Income 510-05-85

Income Considerations 510-05-85-05

(Revised 10/1/13 ML #3390)

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(N.D.A.C. Section 75-02-02.1-34)

Income is defined as any cash payment, which is considered available to a Medicaid unit for current use. Income must be reasonably evaluated.

MAGI households:

MAGI income methodologies must be applied to all MAGI households.
Current, point-in-time income must be used.
All income which is actually available must be considered. Income is actually available when it is at the disposal of an applicant, recipient, or responsible individual; when the applicant, recipient, or responsible individual has a legal interest in a liquidated sum and has the legal ability to make the sum available for support, maintenance, or medical care; or when the applicant, recipient, or responsible individual has the lawful power to make the income available or to cause the income to be made available.

An individual may have rights, authority, or powers that he or she does not wish to exercise. An example includes an individual who allows a relative to use excluded assets free or at a reduced rental. In such cases, a fair rental amount will be counted as available income whether the applicant or recipient actually receives the income.

Income that is withheld because of garnishment or to pay a debt or other legal obligation is still considered available.

Title II and SSI overpayments being deducted from Title II benefits are normally considered to be available because the applicant or recipient can pursue a waiver of the overpayment. Only if the waiver has been denied after a good faith effort, can the Title II or SSI overpayment deductions be considered unavailable.

Occasionally other delinquent debts owed to the federal government may be collected from an individual’s federal payment benefit (i.e. Title II, Civil Service, and Railroad Retirement). These other reductions of federal benefits are not allowed to reduce the countable benefit amount. The award amount of the federal payment benefit is counted as available except to the extent an undue hardship is approved for the individual.

Requests for undue hardship exceptions must be submitted to the Medicaid Eligibility Unit where a determination will be made whether an undue hardship exists. An undue hardship may be determined to exist for all or a portion of the debt owed, or all or a portion of the reduction from the monthly income.

An undue hardship will be determined to exist only if the individual shows all of the following conditions are met:

The debt is a debt owed to the Federal government;
The deduction from the individual’s federal payment benefit was non-voluntary;
The amount of the deduction exceeds the Medicaid income level(s) to which the individual and the individual’s spouse is subject;
The individual has exhausted all lawful avenues to get the reduction waived, forgiven, or deferred; and
The individual or their spouse does not own assets that can be used to pay for the debt.

Financial responsibility of any individual for any applicant or recipient is subject to their tax filing status as defined at “Medicaid Unit” 510-05-35-05.
Monthly income is considered available when determining eligibility for Medicaid, however, an individual may die before their income is actually received for the month. An income payment received after death is no longer considered income, but an asset to the individual’s estate. In circumstances where the Department will pursue estate recovery, Medicaid eligibility can be redetermined counting only that income which was received prior to the individual’s death; resulting in the elimination or reduction of the client share/recipient liability.

When a Medicaid provider reports that a recipient’s current month recipient liability was not paid as of the date of death, determine whether the following conditions are met:

There is no surviving spouse;
There is no surviving minor or disabled child; and
Countable monthly income was not received prior to death.

If all conditions are met, refer the case to the Medicaid Eligibility Unit. Information regarding the date of death and the dates of the month in which each source of income is received must also be provided. The Medicaid Eligibility Unit will determine whether Medicaid estate recovery is being pursued and an adjustment to recipient liability can be approved. If approved, the Medicaid Eligibility unit will process the adjustment.

Income may be received weekly, biweekly, monthly, intermittently, or annually. However income is received, a monthly income amount must be computed.
Many benefit programs deposit an individual’s monthly benefit onto a debit card. Examples of these benefit programs are TANF benefits, Unemployment Insurance Benefits (UIB), Child Support benefits, Workforce Safety and Insurance (WSI), Social Security Administration Benefits (SSA), and Supplemental Security benefits. Individuals may also receive as gifts or bonuses such things as gift cards, debit cards, prepaid credit cards or ‘in-store credits’. Examples include bonus or commission payments, compensation for work performed, or Tribal Gaming Per Capita Distributions from gaming revenues etc. These could be earned or unearned income by applying appropriate policy.

Payments that are normally disregarded as income, such as SNAP or TANF benefits, disregarded Tribal payments (other than per capita payments from gaming revenues), and occasional small gifts, continue to be disregarded as income regardless of the form of payment (510-05-85-25 Post Eligibility Treatment of Income, 510-05-85-30 Disregarded Income – Medicaid, 510-07-40-30 Disregarded Income – Healthy Steps). All other such payments are counted as income.

Non-MAGI households:

All income which is actually available must be considered. Income is actually available when it is at the disposal of an applicant, recipient, or responsible relative; when the applicant, recipient, or responsible relative has a legal interest in a liquidated sum and has the legal ability to make the sum available for support, maintenance, or medical care; or when the applicant, recipient, or responsible relative has the lawful power to make the income available or to cause the income to be made available.

Income that is withheld because of garnishment or to pay a debt or other legal obligation is still considered available.

An undue hardship will be determined to exist only if the individual shows all of the following conditions are met:

The debt is a debt owed to the Federal government;
The deduction from the individual’s federal payment benefit was non-voluntary;
The amount of the deduction exceeds the Medicaid income level(s) to which the individual and the individual’s spouse is subject;
The individual has exhausted all lawful avenues to get the reduction waived, forgiven, or deferred; and
The individual or their spouse does not own assets that can be used to pay for the debt.

The financial responsibility of any individual for any applicant or recipient of Medicaid will be limited to the responsibility of spouse for spouse and parents for children under age twenty-one. Such responsibility is imposed as a condition of eligibility for Medicaid. Except as otherwise provided in this section, the income of the spouse and parents is considered available even if that income is not actually contributed. Natural and adoptive parents, but not stepparents, are treated as parents (exceptions to counting a stepparent’s income applies when the stepparent is the only eligible caretaker and is eligible for Medicaid because of the child, as described in 05-35-20(2) or when budgeting for Transitional Medicaid Benefits as described in 05-50-05(7)).
All spousal income is considered actually available unless:

A court order, entered following a contested case, determines the amounts of support that a spouse must pay to the applicant or recipient;
The spouse from whom support could ordinarily be sought, and the property of such spouse, is outside the jurisdiction of the courts of the United States; or
The applicant or recipient is subject to marital separation, with or without court order, and there has been no collusion between the applicant or recipient and his or her spouse, to render the applicant or family member eligible for Medicaid.

All parental income is considered actually available to a child unless:

The child is disabled and at least age eighteen;
The child is living independently; or
The child is living with a parent who is separated from the child’s other parent, with or without court order, if the parents did not separate for the purpose of securing Medicaid benefits.

Monthly income is considered available when determining eligibility for Medicaid, however, an individual may die before their income is actually received for the month. An income payment received after death is no longer considered income, but an asset to the individual’s estate. In circumstances where the Department will pursue estate recovery, Medicaid eligibility can be redetermined counting only that income which was received prior to the individual’s death; resulting in the elimination or reduction of the client share/recipient liability.

When a Medicaid provider reports that a recipient’s current month recipient liability was not paid as of the date of death, determine whether the following conditions are met:

There is no surviving spouse;
There is no surviving minor or disabled child; and
Countable monthly income was not received prior to death.

Income may be received weekly, biweekly, monthly, intermittently, or annually. However income is received, a monthly income amount must be computed.
Many benefit programs deposit an individual’s monthly benefit onto a debit card. Examples of these benefit programs are TANF benefits, Unemployment Insurance Benefits (UIB), Child Support benefits, Workforce Safety and Insurance (WSI), Social Security Administration Benefits (SSA), and Supplemental Security benefits. Individuals may also receive as gifts or bonuses such things as gift cards, debit cards, prepaid credit cards or ‘in-store credits’. Examples include bonus or commission payments, compensation for work performed, or Tribal Gaming Per Capita Distributions from gaming revenues etc. These could be earned or unearned income by applying appropriate policy.