Revision 11-4; Effective December 1, 2011

 

The MBI program has different budgeting than other Medicaid programs.

  • There are two income-related budgets for the MBI program
  • Normally exempt income is considered in the MBI Income Verification. For example, irregular and infrequent income of $30 or less per quarter is excluded in other programs. In the Income Eligibility Budget, all irregular and infrequent earned income is counted.
  • The Income Eligibility Budget is based on monthly gross earned income only. Do not consider gross unearned income in the income eligibility budget.
  • The Post Eligibility – Premium Budget is based on gross monthly unearned and monthly net earned income.
  • Mandatory order of allowable exclusions.
    • Income Limit — 250% federal poverty level (FPIL)
    • Income Verification — Verify that a person currently is employed. Use established verification of earnings.
    • Eligibility Budget — Based on all gross earned income, after all allowable exclusions and tested against 250% FPIL. Unearned income is not considered.
    • Post Eligibility Budget – Premium Budget — Unearned income and earned income is used to determine the MBI monthly premium amount.

Income limits are subject to change annually. See Appendix XXXI, Budget Reference Chart, for current limits.

For assistance in the budget process, see Appendix XXXIX , Screening Tool and Worksheets.

 

M-6100 Income Eligibility Budget

Revision 11-4; Effective December 1, 2011

 

Do not consider unearned income in the income eligibility budget for MBI. The income eligibility test for the MBI program is based on all gross earned income from wages and self-employment based on a monthly amount.

Exclusions to the monthly gross earned amount are allowed in the MBI program. The exclusions are subtracted in a mandatory order. The 10 potential exclusions in the mandatory order are:

  1. Earned income tax credit payments
  2. Child tax credit
  3. Infrequent or irregular income equal to or less than $30 per month
  4. Earned income of blind or disabled student
  5. $20 general income
  6. $65 earned income
  7. Impairment-related work-related expenses
  8. One half of remaining earned income
  9. Blind work-related expenses
  10. PASS-related earned income

Note: If the person fails to provide verification for the exclusion, do not allow the exclusion in the income eligibility budget. Do not deny the case for "failure to provide" verification.

 

M-6110 Earned Income Tax Credit Payments Exclusion

Revision 11-4; Effective December 1, 2011

 

See Section E-2210, Income Tax Credits. An earned income tax credit (EITC) is a special tax credit that reduces the federal tax liability of certain low-income working taxpayers. This tax credit may or may not result in a payment to the taxpayer. EITC payments are allowed as an advance from an employer or as a refund from the Internal Revenue Service (IRS) and are excluded from income, regardless of the tax year involved. Normally this is exempt income – never considered as income and never deducted. For the MBI program, deduct the EITC in the month received from the employer or divide the annual EITC refund from the IRS by 12 to get the monthly EITC exclusion.

 

M-6120 Child Tax Credit Exclusion

Revision 11-4; Effective December 1, 2011

 

The child tax credit is the annual amount. Divide the annual child tax credit by 12 to get the monthly child tax credit exclusion. Child tax credit exclusions apply only to the MBI program. Use the federal tax return or other IRS documentation for sources of verification.

 

M-6130 Infrequent or Irregular Income Exclusion

Revision 11-4; Effective December 1, 2011

 

The first $30 of infrequent or irregular earned income is excluded in the Income Eligibility Budget. See Section E-9000, Infrequent or Irregular Income.

 

M-6140 Earned Income - Blind or Students with Disabilities Exclusion

Revision 11-4; Effective December 1, 2011

 

See Section E-2220, Student Earnings. For the MBI program, consider all gross monthly earned income and allow the income exemption when the MBI person is:

  • blind or disabled,
  • a student,
  • younger than age 22.

See Special Income Exemption for Student in Appendix XXXI, Budget Reference Chart, for the monthly and yearly amount limits for the exemption.

 

M-6150 $20 General Income Exclusion

Revision 11-4; Effective December 1, 2011

 

Since unearned income is not considered in the MBI Income Eligibility Budget, subtract the $20 general income exclusion from the remaining earned income after subtracting the first four exclusions.

See Section M-6100, Income Eligibility Budget, for mandatory order of allowable exclusions.

 

M-6160 $65 Earned Income Exclusion

Revision 11-4; Effective December 1, 2011

 

Subtract the $65 earned income exclusion from the remaining earned income after subtracting the first five exclusions. Do not subtract the normal "one half of the remaining earnings" as part of the $65 earned income exclusion until Step 8 in the mandatory order of allowable exclusions.

 

M-6170 Impairment-Related Work-Related Expense (IRWE) Exclusion

Revision 11-4; Effective December 1, 2011

 

This exclusion is based on the SSI work incentive for persons who are determined to be disabled. The cost of certain items and services that a person with impairment needs in order to work can be deducted from earnings, even though such items and services also are needed for normal daily activities. The IRWE exclusion is subtracted if the MBI person is under age 65 and the items are used to pay expenses directly related to the impairment and needed in order to work.

In the following table, possible IRWE exclusion items are listed. There are also items that are not allowed as IRWE items. Allow only the possible IRWE exclusion item if the person's earnings are used to pay the cost of the item.

 

Possible IRWE Exclusion Items Prohibited IRWE Exclusion Items
  • Attendant care services
  • Drugs to control disabling condition
  • Expendable medical supplies
  • Medical devices and equipment
  • Medical services to control disabling condition
  • Non-medical equipment/services
  • Other work-related equipment/services
  • Physical therapy
  • Prostheses
  • Service animal expenses
  • Structural home modifications
  • Training to use impairment-related item
  • Transportation
  • Vehicle Modification
  • Expenses that will be reimbursed
  • Health and life insurance premiums
  • Routine annual physical examinations
  • Routine optician services (unrelated to a disabling visual impairment)
  • Routine dental examinations

 

M-6180 Blind Work-Related Expense (BWE) Exclusion

Revision 11-4; Effective December 1, 2011

 

This exclusion is based on the SSI work incentive for persons who are determined to be legally blind. From the earnings of the legally blind MBI person, an exclusion for most work-related expenses, whether or not they relate to blindness, is allowed. The MBI person must be:

  • legally blind,
  • under age 65,
  • if age 65 or older, must have received SSI payment due to blindness for the month before attaining age 65.

In the following table, possible BWE exclusion items are listed. There are also items that are not allowed as BWE items. Allow only the possible BWE exclusion item if the person's earnings are used to pay the cost of the item.

Possible BWE Exclusion Items Prohibited BWE Exclusion Items
  • Attendant care services
  • Child care
  • Drugs to control disabling condition
  • Expendable medical supplies
  • Federal, state and local income taxes
  • Fees, licenses and dues
  • Mandatory pension contributions and savings plans
  • Meals consumed during work or school hours
  • Medical devices and equipment
  • Medical services to control disabling condition
  • Non-medical equipment/services
  • Other work-related equipment/services
  • Physical therapy
  • Prostheses
  • Service animal expenses
  • Structural home modifications
  • Training to use impairment-related item
  • Transportation
  • Vehicle modification
  • Expenses that will be reimbursed
  • Expenses claimed on a self-employment tax return
  • General educational development
  • In-kind payments
  • Health and life insurance premiums
  • Meals consumed outside of work hours
  • Self care items
  • Voluntary pension contributions and savings plans
  • Work-related items furnished by others

 

M-6190 PASS-Related Earned Income Exclusion

Revision 11-4; Effective December 1, 2011

 

See Section F-4400, Plan for Achieving Self-Support (PASS), and Section M-4130, Plan for Achieving Self-Support (PASS). This exclusion is based on the SSI work incentive for persons who are determined to be blind or disabled. Any earned income used to fulfill an SSA or HHSC-approved PASS is excluded from the person's earnings as long as the PASS is in effect.

The following are allowable PASS expenses only if the person intends to pay the expense and the expense is necessary to meet an occupational goal. If the expense is reimbursable, it is not allowable.

Possible PASS Exclusion Items
  • Attendant care services
  • Basic living skills training
  • Business-related expenses
  • Child care
  • Drugs to control disabling condition
  • Expendable medical supplies
  • Federal, state and local income taxes
  • Fees, licenses and dues
  • Finance and services charges
  • Job coaching/counseling services
  • Job search or relocation expenses
  • Mandatory pension contributions and savings plans
  • Meals consumed during work or school hours
  • Medical devices and equipment
  • Medical services to control disabling condition
  • Non-medical equipment/services
  • Other work-related equipment/services
  • PASS preparation fees
  • Physical therapy
  • Prostheses
  • Service animal expenses
  • Shelter and food due to temporary absence from permanent residence
  • Specialized clothing and appropriate attire
  • Structural home modifications
  • Subscription costs for publications for academic or professional purposes
  • Training to use impairment-related item
  • Transportation
  • Vehicle modification

 

A person may have more than one PASS during the person's lifetime; however, a person is limited to only one PASS at a time.

The SSI work incentives – IRWE, BWE, PASS – allow for earned income exclusions to occur for a person. A person may have an IRWE, a BWE, and a PASS at the same time. Expenses allowed, as an income exclusion from one of the SSI work incentives, must be mutually exclusive unless the expense is for a different reason. For example, child care is allowable under a BWE or a PASS. If the child care is for work and attending night school, allow the expense as an exclusion under one or both of the SSI work incentives depending on what is available to the person. Another example would be transportation. Transportation is allowable under IRWE and BWE. If the gas expense is for work and attending training, allow the expense as an exclusion under one or both of the SSI work incentives depending on what is available to the individual.