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Effective: December 1, 2006 |
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20.05ar1 - Availability of Income (Archive) |
Archived: March 1, 2009 |
Determine if income is available or unavailable. Count only available income in the income calculation used to determine eligibility.
What if Availability is Unclear?
For all programs, income is considered available in any of the following situations:
l It is received by the client.
l It is received by someone else on the client's behalf.
Example:
Evan is disabled and receives RSDI. His mother is his representative payee and receives Evan’s RSDI for him.
Action:
Count the RSDI as income to Evan, not his mother.
Example:
Joe receives a Veteran’s Administration (VA) disability pension. His ex-wife and minor children, who do not live with Joe, receive VA dependent benefits based on his account. The award letter indicates that Joe has designated the dependent benefits be issued directly into his ex-wife’s account. Joe had the choice of receiving the dependent benefits directly and then distributing them to his children.
Action:
Disregard the VA dependent benefits as income for Joe. Even though he could have received them, he would have been receiving them on behalf of his children. The benefits are counted as income for each dependent who receives the benefit.
l In some circumstances, it is available whether or not the client receives it.
n Income withheld from payments due to an overpayment, or other situation may or may not be available. See Overpayment Withholding for further information.
n Income received by a spouse, parent or other household member may be deemed. For specific details see Deeming Assets and Income.
Example:
Jake is 19 years old and lives with his parents. He does not receive any money from his parents. MA policy requires a 19-year-old who lives with his parents to have parental income counted toward his eligibility.
Action:
Count his parents' income toward his MA eligibility whether or not he receives any cash payments from them.
Example:
Rhoda is in arrears for her child support payments. $300 is garnished from each paycheck.
Action:
Count the $300 as income in Rhoda’s income calculation. It is considered available because a debt is being repaid.
n It is withheld by the employer or other payor at the client's request.
Example:
Enrollee asks his employer to withhold his last two paychecks of the year until the following tax year.
Action:
Because he has access to the income but by his own choice is not accessing the income, the paychecks are considered available on the date they would normally be paid to the enrollee.
For all programs, income is unavailable when the client cannot gain access to the income.
Example:
Applicant has a court order requiring her ex-husband to pay $400 per month child support for their two children. He is paying only $300 per month and efforts to enforce the full order have been unsuccessful.
Action:
Count only the $300 child support paid as income. The unpaid portion is unavailable because the client cannot gain access, and has attempted to do so.
For MA and GAMC only, a client must try to gain access to potentially available income as a condition of eligibility.
l If they cannot gain access, document that the income is permanently unavailable.
l Deny or terminate MA or GAMC if clients refuse to cooperate in trying to gain such access.
What if Availability is Unclear?
For all programs, when availability is not clear, follow your agency's procedures to submit a policy question to HealthQuest.
For all programs, if applicants or enrollees claim no income from any source, and there is:
l No conflicting information: Accept the client’s statement and count zero income.
l Conflicting information found: Ask the client for an explanation, and document the client’s response.
Example:
Pete applies for health care and reports no income.
Action:
Accept his statement and count zero income.
Later, Pete reports that he is making child support payments.
Action:
There is now conflicting information because it would be difficult for Pete to pay child support if he has no income, unless of course he had a large amount of money in an account. Contact Pete to resolve the conflicting information.
Example:
Mary applies for GAMC and reports no income.
Action:
Accept her statement and count zero income.
Later, Mary reports that she is paying $200.00 for rent.
Action:
Request an explanation from Mary regarding how she is meet her housing expenses.