H-3210 Variable Income

Revision 10-1; Effective March 1, 2010

  1. Variable income is received from all sources in fewer than three of the preceding six months and is not anticipated to increase in frequency. Variable income which is not projected is restituted at the annual redetermination if the amount in the month of receipt is $5 or more.

    Example: The applicant entered the nursing facility (NF) in January and applied for Medicaid in the same month. During the six months preceding the month the case is worked (February), the applicant received the following variable payments, 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.
  1. Variable income is received during three of the preceding six months from any combination of sources, but payment from at least one of the sources is not anticipated to reoccur during the next six months, and payments from remaining sources were not received during three of the preceding six months.

    Examples:
    • The applicant entered an NF in January and applied for Medicaid the same month. During the six months preceding the month the case is worked (February), the applicant received the following unearned variable payments, but the payment from Source #3 was a one-time payment and is not anticipated to continue.
      Month Source #1 Source #2 Source #3 Payment Rec.
      Payment Rec.
      Aug. $30     X
      Sept.        
      Oct.   $30   X
      Nov.        
      Dec.        
      Jan.     $50 X

 

  • Although the person received variable income from all sources during three of the preceding six months, the payment from Source #3 is not anticipated to reoccur. Therefore, the variable payments from Sources #1 and #2 are not averaged and projected for future months.

Note: If eligibility is being determined for the prior month of October, the unearned variable income of $30 received during that month is not countable income, as the amount is less than the infrequent or irregular exclusion of the first $60 unearned in a calendar quarter. (See Section E-9000, Infrequent or Irregular Income.) There is no applied income for October since the person did not enter the NF until January.

  • The applicant entered the NF in January and applied for Medicaid the same month. During the six months preceding the month in which the case is worked (February), the person received the following variable payments, but the payment from Source #3, received in October, was a one-time payment and is not anticipated to recur.
     
    Month Source #1 Source #2 Source #3 Payment Rec.
    Aug. $20     X
    Sept.   $20   X
    Oct.     $20 X
    Nov.        
    Dec. $20 $20   X
    Jan.        
  • Since the person received variable income from Sources #1 and #2 during three of the preceding six months, the income from Sources #1 and #2 is averaged and projected into the applied income budget for the coming six months (March through August). However, since the one-time $20 payment from Source #3 is not anticipated to recur, it is not included in the average of variable income to be projected.
  1. Variable income from all sources was received during three of the preceding six months and is anticipated to recur, but the average of income from all sources is less than $5.

    Example: The applicant entered the NF in January and applied for Medicaid the same month. During the six-month period preceding the month in which the case is worked (February), the person received the following variable payments, all of which are anticipated to recur.
    Month Source Payment Rec.
    Aug. $2 X
    Sept. $1 X
    Oct. $2 X
    Nov. $5 X
    Dec. $3 X
    Jan. $4 X

    The person received variable payments from all sources during each of the six preceding month; however, since the average of all payment is less than $5 ($2 + $1 + $2 + $5 + $3 + $4 = $17 ÷ 6 months = $2.83) and is not anticipated to increase, that average is not projected into the applied income budget.

 

H-3220 Incurred Medical Expenses (IMEs)

Revision 09-4; Effective December 1, 2009

  1. Medical services were received prior to the medical effective date (MED).

    Example: The person entered the nursing facility (NF) on Jan. 10, applied for Medicaid the same month, and meets all eligibility criteria as of Jan. 10. She underwent routine dental treatment during the preceding October, for which she will be making monthly payments of $30 for 12 months. Since the treatment occurred prior to the medical effective date, no deduction for IMEs is allowed.
  2. Someone other than the person (or community-based spouse to whom income is being diverted in the co-payment calculation) is paying the IME.

    Example: A NF person has an assignable general health insurance policy. The premiums are $50 a month and are paid by the person's son. The son states that he will continue to make these premium payments for the person. Since the person is not paying the premiums, they are not deductible as an IME.

 

H-3230 Both Variable Income and Incurred Medical Expenses (IME)

Revision 09-4; Effective December 1, 2009

Co-payment is $0 and is not anticipated to change. In this situation, semi-annual reviews of variable income/IMEs are not required, and variable income/IMEs may be re-budgeted on an annual basis.