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Effective: October 1, 2009 |
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21ar4 - Income Calculation (Community) (Archive) |
Archived: June 1, 2011 |
This chapter defines income calculation policy for each health care program. This section provides an overview of the income calculation process, and 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 income.
l MinnesotaCare uses the household’s gross income to establish initial and continuing eligibility. The gross income along with other factors, determine the premium amount.
l GAMC uses gross income to establish initial and continuing eligibility.
l MA Method A, MA Method B and Medicare Savings Programs (MSP) do not use the gross income to establish eligibility. These programs use the net income to establish initial and ongoing eligibility. The income deductions and disregards vary among different populations. See MA and GAMC Countable Income Determination for rules on calculating this amount.
Net income is the income remaining after subtracting deductions and disregards from gross income. MA Method A, MA Method B and Medicare Savings Programs each use different rules for applying deductions and disregards in the income calculation.
See the following sections for more information:
l MinnesotaCare Income Calculation.
l MA Method A Income Calculation.
l MA Method B Income Calculation.
l Medicare Savings Programs Income Calculation.
Compare either the gross income (for MinnesotaCare and GAMC) or net income (for MA Method A, MA Method B and MSP) to the appropriate program income standard to determine income eligibility. 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.
Compare the household’s gross income to the applicable income standard to determine an individual’s income eligibility.
n 275% FPG for:
m Pregnant women.
m Children under 21.
n 275% FPG or $50,000 annual gross income, whichever is less, for:
m Parents.
m Caretakers.
m Legal Guardians.
m Foster Parents.
n 250% FPG for adults without children in the household.
Also compare the gross income of a household with children to 150% FPG. This standard is not used to determine eligibility but affects whether a child:
n is exempt from insurance barriers.
n pays a fixed premium or a sliding scale premium.
l GAMC.
Compare the gross income to the six-month income standard to determine income eligibility.
n 75% FPG: GAMC.
l MA Method A, MA Method B, Medicare Savings Programs and MA-EPD.
Compare the person's net income to the applicable income standard to determine income eligibility 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 150% FPG: Children between ages two through 18 without a spenddown.
n 135% FPG - 120% FPG: QI. To be eligible the income must be at or below 135% and above 120% FPG.
n 120% FPG: SLMB.
n 100% FPG. Use for:
m Children ages two through 18 who have a spenddown because income exceeds 150% FPG.
m Children ages 19-20.
m Pregnant women who have a spenddown because income exceeds 275% FPG.
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.
m Disabled eligibility basis with a spenddown.
m Age 65 or older eligibility basis with a spenddown.
For more information see: