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Effective: December 1, 2006 |
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21ar1 - Income Calculation (Community) (Archive) |
Archived: February 1, 2008 |
This chapter defines income calculation policy for each health care program. This section provides an overview of the income calculation process, and provides links to sections with more detailed information.
The certification period must be defined before determining a client’s income eligibility in order to be sure to use the client’s correct income amounts in the income calculation.
The income calculation process begins with determining gross countable income. Gross countable income is the total available non-excluded income before any deductions or disregards are applied.
l MinnesotaCare (MCRE) considers the household’s gross income to establish initial and continuing eligibility. The gross income along with other factors, determine the premium amount. See MCRE Countable Income Determination for rules on calculating this amount.
l MA and GAMC consider the net income, for most people, to establish eligibility. The income deductions and disregards vary among different populations. See MA and GAMC Countable Income Determination for rules on calculating this amount.
After the gross countable income has been determined, each program has different rules about allowing deductions and disregards in the income calculation.
See the following sections for more information on MA and GAMC income calculations:
l MA Method A Income Calculation.
l MA Method B Income Calculation.
l Medicare Savings Programs Income Calculation.
The completed calculated income total is compared to the appropriate program income standard. Income standards for health care programs are based on the Federal Poverty Guidelines (FPG). These guidelines are updated annually by the federal government and are effective in July of each year.
l MinnesotaCare.
MinnesotaCare uses the following standards to determine if a person is income eligible based on their household’s gross annual countable income:
n 275% FPG for:
m Pregnant women.
m Children under 21.
n 275% FPG or $50,000 gross annual income, which ever is less, for:
m Parents.
m Caretakers.
m Legal Guardians.
m Foster Parents.
n 175% FPG for adults without children in the household.
Note: Adults without children whose income is equal to or below 75% FPG qualify for increased benefits.
Adults with income over 75% FPG but at or under 175% FPG are eligible for the MCRE Limited Benefit (MLB) Set.
Also compare the income of a household with children to the 150% FPG. This standard is not used to determine eligibility but affects the following factors:
n Children’s group status and insurance barriers.
n Whether a child pays a fixed premium or a sliding scale premium.
l MA and GAMC.
Compare the total countable net income to the applicable income standard for each person.
n 280% FPG: Infants through the month of their second birthday who are not eligible as auto newborns.
n 275% FPG: Pregnant women.
n 200% FPG: QWD.
n 185% FPG: TYMA second six months.
n 175% FPG - 75% FPG: GHO. To be eligible the client must be at or below 175% and above 75% FPG.
n 150% FPG: Children between ages two through 18 without a spenddown.
n 135% FPG - 120% FPG: QI. To be eligible the client must be at or below 135% and above 120% FPG.
n 120% FPG: SLMB.
n 100% FPG use for:
m Children between ages two through 18 who have a spenddown using the 150% FPG.
m Children between ages 19 through 20.
m Parents of dependent children.
m Caretakers of dependent children.
m QMB.
m Blind eligibility basis without a spenddown.
m Disabled eligibility basis without a spenddown.
m Age 65 and over eligibility basis without a spenddown.
n 75% FPG use for:
m Blind eligibility basis with a spenddown using 100% FPG.
m Disabled eligibility basis with a spenddown using 100% FPG.
m Age 65 or older eligibility basis with a spenddown using 100% FPG.
m GAMC.
For more information see: