Revision 13-4; Effective December 1, 2013

 

G-5100 Individual and Couple Noninstitutional Budgets

Revision 09-4; Effective December 1, 2009

 

Reminders:

  • Monitor eligibility at least every three months if the client's total countable income is within $10 of the income limit.
  • When income tax is withheld from retirement, pensions and disability benefits, use the gross amount for the eligibility calculation.
  • If the person has VA, see Section E-4311.2, $90 VA Pension and Institutional Setting.

 

G-5110 COLA Disregard Programs

Revision 11-4; Effective December 1, 2011

 

Use the following steps to prepare a budget for an individual or an eligible couple in a noninstitutional living arrangement. Follow this procedure at application and for every redetermination.

Step Procedure

1

Determine the appropriate income limit for either an individual or couple using the SSI federal benefit rate (FBR). See Appendix XXXI, Budget Reference Chart.

2

Determine monthly earned income.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-2000, Exempt Income
Section E-2200, Earned Income Exemption
Section E-1700, Things That Are Not Income
Section E-1770, Mandatory Payroll Deductions

3

Determine monthly unearned income, including income from support and maintenance, if appropriate.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-1700, Things That Are Not Income
Section E-2000, Exempt Income
Section E-4000, Fixed Income
Section E-5000, Variable
Section E-7000, Deeming Income
Section G-2310, Noninstitutional Deeming
Section E-8000, Support and Maintenance
Section E-9000, Infrequent or Irregular

4

Deduct earned and unearned income exclusions, as appropriate.

See Section G-4000, Noninstitutional Exclusions.

Compare the remainder to the appropriate SSI FBR to test for the income element of eligibility.

Note: If the remainder is less than the SSI income limit, refer the person to SSA.

See Section G-4312, Ping-Pong, for this exception.

5

Determine the amount of COLA disregard.

See Section G-4300, Special Income Exclusion for COLA Disregard, for the MEPD group.

See Chapter A, General Information and MEPD Groups, for the descriptions of the MEPD groups.

 

For Pickle (ME-Pickle) type of assistance, deduct the amount of the RSDI increases received since the person last was eligible for and entitled to both SSI and Social Security in the same month.

Reference: See Section G-4310, Computing Social Security Cost-of-Living Increases.

 

For the Disabled Adult Children's (DAC) benefits type of assistance (ME-Disabled Adult Child), the amount of the appropriate RSDI disabled children's entitlement/increase(s) and any subsequent DAC increase.

Reference: See Section G-4320, Special Income Exclusion for Disabled Adult Children.

 

For Receipt of Early Aged Widow's or Widower's benefits type of assistance (ME-Early Aged Widow(er)), the amount of the appropriate Social Security early aged widow's or widower's benefits that resulted in SSI denial, and any subsequent RSDI COLAs.

Reference: See Section G-4330, Special Income Exclusion for Widow/Widower.

 

For Receipt of Disabled Widow's or Widower's benefits type of assistance (ME-Disabled Widow(er)), the full RSDI amount, including the appropriate amount of the disabled widow's or widower's benefits or surviving divorced spouse's benefits that resulted in SSI denial and any subsequent increases (whether COLA or not).

Reference: See Section G-4330, Special Income Exclusion for Widow/Widower.

 

Deduct the COLA disregard amount of the appropriate MEPD program.

9

The remainder is countable income. Compare the remainder to the appropriate income limit to test for the income element of eligibility.

 

The remainder must be at least 1 cent less than SSI FBR.

 

G-5120 Community Attendant Services

Revision 09-4; Effective December 1, 2009

 

Use the following steps to prepare a budget for an individual or an eligible couple in a noninstitutional living arrangement. Follow this procedure at application and for every redetermination.

Step Procedure

1

Determine the appropriate income limit for either an individual or couple using the special income limit. See Appendix XXXI, Budget Reference Chart.

2

Determine monthly earned income.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-2000, Exempt Income
Section E-2200, Earned Income Exemption
Section E-1700, Things That Are Not Income
Section E-1770, Mandatory Payroll Deductions

3

Determine monthly unearned income, including income from support and maintenance, if appropriate.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-1700, Things That Are Not Income
Section E-2000, Exempt Income
Section E-4000, Fixed Income
Section E-5000, Variable
Section E-7000, Deeming Income
Section G-2310, Noninstitutional Deeming
Section E-8000, Support and Maintenance
Section E-9000, Infrequent or Irregular

4

Do not subtract either the:

  • $20-general exclusion, or
  • earned income exclusion.

See Section G-4000, Noninstitutional Exclusions.

Compare the remainder to the appropriate SSI FBR to test for the income element of eligibility.

Note: If the remainder is less than the SSI income limit, refer the person to SSA.

5

The remainder is countable income. Compare the remainder to the appropriate income limit to test for the income element of eligibility.

 

The remainder must be equal to or less than the Special Income Limit.

 

G-5130 Medicare Savings Programs (MSP)

Revision 09-4; Effective December 1, 2009

 

Use the following steps to prepare a budget for an individual or an eligible couple in a noninstitutional living arrangement. Follow this procedure at application and for every redetermination.

Step Procedure

1

Determine the appropriate income limit for either an individual or couple using the MSP income limits. See Appendix XXXI, Budget Reference Chart.

2

Determine monthly earned income.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-2000, Exempt Income
Section E-2200, Earned Income Exemption
Section E-1700, Things That Are Not Income
Section E-1770, Mandatory Payroll Deductions

3

Determine monthly unearned income, including income from support and maintenance, if appropriate.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-1700, Things That Are Not Income
Section E-2000, Exempt Income
Section E-4000, Fixed Income
Section E-5000, Variable
Section E-7000, Deeming Income
Section G-2310, Noninstitutional Deeming
Section E-8000, Support and Maintenance
Section E-9000, Infrequent or Irregular

4

Deduct earned and unearned income exclusions, as appropriate:

  • $20-general income exclusion
  • earned income exclusion

See Section G-4000, Noninstitutional Exclusions.

Compare the remainder to the appropriate SSI FBR to test for the income element of eligibility.

Note: If the remainder is less than the SSI income limit, refer the person to SSA. See Section G-4312, Ping-Pong, for this exception.

5

Determine the amount of COLA disregard if appropriate.

The RSDI COLA is disregarded in determining QMB/SLMB/QI-1 eligibility for the months of January through February.

6

Deduct the COLA disregard amount, if appropriate, for the QMB/SLMB/QI-1 program.

7

The remainder is countable income. Compare the remainder to the appropriate income limit to test for the income element of eligibility.

 

QMB – The remainder must not exceed the limit.

 

SLMB – The remainder must be less than the limit.

 

QI-1 – Must be equal to or greater than the lower limit, but less than the upper limit.

 

G-5140 SSI Denied Child

Revision 13-4; Effective December 1, 2013

 

Note: This program is retired.

The Medicaid program covers children who were receiving SSI benefits as of Aug. 22, 1996, and were subsequently denied because of the change in disability criteria required by Public Law 104-193. This coverage is mandated by Public Law 105-33, the Balanced Budget Act of 1997, effective July 1, 1997.

HHSC ensures continuous Medicaid coverage for children under age 18 who are denied SSI with a denial code of N07 by automatically placing them in "transition Medicaid."

Transition Medicaid status provides four months of continued Medicaid coverage as ME-Interim SSI Denied Child.

At the end of the four-month transition period, these cases are automatically converted to ME-SSI Denied Children. HHSC will continue the transition Medicaid process indefinitely, or until the Social Security Administration notifies HHSC that it has completed reviews of this specific SSI client population.

All eligibility criteria for MEPD Medicaid apply when determining ongoing eligibility for children in ME-SSI Denied Children. Eligibility specialists should be especially aware of exemptions for student earnings and child support. Deeming of income and resources applies. Verify the child's and parent(s)'s income and resources and the income of any ineligible child in the household. (See Section G-2312, Parent-to-Child Noninstitutional Deeming.)

Support and maintenance also apply to ME-SSI Denied Children. However, if the only adult living with the child is the child's parent(s), support and maintenance can only be received from outside the household. Otherwise, it need not be developed. If another adult lives in the household, support and maintenance can be received from inside or outside the household.

If a child no longer meets financial criteria for ME-SSI Denied Children, TIERS tests eligibility for both MEPD and Texas Works (TW) programs. Eligibility specialists must also coordinate with TW staff when a family requests that an active ME-SSI Denied Children-eligible child be included in the family's TANF or Texas Works Medicaid case.

Note: The eligibility specialist must deny the child's ME-SSI Denied Children case before TW staff can certify the child for Medicaid through one of the Texas Works programs. Likewise, TW staff must notify MEPD staff when the child's Medicaid through one of the Texas Works programs ends. If the child is still under age 18 and continues to meet ME-SSI Denied Children eligibility, the eligibility specialist must ensure that the child's ME-SSI Denied Children coverage is reinstated.

If the child remains financially eligible for ME-SSI Denied Children, Medicaid coverage continues until age 18. Prior to the last day of a month before the actual birth month of the child's 18th birthday, the system automatically sends the client Form TF0001, Notice of Case Action, advising the client of pending denial because of age. The system has an automatic process to deny the Medicaid coverage effective the end of the month of the child's 18th birthday.

 

G-5141 SSI Denied Child Eligibility Budget Steps

Revision 13-4; Effective December 1, 2013

 

Note: This program is retired.

Step Procedure

1

Determine the appropriate income limit for a child using the SSI federal benefit rate (FBR) for an individual. See Appendix XXXI, Budget Reference Chart.

2

Determine monthly earned income.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-2000, Exempt Income
Section E-2200, Earned Income Exemptions
Section E-1700, Things That Are Not Income
Section E-1770, Mandatory Payroll Deductions

3

Determine monthly unearned income, including income from support and maintenance, if appropriate.

See the following:
Section G-2000, Income Treatment
Section E-3000, Earned and Unearned Income
Section E-1700, Things That Are Not Income
Section E-2000, Exempt Income
Section E-4000, Fixed Income
Section E-5000, Variable Income
Section E-7000, Deeming Income
Section G-2310, Noninstitutional Deeming
Section E-8000, Support and Maintenance
Section E-9000, Infrequent or Irregular Income

4

Deduct earned and unearned income exclusions, as appropriate.

See Section G-4000, Noninstitutional Exclusions.

Compare the remainder to the appropriate SSI FBR to test for the income element of eligibility.

Note: If the remainder is less than the SSI income limit, do not refer the person to the Social Security Administration.

5

The remainder is countable income. Compare the remainder to the appropriate income limit to test for the income element of eligibility.

 

The remainder must be at least 1 cent less than SSI FBR.

 

G-5150 Medicaid Buy-In for Children Program (MBIC)

Revision 11-3; Effective September 1, 2011

 

See Section N-6300, Eligibility Income Budgeting, for budgeting steps for the MBIC program.