Medicaid Policy                                                                 

410-2 Deeming Income from a Spouse

Effective Date: November 1, 2021

Previous Policy (410-2 were previously found in 427-2 until November 1, 2021)

 

A.   Introduction

To determine eligibility for aged, blind or disabled Medicaid programs, and Medicare Cost-Sharing programs, you must deem income from the ineligible spouse to the eligible spouse. (See 410 for definitions)

B.   Special Considerations when Deeming from a Spouse

 

1.    If both spouses are aged, blind or disabled, and both want coverage under the applicable program, deeming does not apply. Income is combined to determine eligibility.

2.    If one aged, blind or disabled spouse receives a VA needs-based payment (or other PIM), and does not want to be included in coverage, none of the spouse's income is counted to the other spouse. This may allow the other spouse to qualify for Medicaid without a spenddown (or with a lower spenddown), or for a Medicare Cost-Sharing program.

3.    If one spouse will be eligible for a HCB waiver, do not deem income to determine eligibility for Medicaid. Refer to the applicable waiver policy to determine eligibility. [Only certain New Choices, Community Transitions and Limited Supports Waiver groups may require income deeming from a spouse.]

a.    If both will be eligible for an HCB waiver, treat each one as a separate household. Do not deem income to each other. The only exception is the New Choices, Community Transitions and Limited Supports Waivers. (See 386)

b.    If one spouse will be eligible for a waiver and the other spouse wants coverage, count the community spouse's income and any cash contribution (Spousal Needs Allowance) the waiver spouse makes to the community spouse as that spouse's income.

c.    However, if both qualify for a Medicare Cost-Sharing program, both want coverage and they live together, combine their income to determine eligibility.

 

C.   Determine Spouse's Deemed Income

To deem income from an ineligible spouse, determine the deemable income of the ineligible spouse as follows. Do not count income excluded under 417 or 421 for aged, blind and disabled medical programs for the spouse, or for an ineligible child. Do not deem from Public Income Maintenance payments described in 410.

Note: When a parent receives past-due child support payments or an ineligible child receives child support, the full amount counts as that person's income.

1.    Add all countable unearned income received by the ineligible spouse.

2.    Subtract an allocation for each ineligible child.

a.    Do not subtract an allocation for any child who receives PIM payments.

b.    Determine what countable income the ineligible child has.

                    i.    Include the full amount of current child support payments from an absent parent received for that child.

                   ii.    Include other unearned income the child has.

          iii.    If an ineligible child has earned income, allow the earned income disregard for a child found in 410-2 each month income is being deemed until the annual maximum has been allowed. Only count earnings in excess of the disregard. 

Note: if a spenddown is owed but not met in one or more months, this allocation has not effectively been applied. Do not reduce the annual maximum allocation by the ineligible child's earned income from such months.

                  iv.    Combine the countable unearned and countable earned income.

c.    Subtract the child's countable income from the Maximum Allocation for Children. (See Table II.) The amount remaining is the amount that can be deducted from the spouse's income.  

                    i.    Subtract this first from the spouse's unearned income, if any. 

                   ii.    If it cannot all be deducted from unearned income, subtract the rest from the spouse's earned income.

3.    Subtract any amount the spouse pays to someone outside the home to comply with court–ordered child support or alimony, including past due amounts. Subtract any amount collected from the spouse by ORS and any amount paid directly by the spouse. 

a.    Subtract this first from unearned income.  

b.    Subtract any remaining amount from earned income.

4.    Total all earned income received by the spouse. Subtract from the earned income the remainder of the allocation for each ineligible child and the remainder of child support or alimony payments that could not be subtracted from unearned income. 

5.    Add the remaining unearned income to remaining earned income.

6.  Income under the Spousal Allocation:

If the total from 5 (remaining unearned and remaining earned income) is less than or equal to the Spousal Allocation on Table II, do not count any of the spouse's income.  Use only the individual's income to determine eligibility.  

7.  Income over the Spousal Allocation:

a.    If the total from 5 (remaining unearned and remaining earned income) is more than the Spousal Allocation on Table II, add the deemable unearned income of the spouse to the individual's unearned income. Deduct the $20 general disregard.

b.    Then add the deemable earned income of the spouse to the individual's earned income.             

                    i.    Deduct any portion of the general $20 disregard that could not be deducted from the combined unearned income.

                   ii.    Deduct the earned income disregard from earned income only.

                  iii.    Total the remaining unearned and earned income. This is the countable income to use to determine eligibility.

                  iv.    Include the spouse in the household size and use the applicable income limit for a two-person household to determine eligibility.