3300, Income Eligibility

3310 Income and Income Eligibles

Revision 21-3; Effective September 1, 2021

To be eligible for CCSE services, the person must either be:

1. categorically eligible by receiving
   • Supplemental Security Income (SSI);
   • Temporary Assistance for Needy Families (TANF);
   • Supplemental Nutrition Assistance Program (SNAP);
   • Medicaid, Specified Low-Income Medicare Beneficiary (SLMB) or Qualified Medicare Beneficiary (QMB) benefits; or
2. income eligible. The person's and their spouse's countable income must be equal to or less than the income limit set by the U.S. Department of Health and Human Services (HHS).

Categorical Eligibility for Title XIX Services

A person with full Medicaid is financially eligible for Title XIX services. These people are referred to as categorically eligible.

Use the Texas Integrated Eligibility Redesign System (TIERS) to determine the eligibility status of a person applying for Title XIX CCSE programs.

Related Policy

TIERS Inquiries, 7110
SAVERR/TIERS Type Program Chart, Appendix XIV

Categorical Eligibility for Title XX Services

Recipients of some non-Medicaid programs are financially eligible for Title XX benefits based on existing program eligibility. These people are referred to as having categorical eligibility for Title XX services.

Financial Eligibility Determination for Title XX Services

CCSE staff determine financial eligibility for applicants for Title XX programs unless financial eligibility has already been determined based on existing program eligibility. These people are referred to as income eligibles.

Related Policy

Determination of Countable Income, 3320
Budgeting Countable Income, 3330
Computation of Gross Income, 3340
TIERS Inquiries, 7110

Financial Eligibility for Community Attendant Services (CAS)

Financial eligibility for CAS is determined by both Medicaid for the Elderly and People with Disabilities (MEPD) and Texas Works (TW) staff. CCSE staff must not deny CAS, STAR+PLUS Home and Community Based Services (HCBS) or 1915(c) Medicaid waiver cases based on income or resources,  even if the applicant's assets appear to substantially exceed the eligibility limits.

Effect of Living Arrangement on Financial Eligibility for Title XX Programs

If both spouses apply for services and only one spouse receives SSI, TANF, Medical Assistance Only or another program that provides categorical eligibility for CCSE services, compare the total income of both spouses with the couple’s income limit to determine the second spouse's eligibility.

If a married person does not live with their spouse, use the individual income limit. Do not consider the income of the spouse unless that income (or part of it) is given to the person. Income diverted from a spouse in a nursing home to the person at home is included in the person's income calculation. If income diverted from a spouse in a nursing home makes a person ineligible, explain to the person that they can request the amount of income they keep from the institutionalized spouse may be reduced. If the amount they keep is reduced, they will be required to pay more to the nursing home. The person must contact MEPD to request this change. Explain that the person may need to reapply for CCSE, if the situation changes.

A CAS, PHC or Title XIX Day Activity and Health Services recipient who requests a Title XX service, is categorically eligible for Title XX services based on the current Medicaid eligibility certification.

Related Policy

Income and Resource Limits, Appendix XI

3320 Determination of Countable Income

Revision 24-1; Effective March 1, 2024

Countable income is determined by totaling gross income from all the following sources, less all applicable exclusions and exemptions. Applicable exclusions and exemptions are specified in 26 TAC Section 271.55 and 26 TAC Section 271.59 of this title relating to Income from Excludable Sources and Income from Exempt Sources.

(1) Total gross earnings — This includes money, wages, commissions, tips, piece-rate payments, cash bonuses, or salary received for work performed as an employee. This also encompasses pay for members of the armed forces including allotments from any armed forces pay received by a member of the family group from a person not living in the household.
(2) Self-employment income including farm income — For earned income to be considered self-employment, either the person or spouse must be actively involved or materially participating in producing the income.
(3) Social security and railroad retirement benefits.
(4) Dividends — This consists of dividends from stocks or membership in associations, and periodic receipts from estates of trust funds. These payments are averaged over a 12-month period.
(5) Rental income — This includes payments to the person from the rent of housing, store, or other property, as well as from boarders or lodgers.
(6) Net income derived from oil, gas, or mineral rights — This can include both lease and royalty payments. These payments are averaged over a 12-month period.

Reminder: Refer to Section 3330, Budgeting Countable Income, to determine if this income can be excluded as infrequent and irregular or as a lump sum payment.

(7) Income from mortgages or contracts.
(8) Public assistance or welfare payments — Temporary Assistance to Needy Families, Supplemental Security Income, and general assistance such as cash payments from a county or city are included.
(9) Veterans' pensions and compensation checks — This may include money paid periodically by the Veterans Administration to disabled members of the armed forces or to survivors of deceased veterans, subsistence allowances paid to veterans for education and on-the-job training, and refunds paid to ex-servicemen as GI insurance premiums.
(10) Educational loans, grants, fellowships, and scholarships.
(11) Unemployment compensation — Unemployment compensation may be received from government employment insurance agencies or private companies during periods of unemployment, and includes any strike benefits received from union funds.
(12) Workers compensation and disability payments — This includes compensation received periodically from private or public insurance companies for injuries incurred at work.
(13) Alimony.
(14) Regular monthly cash support payments from friends or relatives.
(15) Pensions, annuities, and irrevocable trust funds — Payments may be paid to a retired person or their survivors by a former employer or by a union, either directly or through an insurance company. Periodic payments from annuities, insurance, irrevocable trust fund payments, and civil service pensions are included.
(16) Income from the person's share of a life estate.

Related Policy

26 Texas Administrative Code Section 271.55 

3330 Budgeting Countable Income

Revision 17-1; Effective March 15, 2017

The sources of income that may be included in the income eligibility budget fall into one of three categories: countable, excludable and exempt. Countable income is addressed in Section 3320, Determination of Countable Income. Treatment of the excludable and exempt income varies, as illustrated below.

3330.1 Excludable Income

Revision 24-1; Effective March 1, 2024

Income may be fully or partially countable or may be excluded from the current eligibility budget. Excludable income will continue to be monitored by the caseworker at each financial review to determine how eligibility is affected. Excludable sources of income include:

• deductions from earned income, including social security payments, Medicare premium payments, bonds, pensions, and union dues;
• the first $65 of a client's or couple's net earned income, plus half of the remainder;
• loans, grants, scholarships, and fellowship funds obtained and used under conditions that preclude their use for current living costs. 
  • any portion used to pay any other expense such as room, board or books cannot be excluded;
• Veterans Administration aid-and-attendance benefits, homebound elderly benefits, and payments to certain eligible veterans for purchase of medications;
• infrequent or irregular income including income received less frequently than once a month, that averages $20 per month or less;
• one-third of the total amount of child support payments for an eligible child; and
• allowable exclusions from self-employment income, as indicated on the following chart.

Mandatory deductions from unearned income may also be excluded from the eligibility budget. Documentation in the case record must clearly state that the deduction is mandatory and if or when the mandatory deductions will end.

For earned income to be considered self-employment, either the person or spouse must be actively involved or materially participating in producing the income. A business owner is determined to be materially participating if they meet any one of the following criteria. The owner:

• engages in periodic advice and consultation with the tenant, inspection of the production activities, and furnishing of machinery, equipment, livestock, and production expenses;
• makes management decisions that affect the success of the enterprise;
• performs a specified amount of physical labor to produce the commodities raised and
• does not meet the full requirements above, but their involvement in crop production is still significant.

A blind or disabled student under 22 years who regularly attends school, college, a university or a course of vocational or technical training can have limited earnings that are not counted toward the income eligibility budget. This exclusion does not apply to unearned income.)

The maximum amount of the income exclusion varies from year to year and is determined annually by the Social Security Administration (SSA). Exclusion amounts can be determined on the Student Earned Income Exclusion For SSI webpage.

Section 2002 of the American Recovery and Reinvestment Act of 2009 (ARRA) authorizes more unemployment compensation benefits of $25 per week for people receiving unemployment benefits. The additional $25 unemployment compensation benefits received because of ARRA are not countable income for either eligibility or co-payment purposes. As the additional unemployment compensation may be included either with the regular payment or as an additional payment, a contact with the Texas Workforce Commission may be needed to determine if any of the payments are part of the ARRA additional compensation.

Related Policy

26 Texas Administrative Code Section 271.57

3330.2 Exempt Income

Revision 17-8; Effective September 1, 2017

There are numerous exemptions on countable income. These exemptions can be found in Appendix XXX, Income and Resource Exemptions for Determining Financial Eligibility.

Exempt income is not included in the income eligibility calculation. Once identified and documented, caseworkers will not be required to monitor exempt income at subsequent financial redetermination. Sources of exempt income include:

(1) interest income.
(2) cash received from the sale of a resource. This cash is a resource, not income.
(3) income of minor children who are supported by or dependent upon the client.
(4) refunds from the Internal Revenue Service for earned income tax credit.
(5) reimbursement from an insurance company for health insurance claims.
(6) any cash from a non-governmental medical or social services organization if the cash is:

• for medical or social services already received by the individual and approved by the organization, and which does not exceed the value of those services; or
• a payment restricted to the future purchase of a medical or social service.

(7) proceeds of either a commercial loan or an informal loan, for which repayment is required with or without interest. The proceeds (amount borrowed) are not counted as income in the month in which they are received, but are considered to be a resource in the following month(s). To claim exemption of the proceeds of a loan, a client must prove that he acknowledges an obligation to repay and that some plan for repayment exists. If these conditions can be verified, no written contract is required.
(8) the amount of the cost-of-living increase in any pension or benefit, received on or after January 1, 1985, that would cause the client to be ineligible for continued services. This exclusion applies only to community care clients who are already receiving services or case management and would become ineligible because of the increase. It does not apply to applicants.
(9) in-kind income, such as food, clothing, shelter, rent subsidies.
(10) one-time or lump-sum payments from any source.
(11) funds from the Transition to Life in the Community Program.

For a complete list of income exemptions, see Appendix XXX.

The term "lump sum," as listed in (10) above, can be defined as income that is not expected to recur with a predictable pattern of frequency.

Income received less than three times per year that does not meet the $20 monthly average requirement, as listed in (5) above, should be treated as a lump sum payment. If the lump sum could affect eligibility, the case should be monitored 30 days following receipt to ensure that resource eligibility is not affected.

3340 Computation of Gross Income

Revision 17-1; Effective March 15, 2017

If an individual receives gross income more often than monthly, compute the income as follows.

• Weekly income — multiply by 4.33
• Bi-weekly income — divide by 2 and multiply by 4.33
• Twice monthly income — multiply by 2.

3341 Income Averaging

Revision 17-1; Effective March 15, 2017

Calculate the income average of all income that may be received monthly, but is usually received less often. The case worker also may need to calculate the 12-month average income for monies received for seasonal employment, such as agricultural or construction work.

If an individual ends regular employment to accept seasonal employment but later returns to the regular job, calculate the income average from the combined sources over the 12-month period.