Obsolete 1121 - 427-1 When to Deem Income

Effective Date: June 1, 2020 - October 31, 2021

(Sections in 412 & 413 Were rewritten into sections in 427 as of June 1, 2020)

Introduction

In general, income deeming occurs each month the eligible person lives with an ineligible spouse, or with an ineligible parent or parents when the eligible person is a minor child. When both members of a married couple are aged, blind or disabled, or both are eligible for Medicare, and both want to be included in the medical assistance coverage, deeming does not apply. Rather we combine income of the couple to decide if they are eligible.

A. When deeming applies

1. Deeming applies when the eligible person

a. does not receive Supplemental Security Income and is not eligible as a 1619b Protected Group, and

b. lives with an ineligible spouse, or when an eligible child lives with an ineligible parent. (See 427 for definitions of Ineligible Spouse or Parent)

2. Deem income from a spouse or parent who is eligible under an SSI-Protected group to the other spouse or to the eligible child.

3. Deem income during temporary absences of the eligible person, the ineligible spouse, or the ineligible parent or spouse of the ineligible parent. (See 427 about temporary absences)

4. Deem from all legal parents of the eligible child living with the child.

B. When deeming does not apply

Do not deem income from an ineligible spouse, or ineligible parent or spouse of an ineligible parent in the following situations:

1. The eligible person receives Supplemental Security Income (SSI) or is eligible as a 1619b Protected group person.

2. The spouse of the eligible person receives SSI. (See when both spouses are aged, blind or disabled, or both have Medicare.)

3. The ineligible spouse receives a Needs-based VA payment AND that spouse will not be included in the Medicaid coverage, or in the Medicare Cost-Sharing Program coverage.

· If both spouses want Medicaid or both want a Medicare Cost-Sharing Program, the VA payment is countable income for the couple; deeming rules do not apply.

4. The ineligible spouse receives FEP, General Assistance, Refugee Cash Assistance, BIA General Assistance, or Federal Disaster Relief Assistance.

5. At least one parent of the eligible child receives SSI. If the parent is married, do not deem from either parent.

· However, if a child’s parents are not married, you must still deem from the parent who does not receive SSI.

6. The eligible individual qualifies for the Medicaid Work Incentive (MWI) program. (See 462-1 for the income calculation)

7. An infant born in a hospital must remain for a prolonged period and is determined disabled.

· Deeming from parents does not occur until the month after the child leaves the hospital or medical facility and begins living in the parents' home.

8. An eligible child is placed in the parent's home for adoption and the adoption is not finalized.

· Deeming does not begin until the month after the adoption is finalized.

9. An ineligible parent receives a Public Income Maintenance (PIM) payment, in which case do not deem from that parent. (See 427, Definitions)

· If the parent is married, deem income from his or her spouse unless the agency making the PIM payment used the spouse's income to determine the amount of the PIM payment.

· If the parents are not married, deem from the parent who does not receive a PIM payment.

· If the PIM payment is FEP or General Assistance, assume the income of the parent's spouse was used to determine the payment.

10. One or both spouse's qualify for a home and community based services waiver, with some exceptions for the New Choices Waiver. (See 380)

11. The eligible child qualifies for a home and community based services waiver.

C. When to stop deeming

1. Stop deeming the month an eligible person will be eligible for a home and community based waiver program (with some exceptions for the New Choices Waiver.) Refer to the applicable waiver policies to determine eligibility. (380)

2. Stop deeming from a spouse the month after they separate and no longer live with each other.

3. Stop deeming from a parent who permanently leaves the home. Deeming from the absent parent ends the month after that parent moves out.

· If the parent later returns to the home, deeming from the returning parent resumes the month after the parent moves back into the home.

· If an eligible child lives with a step-parent, but the biological or adoptive parent has permanently left the household, stop deeming income from the step-parent (and the absent parent) the month after the biological or adoptive parent moves out.

4. Stop deeming the month after an eligible child turns 18.

5. Stop deeming when the eligible person becomes a resident of a medical institution.

· For spouses, deeming stops the month the eligible spouse enters the medical institution for a stay of 30 or more days, and resumes the month after the spouse returns home.

· For a blind or disabled child, deeming stops the month after the child enters a medical institution and resumes the month after the child returns home.