All Medicaid Programs |
Obsolete Policy |
Changes in Income – MAGI Programs
Workers will only take action on the change that is reported, unless the change requires the client to verify other factors of eligibility, such as verifying TPL on a new job.
Do not complete a new income determination in the following situations:
A woman on poverty level pregnant woman Medicaid reports a change in income. Do not change her eligibility. (The change in income may affect other household members.)
The change in income (increase or decrease) was included as an anticipated change in the original best estimate, i.e., a seasonal source of income ended (or started) and the agency included this income in the best estimate for the certification period;
Income terminates unexpectedly or the client's work hours are reduced unexpectedly, but the change in income does not change eligibility for any recipient in the household as everyone is already on the best coverage group possible.
Complete a new income determination when the agency has not accounted for the income change in the original best estimate and the change may affect eligibility for a household member.
The client reports a new job that was not anticipated. If some other source of income has ended, such as UI, do not include that terminated source of income in the new best estimate for the remainder of the certification period.
The client reports a reduction in work hours and could possibly move from PCN to PCR.
If the income makes a beneficiary ineligible for ongoing medical, the effective date of change is the end of the month in which proper notice is sent. Determine eligibility for other medical programs.
Budget income changes over a 12 month period to arrive at a monthly income amount (435-2). The worker may have to adjust the best estimate at the next review.
EXAMPLE 1: Helen is open for Child Medicaid for her two children and her review is scheduled for November. On May 12th, Helen submits an employer statement for her new job which she started on May 5th. She is working 24 hours a week at $10.00 an hour. She is paid weekly and will get her first pay check on May 16th. The worker completed a new best estimate for June benefits.
Best estimate for remaining months = $240 a pay period x 52 (total pay periods in a 12 month period) = $12,480/12 = $1040 a month in countable income. Base June eligibility on the new income estimate of $1040 a month. If this causes an adverse effect on any household member, the agency must provide proper notice before making the change.
EXAMPLE 2: Bob is open for Child Medicaid for his three children and his review is scheduled for December. On April 14th, Bob starts a new job and submits an employer statement. He is working 30 hours a week at $11.75 an hour. He is paid every two weeks and will get his first pay check on May 16th. The May 16th pay period will be a partial pay period with only 30 hours on it. May is a 3 pay period month. The worker completed a new best estimate for May benefits.
Best estimate for remaining months = $352.50 (for partial pay period)/12 = $29.38 a month. $705 a pay period x 24 (pay periods remaining (minus zero and partial pay periods in May)) = $16,920/12 = $1410 a month. $29.38 + $1410 = $1,439.38 in total countable monthly income.
Due to change reporting requirements, many cases will not have a partial pay period in the best estimate.
EXAMPLE 3: Alice is open for PCN and has a review scheduled for September. On March 8th, she submits an employer statement. Alice started her new job on March 3rd and she working 24 hours a week at $9.45 an hour. She will receive her first pay check on March 14th. The job is a temporary and will last for 16 weeks. The worker completed a new best estimate for April benefits.
Best estimate for remaining months = $226.80 a pay period x 13 (pay periods remaining, as she was paid 3 times in March) = $2,948.40/12 = $245.70 in total countable monthly income.
In most cases, continue with the original certification period, even if a decrease in income moves an individual to a better program, such as from PCN to PCR.
The worker may set a new 12-month certification period if all factors of eligibility have been reviewed. The worker cannot request additional verification unrelated to the reported change just to set a new 12-month certification period.
Changes in Income – Non-MAGI Programs
Count the income in the month or months it will be received. Factor income for family-related medically needy programs as described in 435-2 to determine a monthly income amount. See section 435 for budgeting of income.
Stop counting income that is no longer being received.
If a decrease in income makes an individual eligible for a MAGI-based program, determine eligibility using MAGI methodology. Set a new 12-month certification period.
If a change results in a decrease in spenddown, MWI premium or cost of care and the change is verified timely, the effective date of the change is the month of report. If the change is not verified timely, the effective date of the change is the month following the month of report.
If a change results in an increase in spenddown, MWI premium or cost of care, the effective date of the change is the first day of the month after which proper notice is sent.
In most cases, continue the same certification period; however, the worker may set a new certification period, if all factors of eligibility have been verified. The worker cannot request additional verification unrelated to the reported change just to set a new 12-month certification period.