DATE: OCTOBER 26, 2001
Manual: Family and Children’s Medicaid
Change No: 08-02
To: County Directors of Social Services
Effective: November 1, 2001
I. MAJOR CHANGES TO MA-3260, INCOME
The definition of base periods for applications and redeterminations is expanded to allow more flexibility, as long as the verification is current and representative of the family's anticipated income. The primary base period is still the month prior to the month of application. However, verifications for other pay periods are acceptable as long as they are current (within 2 months) and representative of the family's anticipated income. Verifications provided for other programs, such as active Food Stamps or Medicaid cases, are acceptable if they meet the definition of current and representative. Since many families use mail-in applications and reenrollments, base period flexibility will expedite processing and avoid delays waiting for verifications.
The definition of the date of change is expanded. For earned income, the date of change is the date the changed employment begins (the date the budget member begins a job, begins working at a new rate of pay or begins working new required hours).
For unearned income, the date of change is the date the new benefit amount is received.
If income changes prior to the date of application (such as the budget member begins working), the new income is considered in determining eligibility for the entire certification period. This is consistent with policy for continuous eligibility for children.
If income changes after the date of application but before the application or review is completed, and income in the base period establishes eligibility, the assistance unit is eligible. The change does not affect ongoing eligibility for children under 19 because of continuous eligibility for children. However, the change must be considered for the remainder of the certification period for assistance unit members over age 18.
Terminated income is no longer considered at application or redetermination if the source of the income stops prior to disposing the application or prior to completing the redetermination. Eligibility is determined based only on the anticipated income in the certification period.
The exception is for MPW cases and for retroactive certification periods, both of which require counting the actual income available in the base period.
A termination of income during the certification period for a Medically Needy case is treated as a change in situation as it may result in authorization as Categorically Needy or a reduction in the deductible.
The base period for self-employment income is changed to 6 months for all self-employment income received other than annually.
The base period remains 12 months for:
Procedures for verifying operational expenses are expanded to allow additional sources, such as IRS tax records and computer-based software accounting programs maintained by the client (such as Quicken). Counties are encouraged to use business records maintained by the client. Requesting individual receipts for expenses should be used only if there are no other verifications available.
Many new sources and types of income are added, including:
The section on VA benefits is revised to be consistent with Work First policy. All types of VA income are countable, except for VA benefits provided to pay for school. This includes all increased benefits such as improved pensions, Aid & Attendance and homebound assistance.
The Job Bonus section is revised and is now consistent with Work First policy. The parent/specified relative must be in the budget unit, rather than assistance unit, to be eligible for the Job Bonus.
There is an expanded definition of "new employment" for the purposes of applying the Job Bonus. A budget unit member has new employment if he begins working for a new employer for whom he has not worked before, or begins working for an employer for whom he has worked before but there has been a break in employment during which the job was not held for him. An individual who is out on leave (sick, maternity, family medical) and whose job is being held for him is not considered to have new employment when he returns to work. (This does not affect whether income is countable as new or terminated income, only whether the Job Bonus applies.)
Client statement is not acceptable verification of income for NC Health Choice. Client statement is also not acceptable verification at redeterminations.
Applications: Apply these procedures to all applications taken on or after November 1, 2001, including applications for retroactive coverage.
Redeterminations: Apply these procedures for redeterminations that started on or prior to November 1, 2001. "Started" means the reenrollment form is mailed to the family prior to November 1 or the initial interview is held prior to November 1.
Remove MA-3260 and Table of Contents.
Insert MA-3260 and Table of Contents, effective 11/1/01.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
Nina M. Yeager
[This policy material was researched and written by Jackie Franklin, Policy Consultant, Medicaid Eligibility Unit.]
MA-3260, Table of Contents
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.