An official State of Texas website.
Revision 15-4; Effective October 1, 2015
All Programs
A household's income is computed to determine eligibility and benefit amount. Household income is computed by using:
- actual income (income that was already received), or
- projected income amounts (not received but expected).
Notes:
- Both actual income amounts and projected income amounts for the current month are used to determine eligibility and benefits.
- For households paid on a monthly or semi-monthly basis, income is counted for the month it is intended if the household receives:
- the income in a different month because of a change in the mailing cycle or pay date; or
- an additional or missed payment because of weekends or holidays.
Exception: A-1355.2, How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income, may be used when using the TWC wage record to calculate income.
TANF
If a child lives with a married relative (not a parent) who wants to be the caretaker, eligibility and benefits are determined using:
- normal budgeting for the applicant's income, and
- stepparent budgeting for the income of the applicant's spouse.
Medical Programs
See A-1341, Income Limits and Eligibility Tests, for Medical Programs.
A—1351 Irregular and Unpredictable Income
Revision 15-4; Effective October 1, 2015
SNAP
Income that is irregular and unpredictable is exempt if both of the following conditions apply:
- The anticipated income will be less than or equal to $30 per household in a federal fiscal quarter; and
- The individual receives the income too infrequently or too irregularly to reasonably anticipate it. "Reasonably anticipate" means the individual knows:
- who the income will come from,
- in what month it will be received, and
- how much it will be.
A—1352 Terminated Income
Revision 15-4; Effective October 1, 2015
All Programs
Terminated income counts in the month received. Actual income must be used and conversion factors are not used if terminated income is less than a full month's income.
Income is terminated if it will not be received in the next usual payment cycle.
Income is not terminated if:
- someone changes jobs while working for the same employer;
- an employee of a temporary agency is temporarily not assigned;
- a self-employed person changes contracts or has different customers without having a break in normal income cycle; or
- someone receives regular contributions, but the contributions are from different sources.
A—1353 How to Convert Income to Monthly Amounts
Revision 15-4; Effective October 1, 2015
All Programs
If actual or projected income is not received monthly, the income should be converted to monthly amounts using one of the following methods:
- Divide yearly income by 12.
- Multiply weekly income by 4.33.
- Add amounts received twice a month (semi-monthly).
- Multiply amounts received every other week by 2.17.
Note: A-1355.2, How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income, can be used for converting TWC wages.
A—1353.1 Converting New Semi-Monthly Income
Revision 15-4; Effective October 1, 2015
All Programs
The following procedures should be followed if an individual has a new source of semi-monthly income and has not received enough checks to reliably project the income:
- Determine the estimated number of hours the individual will work per week.
- Estimate weekly gross income by multiplying the weekly estimated hours by the hourly wage.
- Determine the monthly projected gross income by multiplying the estimated weekly gross income by 4.33.
- To determine the semi-monthly income amount to enter on the income screen, divide monthly gross income by two.
A—1354 How to Budget Actual Income
Revision 15-4; Effective October 1, 2015
All Programs
Actual income is income that has already been received. Actual income is budgeted by:
- determining the actual income received in a past month; and
- converting the averaged amount to a monthly amount. See A-1353, How to Convert Income to Monthly Amounts, for instructions on how to convert income to a monthly amount.
Actual income should not be converted when:
- determining eligibility for three months prior Medicaid; or
- the income received from a new or terminated source is less than a full month's income.
Note: A-1355.2, How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income, can be used for budgeting TWC wages.
A—1355 How to Project Income
Revision 20-4 Effective October 1, 2020
All Programs
Projected income is income a person has not received, but expects to get. To project income:
- Evaluate the household's income and circumstances with the person.
- Budget income in the month the person anticipates getting it. Budget:
- actual income received as of the interview date (or the date the information was requested); and
- income that can be reasonably anticipated for pay periods after the interview or information request date. "Reasonably anticipated" means the person knows:
- the source of the income;
- in what month the person will get the income; and
- what amount of income the person will get.
- When a person does not get income monthly but anticipates getting a full month's income, convert it to a monthly amount using conversion factors.
- When a person gets an additional payment outside the regular payment cycle, convert the regular payments and add the additional payment to the converted amount.
Note: To determine the date income can be reasonably anticipated, use factors specific to the source of income, distance it travels through the mail, electronic transfers, weekends and holidays.
For people getting unemployment insurance benefits, determine the availability of funds in the account by adding one business day to the payment date listed on the Texas Workforce Commission Inquiry Benefit Payment screen.
For child support payments disbursed through the Texas debit card, follow policy in A-1326.2.1, Counting Child Support.
Fluctuating Income
If income is ongoing, but the amounts fluctuate, it is best to anticipate income by averaging income from past pay periods. When using this method:
- Verify at least two pay amounts in the time period beginning 45 days before the file date through the interview date (or the date the EDG is being processed if an interview is not required).
- Continue to enter amounts for all pay periods in the required budget months, using either year-to-date (YTD) amounts or the average amount of received payments for any unverified pay dates.
If the household states the payments are representative of current income, use YTD amounts, if available, for missing pay periods and use the average amount of verified payments for other unverified pay periods in all budget months. Use more than two pay amounts if they are available, but do not pend to require more than two pay amounts when a person says the pay amounts are representative of current income and the statement is not questionable.
Exception: For Children's Medicaid, see policy in A-1371, Verification Sources.
Use a different method to anticipate income when someone has a new job, seasonal fluctuations occur, or expected changes (such as changes in work hours or rate of pay) cause too many past amounts to be unrepresentative of current income.
Different methods of anticipating future income are:
- asking the employer for an estimate;
- using less than the required number of pay periods when they are not all available;
- multiplying anticipated hours by the rate of pay; or
- other methods.
Document the reason and calculations for the method used.
Example: When an applicant has paychecks, use the YTD amounts to find any missing pay amounts, if possible. In this situation, the gross pay on the checks is representative of current income.
| Pay Date | Gross Pay Amount | YTD |
|---|---|---|
| 05/11 | (missing paycheck) | (missing paycheck) |
| 05/25 | $265.50 | $4,675.93 |
| 06/09 | (missing paycheck) | (missing paycheck) |
| 06/23 | $262.84 | $5,199.18 |
You must have the checks before and after the missing paycheck. Take the YTD gross amount of the check prior to the missing paycheck and subtract it from the check received directly after the missing paycheck.
|
$5,199.18 |
YTD of check dated 06/23 |
|
- $4,675.93 |
YTD of check dated 05/25 |
|
= $523.25 |
Difference of the YTD amounts |
Then subtract the gross pay amount of the paycheck received after the missing paycheck from the difference of the YTD amounts.
|
$523.25 |
Difference of the YTD amounts |
|
- $262.84 |
Gross pay amount of check dated 06/23 |
|
= $260.41 |
Gross pay amount of check dated 06/09 |
Then add the three amounts together and divide by three to determine the average for the other missing pay period.
|
$265.50 |
Gross amount of 05/25 |
|
+ $260.41 |
Gross amount of 06/09 |
|
+ $262.84 |
Gross amount of 06/23 |
|
= $788.75 ÷ 3 |
Total of three checks then divide by three |
| = $262.92 | Average to use for check dated 05/11 |
Non-Fluctuating Income
All Programs (except TP 43, TP 44 and TP 48)
- Verify that a source of income (earned or unearned) does not fluctuate.
- Verify the frequency of the payment.
- Require gross pay from only one payment received in the 45 days before the file date through the interview date if the person states the frequency and gross pay have not changed. Use this income amount for unverified pay periods in all budget months.
Exception: Do not apply this policy to sources of income that involve fluctuations in pay due to overtime, tips, commission, bonuses, hourly wages, etc.
Examples:
- At initial certification, a person gave proof he is paid a weekly gross salary of $400 with no fluctuations. He is now being interviewed for a SNAP redetermination and has one pay stub dated within 45 days of the application file date showing earnings of $400 for the week. He states there have been no changes in his weekly gross pay or the pay frequency. One pay stub is acceptable proof in this example, because the pay amount and frequency were previously verified and the person stated the pay amount and frequency have not changed.
- Another person is being interviewed for a SNAP application and has one pay stub dated within 45 days of the application file date. She states she is paid a weekly gross salary of $500 and that her pay does not fluctuate. The employer verifies the pay frequency and that the gross amount does not fluctuate. Accept the single pay stub as proof of gross pay and do not pend for other pay stubs unless the income is otherwise questionable.
A—1355.1 Budgeting Options for SNAP Households
Revision 15-4; Effective October 1, 2015
SNAP
If income is received more than once a month, monthly converted amounts are used to compute the monthly average. If the monthly income fluctuates, the household may choose to average its monthly income over the entire certification period. The advisor must determine the household's eligibility and benefits based on the average income.
Exception: The income of destitute households must not be averaged over the certification period.
A—1355.2 How to Use Texas Workforce Commission (TWC) Quarterly Wage Information to Budget Earned Income
Revision 21-2; Effective April 1, 2021
All Programs
The quarterly wage records displayed on TWC inquiry reflect wages earned in the quarter ending as late as one month before the current calendar month. However, because the wage records are updated quarterly, wages may be further in the past. TWC quarters are displayed as a number corresponding to the quarter of the year in which the wages were earned, as illustrated below:
- The first quarter is January through March and is displayed as a 1 and the corresponding year.
- The second quarter is April through June and is displayed as a 2 and the corresponding year.
- The third quarter is July through September and is displayed as a 3 and the corresponding year.
- The fourth quarter is October through December and is displayed as a 4 and the corresponding year.
Use the gross monthly amount determined from using TWC wage records, when applicable, in all of the following budget months:
- application; and
- ongoing.
Note: A-831.3, Income Computation, may be used when determining the budget for prior Medicaid months.
Use the following chart to determine payment amounts when using TWC wage records to budget earned income.
| Did the person receive three full months of income in this quarter? | then use one of the following calculations: |
|---|---|
| Yes |
|
| No |
|
Note: TIERS uses the calculations in the chart above to derive the Calculated Payment value on the "TWC Inquiry" section of the Employment Payments screen.
Before using TWC quarterly wage information as a verification source for earned income, use the preferred methods of verification for the applicable program.
TANF and SNAP
The following sources continue to be the preferred methods of wage verification if they are available without having to pend the EDG to obtain them:
- the most recent consecutive check stub(s); or
- Form H1028, Employment Verification.
If these preferred sources of verification are not available during the interview, or when processed if no interview is required, and it would be necessary to pend for wage verification, the TWC quarterly wage information should be used as verification as explained below.
|
Yes– Continue | No – Pend for other wage verification |
|
Yes– Continue | No – Pend for other wage verification |
|
Yes– Continue | No – Pend for other wage verification |
Note: Convert the income to the frequency the person receives the income before discussing with them whether the earnings shown in TWC records are representative of current and/or future earnings. |
Yes – Use TWC wage record as verification | No – Pend for other wage verification |
Note: Verify tip income not included on a person's wage statement by obtaining a signed and dated statement from the person.
Medical Programs
If the person's reported income is not reasonably compatible with electronic data sources, pend for verification of earned income and determine whether the TWC quarterly wage information can be used as verification of earnings. The TWC wage record may be used as a verification source if both of the following conditions are met:
- the current employer listed on the Medicaid application or redetermination form matches the employer listed on the most recent TWC wage record; and
- all household members for whom the household is applying are eligible based on the TWC quarterly wage information.
Convert the quarterly wage data to monthly income amounts, as described above.
If the income reported on the application or redetermination form makes the household ineligible, do not require the verification of earnings. If a member is ineligible based on the TWC data but appears eligible based on wages reported on the application form, request other income verification.
Note: If the TWC quarterly wage data is older than the verification used in the current SNAP budget, use the SNAP budget to determine eligibility for Medicaid applications or renewals.
Related Policy
Income Computation, A-831.3
Verification Requirements, A-1370
Verification Sources, A-1371
A—1356 Income Received Less Often Than Monthly
Revision 15-4; Effective October 1, 2015
TANF and Medical Programs
If income is received less often than monthly, the income is prorated over the period covered.
SNAP
If income is received less often than monthly, the income:
- counts in the month received, or
- is prorated over the period the income is intended to cover (at the individual's option).
Exception: Income of destitute farm workers is not prorated.
A—1357 Computing Benefits by EDG Action Type
Revision 14-1; Effective January 1, 2014
All Programs
| Action Type | Budgeting |
|---|---|
| Application |
|
| Untimely redetermination – interview after the last benefit month |
|
| Untimely redetermination – interview during the last benefit month |
|
| Timely redetermination |
|
| Changes | Project amounts. |
| Claims/Restored benefits | Use actual amounts. |
A—1358 How to Budget Expenses
Revision 15-4; Effective October 1, 2015
TANF and SNAP
Only household expenses expected during the certification period should be considered to determine eligibility and benefits.
Expenses should be projected using the most recent month's bills and any anticipated increases or decreases. The household may choose to average expenses if they are anticipated to fluctuate or occur less often than monthly.
If the individual is billed for expenses weekly, biweekly or semi-monthly, the income conversion factors found in A-1353, How to Convert Income to Monthly Amounts, may be used to determine monthly expenses.
Medical Programs
Budgeting MAGI expenses is explained in A-1411, Rules That Apply to Deductions, Medical Programs.
A—1359 How to Determine Spend Down
Revision 05-1; Effective January 1, 2005
A—1359.1 Determining Eligibility/Spend Down for the Application and Following Months
Revision 15-4; Effective October 1, 2015
TP 56 and TP 32
Children and pregnant women with unpaid medical bills must first be determined ineligible for Medicaid or CHIP before being considered for TP 56 or TP 32.
TP 56 and TP 32 use MAGI rules to determine financial eligibility as explained in A-1341, Income Limits and Eligibility Tests, Medical Programs, with the following exception.
Exception: When calculating MAGI household income in Step 4 for TP 56 and TP 32, the only income that is included for the applicant or recipient is income from the following individuals, if these individuals are in the applicant's or recipient's MAGI household composition:
- The applicant;
- The applicant's parents, if the applicant is under age 19; and
- The applicant's spouse (if applicable).
Informing individuals about spend down is explained in A-1532.1, Spend Down EDGs.
A—1359.2 Determining Eligibility/Spend Down for Three Months Prior
Revision 15-4; Effective October 1, 2015
TP 56 and TP 32
Children and pregnant women must be determined ineligible for Medicaid or CHIP before being considered for TP 56 or TP 32 coverage for three months prior to the application month and must have:
- unpaid medical bills during the prior month(s), or
- received Medicaid services from the Texas Department of State Health Services during the prior months.
Advisors must determine financial eligibility for TP 56 and TP 32 for the three months prior to the application month by following the MAGI rules as explained in A-1359.1, Determining Eligibility/Spend Down for the Application and Following Months.
Children and pregnant women may be determined eligible for TP 56 or TP 32 coverage for any month in the three months prior to the application month. Advisors must notify the applicant of the eligibility determination for each month.
A—1359.3 Corrections to a TP 56 EDG
Revision 15-4; Effective October 1, 2015
TP 56
The following procedures are used to notify the Medically Needy Clearinghouse (MNC) when:
- a correction must be made to a TP 56 EDG with spend down; and
- the Clearinghouse has not processed the EDG.
The claims administrator at 1-800-252-8263 is the contact entity to speak with someone concerning a Medicaid EDG with spend down. Advisors should have access to the following information concerning the EDG before calling:
- EDG name;
- EDG number;
- advisor's name;
- advisor's employee number and mail code;
- advisor's telephone number; and
- all information about the change.