Medicaid Policy
Medicaid Policy
A. Definition
This policy applies only to Aged, Blind, or Disabled Medicaid, QMB, SLMB, and Qualifying Individuals (QI) cases. In-kind shelter is received when someone other than the member or the member's spouse pays for the member's or spouse's shelter expenses. Members who are residents of medical institutions or eligible on a Home and Community-Based Waiver other than members on the New Choices Waiver do not receive this kind of income.
B. Services that Result in Unearned In-Kind Income
A member who receives in-kind payment for the following services is receiving unearned income in-kind. If the payment is in the form of shelter, the value of such shelter is subject to the PMV rule.
· Domestic services in the home of the employer.
· Agricultural services.
· Services that are not in the regular course of the employer’s business or trade.
· In-kind income to members of the Uniformed Services.
· Shelter provided to employees on the employer’s business premises, for the employer’s convenience, and, if shelter, acceptance by the employee is a condition of the employment.
C. When to Count In-Kind Shelter
1. For aged, blind or disabled Medicaid and Medicare Cost-Sharing programs, count either the actual value of the shelter received, or the presumed maximum value, whichever is less.
a. Count in-kind shelter each month the member or spouse receives such help.
b. Count in-kind shelter an unmarried person receives in their home the month the person enters a medical facility. Stop counting it for any full calendar month the person is a resident of a medical facility. Begin counting it again in the month the person returns to their home, if they still receive in-kind shelter.
c. Count in-kind shelter the community spouse of an institutionalized person receives as it may affect their eligibility for Medicaid, or it may affect the amount of income to count when calculating the spousal needs allowance.
d. When a child is temporarily absent for the purpose of attending school or vocational training, count in-kind shelter that the child receives from the school or training facility unless the parents are paying the cost of the shelter. The cost of food and shelter may be part of the overall fees for the child to be at the school. (See 215-2 to decide if the child is temporarily absent.)
2. Count in-kind income the member receives at the permanent residence even during a temporary absence from the permanent residence. (See 408-6)
3. Count in-kind income the member receives while living in someone else's home if the member is not temporarily absent from the permanent residence. The member may intend to return to the permanent residence, but the absence is not temporary if it will exceed two months. For example, a member spends three months in the winter with their aging mother to care for her. They maintain their permanent residence but is not temporarily absent because they will not return by the end of the month after the month their absence began. Their mother pays the shelter costs at her home while they stay with her. They are receiving PMV during their stay at their mother's home.
D. When not to Count In-Kind Shelter
Do Not count in-kind shelter in the following situations.
1. When the eligible member lives in the same household with someone whose income can be deemed to the member, such as a spouse or parent, shelter that person provides is not in-kind income. The PMV rule does not apply. However, if someone outside the household provides shelter for the household, that income is counted under the PMV rule.
2. When the member receives an SSI payment. Do not require an SSI recipient to establish an unearned income in-kind. The SSI program develops PMV for SSI recipients and will reduce the payment if they find that a recipient receives in-kind income for shelter.
3. Do not count PMV for MAGI-based, Family Medically Needy, 1619a, or 1619b programs.
4. If a Medicaid recipient lives in a community group residence or residential treatment facility and is paying the agency’s room and board rate, there is no unearned income in-kind.
5. When the member is paying an adequate amount (fair share) for the food and shelter provided.
To Determine the Member's Fair Share of Expenses:
a. Add up the average household expenses for:
· mortgage or rental payments (do not count subsidies)
· property taxes
· heating fuel
· electricity
· water
· sewer
· garbage
b. Divide the total household expenses by the number of people living in the home. This is each person's fair share.
c. If the member, or member and spouse, are paying at least their fair share, there is no in-kind income. If they are not paying their fair share, the amount of in-kind income is either the PMV rate, or the amount of their fair share less any amount they are paying toward the shelter costs, whichever is less.
6. When the member lives with others who all receive a need-based income, such as FEP, RCA, SSI, or WTEP. Some VA benefits are also need-based income.
7. When it is received in the permanent residence for any month (including partial months) that a married person resides in a medical institution. In-kind income is not counted for the person in the institution, but would be countable for the spouse in the home.
8. Do not count in-kind shelter received in a hospital while a person is a patient there. Do not count it for any full calendar month that a person is a resident of a nursing facility.
9. In-kind income received only during a temporary absence at the location where the person is staying is not counted. (See C.1. above for a child at school.) For example, a member spends two weeks visiting their mother in another state. Do not count the value of any shelter they received during their two-week vacation.
10. Do not count in-kind income received at the member's permanent residence while the member is absent from that residence for more than a temporary absence. Develop whether the member receives in-kind income at the place they are staying. For example, a member must stay with a relative for four months after a surgery. Their relative pays the rent for the apartment the member will return to. The payment of that rent is not counted as PMV because the member is not temporarily absent and does not receive shelter in exchange.
11. When it is given by an organization issuing assistance based on need.
E. Determine the Amount of Countable Income
1. If the member and spouse live alone, but someone outside the home provides shelter, count the value of the shelter, or the Presumed Maximum Value (PMV) listed on Table II, whichever is less.
2. If the member and spouse live with others who do not receive a need-based income, decide if the member is paying their fair share of the expenses.
a. Use Form 17 to determine “Fair Share”. If the member is paying their fair share, there is no countable income in-kind.
b. If the member is not paying their fair share, count the difference between their contribution and their fair share OR the PMV, whichever is less. The PMV is listed on Table II.
c. Use the individual PMV rate if the member’s spouse is not counted in the household size. If both spouses are included in the household size, use the couples’ PMV rate. See 410 for spousal deeming rules to determine if the spouse is included in the HH size or not.
d. If a member has a rental, or room and board agreement, and pays an amount comparable to market price for the arrangement, there may be no in-kind income. Workers should use their best judgment about the reasonable market price. Local newspaper ads offering room and board arrangements may be helpful as a reference. A Form 17 is not needed. Instead, request verification of the rental agreement.
3. If the member does not respond to the request to provide the Form 17, do not deny or close the medical programs. Assign the full PMV value as in-kind shelter. If the addition of PMV results in a negative change, follow the rules for advance notice (811).
4. If a member is homeless for the full calendar month (i.e., does not have a permanent residence), but is staying with friends or family, decide if the member is paying their fair share of shelter costs. If not, then apply the PMV rule. Even if the member stays in more than one person's home during a month, decide the amount of in-kind shelter received in each location and compare it to the PMV. Count the actual value of in-kind shelter or the PMV amount, whichever is less. (Note: a person who lives with a relative as their permanent residence is not homeless.)
5. If the member is staying in shelters, sleeping on park benches, sleeping in a car, etc., and receiving meals from non-profit organizations that feed the homeless (see list above), do not count any of the assistance as in-kind shelter.