in the United States and is mandated by the U.S. Constitution. The U.S. Census Bureau conducts the census every 10 years.

Wages paid by the Census Bureau for temporary employment related to census activities are excluded income for the Medicare Savings Programs (MSP). Do not include these wages in the eligibility budget for MSP.

These wages for temporary employment are not countable income in the month of receipt, but are considered a resource thereafter.

Wages paid by the Census Bureau for temporary employment related to census activities are included in eligibility or co-payment budgets for any other Medicaid for the Elderly and People with Disabilities (MEPD) program that is not an MSP.

Wages received from the Census Bureau for full-time employment are considered earned income and treated according to policy in Section E-3000, Earned and Unearned Income.

For cases with a combination of regular Medicaid benefits and an MSP, the wages are countable in the eligibility budget (and co-payment, if applicable) for the regular Medicaid program, but are excluded in the eligibility budget for MSP.

Example: Individual is being considered for Pickle with Qualified Medicare Beneficiary (QMB) benefits. The wages paid by the Census Bureau for temporary employment related to census activities are included in the eligibility budget for Pickle, but are excluded in the eligibility budget for QMB.

 

G-4300 Special Income Exclusion for COLA Disregard

Revision 09-4; Effective December 1, 2009

 

 

G-4310 Computing Social Security Cost-of-Living Increases

Revision 19-1; Effective March 1, 2019

 

The following chart shows the Pickle (ME-Pickle) multiplier for Social Security cost-of-living adjustments since April 1977.

Last Check Received Multiplier
Jan 2018 to Dec 2018 0.0272
Jan 2017 to Dec 2017 0.0196
Jan 2016 to Dec 2016 0.0225
Jan 2015 to Dec 2015 0.0322
Jan 2014 to Dec 2014 0.0484
Jan 2013 to Dec 2013 0.0625
Jan 2012 to Dec 2012 0.0781
Jan 2011 to Dec 2011 0.1102
Jan 2010 to Dec 2010 0.119
Jan 2009 to Dec 2009 0.1277
Jan 2008 to Dec 2008 0.1755
Jan 2007 to Dec 2007 0.1941
Jan 2006 to Dec 2006 0.2198
Jan 2005 to Dec 2005 0.2505
Jan 2004 to Dec 2004 0.2702
Jan 2003 to Dec 2003 0.2852
Jan 2002 to Dec 2002 0.2951
Jan 2001 to Dec 2001 0.313
Jan 2000 to Dec 2000 0.3362
Jan 1999 to Dec 1999 0.3518
Jan 1998 to Dec 1998 0.3601
Jan 1997 to Dec 1997 0.3732
Jan 1996 to Dec 1996 0.3909
Jan 1995 to Dec 1995 0.4063
Jan 1994 to Dec 1994 0.4225
Jan 1993 to Dec 1993 0.4371
Jan 1992 to Dec 1992 0.4535
Jan 1991 to Dec 1991 0.473
Jan 1990 to Dec 1990 0.5
Jan 1989 to Dec 1989 0.5225
Jan 1988 to Dec 1988 0.5408
Jan 1987 to Dec 1987 0.5594
Jan 1986 to Dec 1986 0.565
Jan 1985 to Dec 1985 0.5781
Jan 1984 to Dec 1984 0.5924
Jul 1982 to Dec 1983 0.6061
Jul 1981 to Jun 1982 0.6333
Jul 1980 to Jun 1981 0.6702
Jul 1979 to Jun 1980 0.7115
Jul 1978 to Jun 1979 0.7375
Jul 1977 to Jun 1978 0.7535
Apr 1977 to Jun 1977 0.7672

 

To calculate the Pickle (ME-Pickle) disregard, use the multiplier for the date the person received the last Supplemental Security Income check, and multiply by the current Retirement, Survivors and Disability Insurance benefit amount. Round the result to the nearest dollar amount. Subtract this disregard amount and all other available exclusions from the person's available income to determine the person's countable income.

Reference: For calculating manual budgets, see step 5 in Section G-5100, Individual and Couple Noninstitutional Budgets, or use Appendix XXXVIII, Pickle Disregard Computation Worksheet.

Also follow this procedure for any family member whose income is considered in the eligibility determination.

 

G-4311 Pickle

Revision 13-1; Effective March 1, 2013

 

For persons who qualify for Pickle (ME-Pickle) and who received a 20% Social Security cost-of-living adjustment (COLA) increase in October 1972, exclude the amount of that increase in determining the person's eligibility.

For persons who qualify for Pickle (ME-Pickle) because of an SSI denial after April 1977, exclude Social Security COLAs received since the person last received both SSI and Social Security benefits in the same month. The person must have been entitled to both benefits in the same month. Because SSA processing procedures can be unpredictable, the person may not actually have received both checks/direct deposits in the same calendar month.

Note: Also exclude Social Security COLAs for the same period from the income of any family member whose income is deemed to the individual. The earliest increase that can be excluded is the July 1977 increase.

When an application for Pickle (ME-Pickle) assistance is received, verify the SSI denial date and current benefit and use the appropriate multiplier to calculate the disregard amount. Do not contact the Social Security office for this information.

Allow the COLA disregard after the date of denial. If the denial was sometime after the normal yearly December/January COLA, then the next available COLA would be available as the disregard.

Example: If denial is in May 2007, the next COLA disregard available to the person would be in January 2008 using Appendix XXXVIII, Pickle Disregard Computation Worksheet.

A variance to this may occur when a decision from SSA is delayed. Address entitlement, date of denial, and date of receipt of notice of denial when dealing with this.

Do not certify the person for Pickle (ME-Pickle) if the income before the COLA disregards is less than the SSI federal benefit rate (FBR). A person whose income, before the COLA exclusion, is less than the SSI FBR cannot be certified for the Social Security COLA programs.

  • An SSI person who goes on and off SSI because of Social Security rounding is not eligible for Pickle (ME-Pickle) until he has been denied SSI because of a COLA increase.
  • Persons who lose SSI eligibility because of a transfer of assets penalty do not qualify for Pickle (ME-Pickle) while the penalty period is in force. These individuals should be tested for potential eligibility under other MEPD programs, including Qualified Medicare Beneficiary.

Except in certain situations, a person cannot be eligible for the Pickle program.

 

G-4312 Ping-Pong

Revision 11-4; Effective December 1, 2011

 

In certain situations, a person whose income is less than the SSI federal benefit rate can be certified for the Social Security COLA programs.

In "ping-pong" cases, when a Pickle (ME-Pickle) person goes on and off SSI with a $1 check, maintain the case as an ongoing Pickle (ME-Pickle). This will stabilize receipt of Medicaid benefits.

 

G-4320 Special Income Exclusion for Disabled Adult Children

Revision 11-4; Effective December 1, 2011

 

ME-Disabled Adult Child. Individuals 18 and older who were denied SSI benefits on or after July 1, 1987, because of entitlement to or an increase in RSDI disabled adult children's benefits may be eligible for Medicaid if they otherwise would meet all current SSI eligibility criteria in the absence of those disabled adult children's benefits. Eligible individuals are also entitled to the exclusion of subsequent increase in those benefits.

After receiving an application for ME-Disabled Adult Child assistance, verify the amount of the appropriate disabled adult children's benefit or increase in order to determine the appropriate disabled adult children exclusion. If the person is in a vendor living arrangement, develop the case under the institutional guidelines.

 

G-4330 Special Income Exclusion for Widow/Widower

Revision 11-4; Effective December 1, 2011

 

ME-Early Aged Widow(er). Disabled individuals 60 and older who were denied SSI benefits because of entitlement to early aged widow's or widower's benefits may be eligible for Medicaid if they meet all current SSI eligibility criteria in the absence of those early aged widow's or widower's benefits.

Eligible individuals are also entitled to the exclusion of subsequent increases in these benefits. They may continue to receive Medicaid until they are eligible for Medicare. Medicaid benefits under Widow/Widower (ME-Early Aged Widow(er)) cannot begin before July 1, 1988, regardless of when an individual became eligible for or was denied SSI.

ME-Disabled Widow(er). Disabled individuals who were denied SSI benefits because of an increase in widow's or widower's disability benefits as a result of the relaxing of disability criteria may be eligible for Medicaid if they meet all SSI eligibility criteria in the absence of those widow's or widower's disability benefits.

Eligible individuals are also entitled to the exclusion of subsequent increases in these benefits. They may continue to receive Medicaid until they are entitled to Medicare. Medicaid benefits under this coverage group were not available before Jan. 1, 1991, regardless of when an individual became eligible for or was denied SSI.

Note: The widow's or widower's disability benefits under Social Security begin at age 50. ME-Disabled Widow(er).

After receiving an application for Widow/Widower (ME-Early Aged Widow(er), ME-Disabled Widower) assistance, verify the amount of the early aged/disabled widow's or widower's benefit. If the applicant/person is in a institutional living arrangement, develop the case as under the institutional guidelines.

 

G-4400 Other Income Exclusions Related to Work

Revision 11-1; Effective March 1, 2011

 

The development of other income exclusions related to work may be necessary when earned income is over the $65 per month earned income exclusion (or up to $85 per month if the $20 general exclusion has not been used up on unearned income) and the person is ineligible for Medicaid.

 

G-4410 Exclusion for Work Expenses for the Blind

Revision 09-1; Effective December 1, 2009

 

In addition to the earned income exclusion, a blind person's earned income is reduced by the amount of expenses that he can reasonably attribute to the earnings of the income.

 

G-4420 Exclusion for Impairment-Related Work Expenses

Revision 11-1; Effective March 1, 2011

In addition to the earned income exclusion, a disabled person's earned income is reduced by the amount of expenses that the person can reasonably attribute to the earnings of the income.

 

G-4430 Income Needed to Fulfill a Plan for Self-Support (Blind or Disabled)

Revision 11-1; Effective March 1, 2011

 

Earned or unearned income not excluded from consideration by the previous exclusions may be reduced to the extent that it is needed to fulfill an approved plan of a blind or disabled person for attaining self-support.

The plan must be submitted to MEPD, State Office, Mail Code 2090, for approval. The objectives of the plan and a time limit for achieving the objectives also must be designated. Each plan must describe the income that would be excluded in the case in addition to the previous income exclusions. Check the MEPD website for current MEPD staff contacts.

 

G-4500 Medicaid Buy-In for Children Income Exclusions

Revision 11-3; Effective September 1, 2011

 

In determining eligibility for the Medicaid Buy-In for Children (MBIC) program, allow a general income exclusion of $65 plus one-half of the remaining income. Deduct this exclusion at the end of the budget calculation. See Section N-6320, MBIC Income Exclusion.

Ineligible Siblings

Allow an exclusion from an ineligible sibling's income before counting the ineligible sibling's income in the budget. This exclusion is allowed for each ineligible sibling in the family unit. See Section N-6330, Ineligible Sibling Exclusion.