*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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21.20 - MA Gross Income Determination |
Archived: June 1, 2016 (Previous Versions) |
MA uses net income to determine income eligibility; however, in order to determine net income the gross income must be calculated first. Determining gross income for MA is a process dependent upon whether retroactive coverage has been requested, whether the income is considered varying, and whose income is being used.
This section provides rules for determining the MA gross income.
Note: For information on calculating income for Long-Term Care (LTC), see LTC Gross Income Determination.
Determining Gross Income - Steps 1 through 4.
Step 5 - Actual or Anticipated Income.
Step 6 - Varying or Unvarying Income.
Determining Gross Income - Steps 1 through 4
Determine the following before calculating gross income for MA:
Note: Use actual dollars and cents to calculate income. Truncate the final monthly figure.
1. Determine if income from another household member must be deemed to the client.
2. Determine if any income is excluded or unavailable. Do not count excluded or unavailable income in a client’s gross income.
3. Determine if appropriate verification of income has been received.
4. Determine self-employment income for self-employed clients by following the instructions in MA Self-Employment.
Step 5 - Actual or Anticipated Income
The next step to calculating the client’s gross income is to determine if actual or anticipated income should be budgeted for each month of the certification period.
l For current and future months: Budget anticipated income to be received in the six-month certification period. The amount of the anticipated income budgeted is determined based on whether it is varying or unvarying income.
l For months: Budget actual income received in the months for which you are determining eligibility.
Note: This includes clients receiving automatic health care coverage but who are also requesting retroactive MA. The client will be automatically eligible for the cash months. See Shortened Spenddown.
Example:
Abigail applies for MA in April. She requests retroactive coverage beginning in January. Her six-month certification period is January - June. The worker processes the application on May 2.
Action:
Determine eligibility for the certification period using actual income received in January, February, and March. For April, budget the actual income received and anticipate the income for the remaining part of the month. Use anticipated income for May and June.
Example:
George applies for MA for himself and his family on October 9. He reports on the HCAPP that he works 40 hours per week at $8.00 per hour. He submits the following pay stubs:
n September 3 $360.
n September 10 $450.
n September 17 $430.
n September 24 $260.
n October 1 $320.
Based on the hours per week and pay rate George reported, his paychecks should be approximately $320 each week.
Action:
Contact George to clarify the discrepancy between his regular reported wage and his recent check stubs.
George explains that the company had a short-term project in late August and early September that resulted in overtime. In mid-September he took time off without pay because of a family emergency. He is now working his regularly scheduled 40 hours per week and does not expect any changes or further overtime.
Action:
Anticipate income beginning in October based on a weekly wage of $320.
Example:
Gerald and Suzanne receive MA for themselves and their two children. Both are employed. On their six-month renewal they report that Suzanne started a new job during the previous month. She has received two weekly paychecks so far. They submit her pay stubs from the past 30 days, which include her final checks from the previous job.
Action:
Use the paychecks from the new job to anticipate Suzanne’s income for the next certification period. Anticipate Gerald’s income based on the 30 days of wages he submitted.
Step 6 - Varying or Unvarying Income
Step 6 is to determine if the income the client or the client’s deemer receives is varying or unvarying. This determination is needed to budget the correct amount of anticipated income.
Varying earned or unearned income may occur in any of the following situations:
1. There are not the same number of pay periods each month.
People who work the same number of hours for the same rate of pay receive the same amount each pay period, but do not have the same number of pay periods in each month. They will receive an additional paycheck in one or more months of the certification period.
Budget income for each month of the certification period using the exact number of pay dates that will occur in each month. This will result in one or more months in the certification period where the income and monthly spenddown amounts will be higher than the other months.
Example:
Megan’s certification period is February through July. She works 40 hours every week at $10.25 an hour; she is paid bi-weekly on Friday and receives $820 each pay period. Megan will receive three paychecks in April.
Action:
Calculate Megan’s monthly income for each month of the certification period. She will receive two paychecks of $820 each in February, March, May, June and July ($820 x 2 = $1,640). For April she will receive three paychecks of $820 ($820 x 3 = $2,460).
Enter Megan’s income of $820 with the exact pay dates for each available month and enter $820 in the HC Income Estimate window in the current month plus one. Entering income correctly in MAXIS allows the correct calculation of anticipated monthly income for the entire certification period.
2. The person works a different number of hours from pay period to pay period or receives a pay differential for some of the hours worked in a pay period.
People whose earned income varies from pay period to pay period due to a different number of hours worked or a pay differential may receive a different amount of pay from month to month.
m Determine the gross income received in the past 30 days and divide by the number of pay periods to anticipate the amount of income the client will receive in future pay periods.
Note: Do not use the past 30 days to anticipate income if a client provides information that the past 30 days does not accurately reflect his or her future income. For example, the client worked overtime in the past 30 days but does not anticipate overtime to continue. Talk to clients about their current circumstances to determine how to best anticipate income.
m Budget income for each month of the certification period using the anticipated income the client will receive in each pay period and the exact number of pay dates that will occur in each month. Depending on the number of pay periods, the monthly income and spenddown amounts may be different from month to month during the certification period.
Example:
Seamus submits his renewal in February for March with his pay stubs from the last 30 days. He is paid weekly on Wednesdays. He does not always work the same number of hours each pay period so his paycheck amounts vary.
His pay stubs show the following gross amounts:
1/06/10 - $250
1/13/10 - $185
1/20/10 - $310
1/27/10 - $215
Action:
Add the paycheck amounts to determine Seamus’ average gross earnings per pay period for January ($230 + $185 + $310 + $215 = $940 / 4 = $235). Determine the anticipated monthly income for each month of the certification period by multiplying $235 by the number of pay periods anticipated for each month.
Enter $235 with the exact pay dates for March and April. In the footer month of April, enter $235 in the HC Income Estimate window.
3. The person works in only some of the months of the certification period due to seasonal or temporary work.
4. The person stops working during the certification period.
Income will vary for the certification period when a person knows the future end date of employment.
m Budget the anticipated earned income for the months the person will receive the income.
m Stop budgeting the earned income in the month the person anticipates receiving the last paycheck.
5. The person expects to receive unearned income less often than monthly.
Count the full amount in the month the person receives it. Do not prorate the payment to convert it to a monthly amount. Use the best information at the time the application or renewal is being processed to anticipate the amount of unearned income and the months during the certification period when the person expects to receive it.
Example:
Rodney applies for MA in February. He does not request retroactive coverage. He receives quarterly payments of $450 on a contract for deed. He receives the payments on January 1, April 1, July 1 and October 1 of each year.
Action:
Anticipate the income for the entire budget period. His certification period is February - July.
Anticipate $450 for the months of April and July. Do not budget an amount for February, March or May.
Varying income expected to be received consistently throughout the certification period
Enter the following on MAXIS:
n Actual income; and
n Income anticipated to be received based on projected pay dates.
MAXIS will calculate the income for the six-month certification period.
Example:
Dave applies for MA in May. He receives UI of $125 per week every other Friday. He received checks on the second and fourth Fridays of May. He anticipates receiving a check every other Friday until the end of October (11 more checks).
Action:
Enter the income anticipated for the entire budget period on MAXIS.
Example:
Andrea applies for MA on April 5. She requests MA retroactive to January. She receives $80 every Friday from her parents to help with living expenses. She received five checks in January, four each in February and March, and one so far in April.
Action:
Budget the actual income received in January, February and March.
m January - $80 X 5 = $400.
m February and March - $80 X4 = $320 each month.
Anticipate income for April, May and June.
Example:
Bert applies for MA on July 10 and does not request retroactive coverage. He reports a job on the HCAPP and provides the following paystubs:
n June 4 $72.
n June 11 $113.75.
n June 18 $98.15.
n June 25 $82.
Action:
Use actual income for June. Anticipate income for each month of the certification period of July - December.
For unvarying income that is received monthly, budget the actual income unless you know the amount will change during the certification period.