Medicaid Policy
Medicaid Policy
Previous Policy (409-2 was previously found in 485-2 until November 1, 2021)
For the Aged and Disabled Poverty-Related Medicaid, QMB, SLMB and QI, count income from the following individuals:
A. Individual
1. For Medicaid, this is the aged or disabled person.
2. For QMB, SLMB, or QI assistance, this is the Medicare recipient.
B. Spouse
1. For all programs:
a. Count income of a spouse who is included in the coverage.
b. Deem income from a spouse who is ineligible or who is not included in the coverage according to deeming policy in 410-2.
· If deemable income exceeds the allocation for a spouse, the deemable income is counted. (If the spouse is an SSI recipient, see #1.)
2. For Aged and Disabled Poverty-Related Medicaid
· Count income of a spouse who receives SSI except for the SSI payment, unless such income is otherwise excluded under policy or is excluded from deeming. (See 417 and 410-2.)
3. For QMB, SLMB, and QI:
a. If the spouse receives SSI and is not included in the coverage, do not count any of the SSI recipient spouse's income.
b. If the SSI recipient is included in the coverage, count all income of the SSI recipient except for the SSI payment.
c. If the SSI recipient is the eligible person on the QMB, SLMB or QI program, count deemed income from a spouse who is not eligible or chooses to not be covered.
d. If one spouse or both spouses are eligible under a HCB waiver, and both have Medicare Part A, open them on the same QMB/SLMB program.
i. They should both be included in the coverage for the QMB/SLMB program unless one chooses to not be.
ii. If one chooses not to be included in the QMB/SLMB case, deem income from that spouse according to policy in 410-2.
e. If one spouse does not have Medicare Part A, deem income to the eligible spouse using the regular deeming policy in 410-2, even if one or both spouses are eligible under a waiver.
f. Deem income from a Medicaid-eligible spouse to a non-Medicaid eligible spouse who is eligible for QI.
i. The Medicaid-eligible spouse cannot be open on the QI program.
ii. Deem income according to policy in 410-2.
C. Child
1. If the individual is a child, count deemable income from parents living with the child or temporarily absent. (To determine the deemable portion of the income, see 410-3.)
a. Do not count any income from a parent who receives a needs-based VA payment.
b. Deem income only from the other parent, if applicable.
c. Do not count any parental income if any parent in the home receives SSI.
d. Consider a parent to be living in the home with the child even if the child or parent is temporarily absent for school, work, vacation, military service or medical care.
2. If the individual is a baby born in the hospital who must remain in the hospital for an extended period of time, and disability has been established beginning with the date of birth, the child is considered an institutionalized person the month of birth. (To decide when disability begins, see 303-2) (Follow rules for Nursing Home Medicaid to set up the case.)
a. In this case, do not count the parent's income and assets for the month of birth, or for any other month of the institutionalization.
b. Begin counting parents' income the month after the child leaves the hospital.
c. These children may qualify for SSI.