|
All Medicaid Programs |
|
Obsolete Policy |
General Budgeting Rules
Budgeting is the process of determining a best estimate of income for an individual or household for the current and future months. Budgeting income is done prospectively meaning that we are using current and historical information to project what income the individual or household will receive during the certification period.
Although budgeting will be similar for both MAGI-based and non-MAGI-based eligibility groups, there are a few differences. There are also some differences for the aged, blind and disabled Medicaid coverage groups.
Budgeting for retroactive coverage months is discussed in sec. 445.
Determine all factors of eligibility, including income, prospectively for all benefit months except retroactive months for the MAGI-based and non-MAGI-based groups.
For MAGI-based groups, determine a best estimate of income to be received during the certification period to arrive at a monthly amount.
For non-MAGI-based groups, use a best estimate of income and household size that will exist in the benefit month. The best estimate could change in future months due to expected changes.
This applies to the client's income, a spouse's income AND the income of any family members whose income must be counted based on the policy for the applicable coverage group to determine eligibility.
Income that begins or ends in a benefit month
If income begins in the application or renewal month, count the actual expected amount of income from that source for the household member.
Do not factor new income in months when the client does not receive the full number of paychecks for that month.
If the income received in the application month is not reflective of income that will be received in future months, a second best estimate may be required for the ongoing months.
If income terminates in a benefit month, decide Medicaid eligibility and spenddown amount or MWI premium, if applicable, by using the actual income received from the terminated source for that household member, up to the point of income termination or point an eligibility decision is made. Anticipate income expected after the termination of income or eligibility decision date through the end of the month
When income terminates in the application month, or will terminate during the application period, do not factor that income when making an eligibility decision, even if the client receives the full number of paychecks in the benefit month. Instead use the actual amount received from the terminated source in such month.
Determine income for the months after the income terminates without counting income from the terminated source. This may require more than one income best estimate: one for the application month and the first ongoing month; another for the future benefit months, depending on when the income from the terminated source ends.
Anticipating future income
For all other months, use the best estimate of monthly income expected to be received in that month. Explain the best estimate in writing. (435-2)
For MAGI-based coverage groups, anticipate income that will be received less often than monthly, but that has a history of being received and is expected to be received again during the certification period. Prorate the income over the certification period, and add the prorated amount to the monthly income. An example is interest income that must be counted, but is received in only 1 month of the year. Prorate the amount over the 12 month certification period and count 1/12 in each month.
For the retroactive period, use income amounts received by all household members (as applicable) during the month, even when the benefit effective date is not the first day of the month. See section 705-1 to determine the retroactive period.