H-3100, When to Project

H-3110 Variable Income

Revision 09-4; Effective December 1, 2009

  1. The person has income that fluctuates from month to month (such as earnings, royalties, dividends, interest, rents, etc.) and the average from all sources is $5 or more.
     
  2. Variable income from any combination of sources was received during at least three of the preceding six months, is anticipated to reoccur, and the average from all sources is $5 or more.

    Example: The applicant entered the nursing facility (NF) in January and applied for MEPD the same month. During the six months preceding the month the case is worked (February), the person received the following variable income payments, all of which are anticipated to reoccur during the projection period (March through August).
     
    Month Source #1 Source #2 Payment Rec.
    Aug.      
    Sept. $20   X
    Oct.      
    Nov.   $20 X
    Dec.      
    Jan.      

    Since the person did not receive variable income from all sources during at least three of the preceding six months, do not average and project variable income, even though these payments are anticipated to reoccur with the same frequency during the coming six months.

    Note: If an eligibility budget is being calculated for the prior month of November, the $20 payment received that month is excluded as infrequent/irregular income in the eligibility budget. There is no co-payment for November, since the person did not enter the NF until January.
     
  3. In spousal impoverishment cases, the community-based spouse received variable income from any combination of sources during at least three of the preceding six months, the variable income is anticipated to reoccur, and the monthly average from all sources is $5 or more.

    Example: The applicant entered the NF in January and applied for Medicaid the same month. The person has no variable income. However, the community-based spouse receives monthly royalty payments from a mineral lease. During the six months preceding the month the case is worked (February), the community-based spouse received monthly royalties as follows: August = $25; September = $30; October = $20; November = $15; December = $22; and January = $25.

    Since the community-based spouse received variable income during at least three of the preceding six months, all payments are anticipated to reoccur during the coming six months, and the average from all sources is $5 or more ($25 + $30 + $20 + $15 + $22 + $25 = $137 ÷ 6 months = $22.83 monthly average). The eligibility specialist projects the $22.83 average as the community-based spouse's income in the co-payment calculation.
     
  4. For applications, variable income which is anticipated to reoccur is calculated into the co-payment budget for the month of certification and is projected over the next six months. If eligibility is being tested for prior months, the amount of variable income actually received during a given month is budgeted as income for that month.
     
  5. For ongoing cases, variable income (earned or unearned) is not calculated into the co-payment budget until the month following the month in which the person received his first variable payment.

    Example (Reviews Only): The person's first monthly variable payment (such as earned income or interest) is received in October. This payment is calculated into the co-payment budget in November to be effective December.

 

H-3120 Incurred Medical Expenses (IMEs)

Revision 09-4; Effective December 1, 2009

  1. IMEs fluctuate from month to month, or they remain constant and are paid on a monthly basis and are anticipated to continue during the coming six-month period.

    Example: A redetermination is performed in February, and the person is making monthly payments for dentures purchased six months ago. During the preceding six months (August through January), the person paid $30 a month for dentures, and these payments are anticipated to continue during the projection period (March through August). The average of IMEs paid from August through January, or $30, is projected in the co-payment budget from March through August.
     
  2. The person pays IMEs that are regular and fixed and paid on a quarterly, semi-annual or annual basis. These IMEs are converted to a monthly amount and projected over a 12-month period.
     
  3. IMEs that have not been paid in preceding months are anticipated to occur in subsequent months.

    Examples:
    • A relative has been paying the person's insurance premium, but the person will begin paying it in March. The IME is calculated into the co-payment budget in February to be effective March.
    • The person will pay for dental work in monthly installments. Both the dental work and the payments begin in March. The monthly payment is calculated into the co-payment budget in February to be effective March.