Adult Medicaid Manual MA-2250 INCOME
II. A/B’S RESPONSIBILITIES
A. Application for Benefits
1. The a/b must apply for all countable unearned income (e.g. RSDI, unemployment, retirement benefits, Veteran’s Assistance, etc.) to which he may be entitled before eligibility can be determined. Accept the applicant’s statement that he has applied for benefits.
a. If the a/b chooses to waive, delay, renounce, or fails to comply with requirements to receive the unearned income, count as income the amount to which he is entitled.
b. If the a/b fails to apply for potential benefits within the processing time standard, count the benefit the day following the processing deadline if you are able to determine the amount. If the amount of benefits cannot be determined, deny the case. Due to the fact that the Social Security Administration often schedules appointments for completing applications with a delay of as much as four to six weeks after contact by the a/b, consider the requirement to apply for Social Security benefits met when the appointment has been scheduled. Flag the case to verify that the a/b completed the application process.
(1) If the appointment to complete the Social Security application is scheduled in the third month of the certification period or earlier, within a week of the date of the applicant’s appointment to complete his Social Security application, verify that the beneficiary did keep his appointment and completed the application.
(2) If the appointment to complete the Social Security application is scheduled for the fourth month of the certification period or later, verify that the individual completed his application for Social Security benefits when completing the first Medicaid redetermination.
c. Terminate an ongoing case when the a/b states that he refuses to apply or cooperate in determining the amount of potential unearned income to which he is entitled unless the amount can be verified (e.g. -unemployment). If so, count the "phantom" benefit.
REVISED 11/01/07-CHANGE NO. 22-07
d. If the client's statement has been accepted as proof of application for benefits and benefits are not being received by the first redetermination, the beneficiary is responsible for proving that an application has been completed. Send a DMA-5097, Request for Information, and give the beneficiary 12 calendar days to provide proof. If proof is not received at the end of the 12 calendar days, send a timely notice proposing termination. Individuals who are applying for or have pending applications for potential benefits do not have stable income. Do not certify for 12 months. Refer to MA-2350, Certification and Authorization.
2. Verbally inform a budget unit member who is not a member of the assistance unit of these potential benefits. Do not pend the application or propose termination of an ongoing case if the budget unit member fails to apply.
B. Reporting Income
Inform the a/b that he must report all income he receives or to which he is entitled. Changes must be reported within ten calendar days of receipt of the changed income. The a/b may have to repay the Medicaid program for services received if he fails to report changes timely which result in ineligibility or a new or increased deductible. Refer to MA-2900, Beneficiary Fraud and Abuse Policy and Procedures.
The a/b must assist in the determination of eligibility by supplying verification of income or providing the source of the income.