Family and Children's Medicaid MA-3300 Income

V. BASE PERIOD FOR MAF, MIC, NC HEALTH CHOICE, AND HSF APPLICATIONS

Use the base period income to make a projection of income that is anticipated to be received during the certification period.

Child support, self-employment income, dividends, and income of school employees are calculated using a different base period. See VIII. for the appropriate base period for these types of income.

A. Definition of Base Period for Applications

1. The primary base period for computing income for the certification period is the calendar month prior to the month of application, except for certain types of income described in VIII.

2. If the applicant provides verification of income from a different period, it is acceptable to use those verifications if the information is current and representative of the actual anticipated income.

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(V.A.2.)

a. Current is defined as wages received within 2 months of the application date. These may be wage verifications received in an active case in another program, such as Food Stamps or another Medicaid case for a member of the budget unit.

b. Representative means that there are no anticipated changes and the verification represents the applicant's average income.

3. Convert this verified income to a monthly amount using the conversion process in V.B. below.

4. Once a monthly amount is computed, compare this to the appropriate income standard for the Needs Unit. If the income is equal to or less than the income limit, the applicant may be eligible for the entire certification period. Refer to MA-3410, Terminations, Deletions, and Ex Parte Reviews for changes that may cause ineligibility. If the income is more than the income limit, the applicant is ineligible as categorically needy. Evaluate for medically needy.

Example: Applicant completes a mail-in DMA-5063 which is signed on 9/27, received in the agency on 10/4. The application date is 10/4 so the primary base period is September. Attached are wage stubs for weeks ending 8/18, 8/25, 9/1 and 9/8. All show an hourly rate of $6.75, with hours fluctuating between 27-30 hrs/wk. The verifications provided are current and indicate no change. This is acceptable wage verification.

Example: Same situation, except applicant provides wage verifications for weeks ending 8/25, 9/1 and 9/8. The last two wage stubs indicate an increase in pay to $7.00/hr. Since there has been a change in the rate of pay, use the last two pay stubs to calculate monthly income. Divide by 2 to get an average, multiply by 4.3 to get a monthly amount.

5. If the applicant was not paid for part of the period because of unusual circumstances, convert the partial pay to a full monthly amount. This applies only when missed pay periods are not expected to recur in the certification period. It is not applicable for normally fluctuating wages.

Example: Applicant is paid weekly. She provides verification for only 3 weeks in base period as she was out of work for a week due to a plant closing. Use the 3 weeks wages. Divide by 3 to get a weekly average, then multiply by 4.3 to get monthly amount.

6. Do not delay application processing to obtain additional verifications if the income verifications provided are current and representative of the applicant's anticipated income during the certification period.

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(V.A.)

7. Retroactive

Verify actual income for the month(s) of retroactive need, except for certain types of income described in VIII. Do not project to a monthly amount. Refer to MA-3220, Retroactive Coverage.

B. Conversion

1. Earned

a. In each step of the conversion computation, round to the nearest whole cent. If the total is .005 or more, round up. If the total is .004 or less, round down. For example, $538.145 is rounded to the nearest whole cent, or $538.15.

b. Upon receipt of the income needed to determine eligibility, total the gross income for each pay period used. Divide by the number of pay periods received in a month. This is the average income per pay period.

c. Convert the average income to a gross monthly amount.

(1) If paid weekly, multiply by 4.3.

(2) If paid biweekly, multiply by 2.15.

(3) If paid semimonthly, multiply by 2.

(4) If paid monthly, use the monthly gross.

Example: Applicant receives income biweekly. On 9/7, she received $218.75 gross and on 9/21, she received $209.38 gross. $218.75 + $209.38 = $428.13. Divide by 2 (number of pay periods received and used) = $214.065, rounded to $214.07 (average income). Convert to a monthly amount by multiplying $214.07 by 2.15 = $460.2505, rounded to $460.25. This is the gross monthly income.

From this amount, subtract the allowable deductions.

2. Unearned Income

a. If the unearned income is a stable amount (such as RSDI or pension), use that amount. If the unearned income varies, obtain the base period unearned income and divide by the number of times received in the month. This is the average income. Round to the nearest whole cent in each step. (If total is $.005 or more, round up. If less than $.005, round down.)

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(V.B.2.)

b. Convert the average income to a gross monthly amount.

(1) If received weekly, multiply by 4.3.

(2) If received biweekly, multiply by 2.15.

(3) If received semimonthly, multiply by 2.

(4) If received monthly, use the monthly amount

C. Definition of Change In Income

1. Earned

a. Change is defined as a new, different or additional employer or source of income, increase or decrease in rate of pay, an increase or decrease in the required number of hours worked, or termination of income.

b. The date of change for earned income is the date of beginning the new or changed:

(1) employer, or

(2) rate of pay, or

(3) required numbers of hours.

Example: A/b begins a new job on September 10. Her first paycheck is received on September 21. The date of change is September 10.

c. The date of change for terminated income is the last day of work.

2. Unearned

a. Change is defined as beginning of benefits or an increase or decrease in the amount as established by the agency distributing the benefit.

b. The date of change is the date of receipt of the new or changed benefit.

3. For the definition of changes in certain types of incomes, such as self-employment, see VIII.E.

4. Do not consider fluctuating income as a change.

For example, it is not considered a change if a recipient's work hours fluctuate from pay period to pay period.

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(V.)

D. Income Changes On or Prior to Date of Application

1. If earned or unearned income changes during the base period or anytime prior to the date of application, move the base period forward to begin with the date of change. Request verification of the new income on the DMA-5097.

2. See C., above for the definition of when a change occurs. The date of the change in relation to the date of application is important in determining the correct action.

3. For earned income, try to get more than one pay period to determine the changed amount. If unable to get more than one pay period, use what changed income you receive to compute the gross monthly amount.

4. Upon receipt of the changed income, use one of the following methods to calculate the anticipated gross monthly income:

a. Earned Income

(1) When the changed income from only a partial pay period is available, determine the daily wages. Use the pay stub/wage statement or contact the employer to determine the daily wages.

(a) Multiply the daily income amount by the number of days per pay period that the applicant is expected to work. If the hours or days are irregular, use the higher amount of hours/days given by the applicant or employer to determine the income.

(b) Using the amount anticipated per pay period, convert to a gross monthly amount using conversion methods in B., above. Use this amount to determine eligibility for the entire certification period.

(2) When at least one full pay period is available, convert the amount from the full pay period to a monthly amount. Disregard any partial pay periods. Use this amount to determine eligibility for the entire certification period.

Example: Application on 10/10 for mom and 2 children. She reports she began working on 10/6 at a movie theatre on weekends. She is working 12 hrs/wk at minimum wage. She will receive a partial paycheck on 10/12 and her first full check on 10/26. The change, beginning employment, began prior to the date of application. Use the earnings from the full check on 10/26 and convert to a monthly amount to determine eligibility for the c.p.

b. Unearned Income

When the changed income has been received only one time and is a partial amount, determine the full amount of the changed income. Using this full amount, convert the income to a gross monthly amount using conversion methods in B., above. Use this amount to determine eligibility for the entire certification period.

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(V.)

Example: Application date 8/29. Applicant reports he just began receiving short-term disability payments from his company that will last up to 6 months. He received a partial payment of $34 on 8/15 and then a full payment of $100 on 8/22 and $100 on 8/29. Disregard the $34 partial payment, and use the full payments to compute income. $100 x 2 (full payments) = $200 ÷ 2 (number of incomes you used) = $100 (average income). Convert $100 to a monthly amount by multiplying by 4.3 = $430 (countable gross monthly income).

E. Changes After the Date of Application

Reminder: For MAF-C applications, see XIII.G. below for instructions on how to evaluate for the Job Bonus if new employment begins after the date of application.

1. See C., above for the definition of when a change occurs. The date of the change in relation to the date of application is important in determining the correct action.

2. If income changes after the date of application and the assistance unit is eligible for C or N coverage based on income in the base period, the assistance unit is eligible. Authorize everyone in the assistance unit.

a. Continuous eligibility for children applies when they are eligible based on income in the base period. Do not react to changes in income after the date of application for individuals under age 19.

b. Follow up to verify changed income if there are individuals age 19 or older in the assistance unit.

(1) Use the base period income to determine eligibility for months up to the month of change.

(2) Use the changed income to determine eligibility for the remaining months in the certification period.

(3) When sending a DSS-8108 to approve the application, send a DMA-5097 to request the changed income if it has not been provided. Allow the recipient 12 calendar days to provide the information. If the recipient does not provide the requested information, send a timely notice to terminate assistance.

(4) If the recipient will not receive the first changed income within the 12 calendar days, send a DMA-5097 on the date he is anticipated to receive the first changed income. Allow the recipient 12 calendar days to provide the information.

(5) Upon receipt of the changed income, convert this income to a gross monthly amount. Follow the procedures in D.4., above, to determine a monthly amount.

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(V.E.2.b.)

(6) Recalculate the budget to determine if a change in eligibility has occurred for the authorized adults in the case.

Example: Application date is 9/5 (mail-in application) for mom and 3 children. Only income in the Aug. base period is $400 child support; the entire a.u. is eligible as MAF-C.

During processing worker learns mom will begin drawing $645 Social Security Disability on 11/1. Send approval notice for MAF-C because income in the base period establishes eligibility for the a.u. The children remain continuously eligible for 12 months, but mom's new income is over the MAF-C limit. Evaluate her for other coverage groups. In this situation, mom is eligible for MAD.

Mom is MAF-C eligible from 9/01 - 10/01. Delete mom from MAF-C and approve for MAD effective 11/01. No signed application is required.

3. If the base period income establishes ineligibility for Categorically Needy and the change is a decrease that will be received prior to the 45th day, contact the applicant or the employer to obtain a verification of income.

If the change is due to terminated income, see IX. below for instructions on treatment of terminated income.

a. Upon receipt of the changed income, follow the steps in D.4., above to determine the monthly income.

b. If the changed income still establishes ineligibility for Categorically Needy, evaluate the assistance unit for all other aid program/categories.

c. If the changed income now results in CN eligibility, authorize beginning no earlier than the month of change. Evaluate for Medically Needy for earlier months.

Example: 19 year old living alone applies 10/5 as he needs dental work and outpatient knee surgery. Income in the Sept. base period is above MAF-N limit due to wages; client has MN deductible for Oct.-Mar. During processing, client reports his hours will decrease starting 12/5 due to the slow season at his job. New income is below CN limit. Authorize CN effective Dec.-Mar. and recompute 2 month deductible for Oct.-Nov. (Month of change is the month he begins working at the reduced hours.)