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Chapter 8 - Determining Income Eligibility

Introduction 8.1

A group's countable income is used to determine whether the group is income-eligible for program benefits. The group's income is also used to determine the level of benefits for which the group is eligible in the TANF, GC, and FS programs. With the exception of groups eligible for MA through the spend-down provision (see Chapter 7: Spend-Down in this Part) and groups eligible under the QM category, once a group is determined eligible for Medicaid or D.C. Medical Charities, the group is eligible for a certain package of benefits and services. Groups with incomes further below the income-eligibility threshold are not eligible for different services than groups with incomes closer to the eligibility threshold.

If a group is categorically eligible for Medicaid or categorically eligible for FS because all household members receive TANF or SSI, the SSR does not have to determine income eligibility. The SSR must determine the level of FS benefits to which a categorically-eligible group is entitled.

Groups that have expanded categorical eligibility for FS because of the receipt of a prescribed TANF-funded service are subject to a gross income test, with the exception of groups with an elderly or disabled member. The SSR must determine the level of FS benefits to which an expanded-categorically eligible group is entitled.

Income is budgeted prospectively for all programs. Prospective budgeting means that you use the income receive in the month to determine eligibility. Since benefits are usually issued on the first of the month for the entire month, prospective budgeting requires that you:

  • Make a 'best estimate' of what the income will be in the month
  • In some circumstances, compute an overpayment or underpayment if that estimate was not correct.

Exhibit VI-2: Summary of Earned/Unearned Income contains a summary table listing various types of income; these various types of income are discussed in greater detail in Chapter 4: Determining Countable Income in this Part.

All issues related to determining eligibility for MA through the spend-down provision are addressed in Chapter 7: Spend-Down in this Part. Similarly, determining eligibility for LTC (and the group's expected contribution toward LTC costs) is addressed in Chapter 2: Long-Term Care/Impoverished Spouse in Part VII.

Legal Authority 8.2

AREA/TOPIC DISTRICT FEDERAL
Determining Income Eligibility

TANF: D.C. Code 3-205.10-11; 3-205.52

GC: See TANF and D.C. Code 3-205.5a

MA: 42 USC 1396a(a)(10); 1396a(l)-(m); 1396u-1; 1396u-3

FS: 7 USC 2014(c); 7 CFR 273.9(a); 7 CFR 273.10(e)(2)

Income Budgeting 8.3

MA

Total countable income for eligibility is determined on the basis of the income anticipated to be received during the certification period.

A person may receive income less often than monthly or may receive a payment that is for a period of more than one month. The SSR enters into ACEDS information on the amount of income and how often the income is received – weekly, bi-weekly, semi-monthly, or monthly. ACEDS then converts all income to a monthly amount if necessary by multiplying the average payment amount by the average number of payment periods in a calendar month:

  • If payments are received weekly, multiply by 4.3, and round to the nearest cent.
  • If payments are received bi-weekly, multiply by 2.15, and round to the nearest cent.
  • If payments are received semi-monthly, multiply by 2.

If the payments received in a month are not identical, then average the payments and then convert this average figure to a monthly amount.

The process of converting earnings or other income to monthly figures evens out a group's earnings so that the timing of paychecks and pay periods does not affect program eligibility. For example, if a person is paid bi-weekly, s/he will receive 26 paychecks in a year. Most months the person will receive 2 paychecks, but in two months s/he will receive 3 paychecks. Without converting bi-weekly pay to an average monthly earnings figure, the group might become ineligible for program benefits in the two months during the year in which the earner receives three paychecks.

Example

Ms. Elizondo and her two children apply for MA. Ms. Elizondo works and is paid bi-weekly. In the month of application, she has already received one paycheck for $350 and is expecting to receive a second paycheck for $400. She worked more hours in the second pay period than in the first. The SSR enters both paychecks into ACEDS and indicates that the applicant is paid bi-weekly. ACEDS uses that information to compute a monthly earnings figure. ACEDS performs the following steps:

  1. Average the two paychecks to compute average bi-weekly earnings.
  2. Convert the bi-weekly earnings to monthly earnings by multiplying the average bi-weekly earnings by 2.15.

In this case, Ms. Elizondo's average bi-weekly earnings is $375. Her countable monthly earnings are computed to be $806.25

When income is received in fewer months than are covered by a contract or agreement, divide the income for the contractual period by the number of months in the period.

Example
Mr. Thompson is under contract to renovate a home. The renovation is scheduled to take six months. The contract calls for paying Mr. Thompson $6,000 for the work which will be provided when the work is completed. Divide the $6,000 (contracted earnings) by the contractual period (six). Mr. Thompson is treated as if he earns $1,000 per month during the months covered by the contract.

If self-employment or rental income is received less often than monthly, convert the self-employment or rental income to a monthly amount based on past or estimated future proceeds.

Divide educational benefits by the number of months in the period the benefits are intended to cover (that is, semester, term, and so on).

If income is received on a regular basis and is representative of the amount the applicant or recipient can reasonably be expected to receive throughout the eligibility period, total countable income is projected on the basis of the income actually received during the thirty days preceding the date of application or recertification.

If total countable income received during the thirty days preceding the date of application is not representative of the income that the applicant or recipient can reasonably be expected to receive, as in cases where the individual has been ill, is performing seasonal labor, or anticipates an increase in income, make the necessary adjustment for an accurate projection of income.

If income is received on an irregular basis, review the case circumstances with the applicant or recipient to determine the most appropriate means of projecting income. A lump sum payment of earned income must be prorated over the months it is expected to take to earn the payment. If the irregular income is from self-employment or seasonal employment, review the income earned during the three months prior to the month of application or recertification if that is the best estimate of what future earnings during the certification period are likely to be.

Example

Ms. Weiss earns $6.15 an hour and usually works 40 hours a week. She is paid every other Friday. Her last three gross pay amounts (from the month prior to the month of application) were $492, $492, and $522.75. The higher pay amount was the result of working overtime.

Ms. Weiss has submitted a signed statement from her employer to verify that her hours will be cut back to 35 hours per week effective the first day of the next month.

When determining Ms. Weiss's income for the month of application (when she was still working 40 hours per week), use her expected gross pay for the month of application. If she expects to work 40 hours during the month of application and does not expect to work overtime, assume that she will earn $492 per paycheck. (ACEDS will convert her gross earnings from these two paychecks to a monthly earnings figure based on her being paid bi-weekly.) Determine the group's eligibility for the month of application based on her expected monthly income in that month.

When determining the group's eligibility in future months, Ms. Weiss's expected earnings, taking into account her reduced hours of work, should be used. Ms. Weiss's paychecks are expected to be reduced to $430.50 based on working 35 hours per week at $6.15 per hour. This bi-weekly earnings figure should be used when determining the group's prospective eligibility.

In determining eligibility on the basis of income, certain deductions are subtracted from countable income to determine net MA income (see Section 6.3: Income Disregards and Deductions in this Part. Net MA income is then compared to the applicable income levels to determine eligibility.

TANF

See MA.

GC

Income is budgeted prospectively. GC groups rarely have countable earnings since GC groups are comprised solely of children enrolled in school who are not working full-time. A child eligible for GC has his/her earnings disregarded entirely. If a GC child is married however, earnings could be deemed. In this rare case, earnings would be converted to expected monthly earnings as in TANF.

FS

See MA.

Determining Income-Eligibility 8.4

MA

For groups categorically eligible for MA (i.e., groups receiving TANF, GC, and/or SSI; see Section 12.3: Who is Categorically Eligible in Part IV), no income-eligibility determination must be made.

For a non-categorically eligible group, determine the group's countable income (including income deemed from individuals outside the group) applying applicable disregards (see Section 6.3: Income Disregards and Deductions in this Part). Compare countable income to the income standards listed in Exhibit VI-3: MA Income Standards.

If the group's income is below the relevant income standard and the group meets all non-financial eligibility criteria and, if applicable, the asset limit, the group is eligible for MA. If the group is ineligible for MA based on its income exceeding the income-eligibility criteria, the group may be eligible for MA through the spend-down provisions which enable individuals with medical bills to 'spend down' their income to qualify for Medicaid coverage (see Chapter 7: Spend-Down in this Part).

TANF

The steps for determining whether a group is eligible for TANF differ depending on whether the group is applying for benefits (applicant) or is already receiving benefits (recipient). Exhibit VI-4: TANF Standard of Assistance and Payment Levels shows the income standards SSRs should use when determining eligibility for groups applying for benefits or for groups already receiving benefits.

 

Effective April 1, 2011, there are two different Payment Levels for TANF. Use the Full Payment Level when determining eligibility for groups that have received TANF for 60 months or less. Use the Reduced Payment Level to determine eligibility for groups that have received TANF for 61 months or more (See Part IV, Chapter 13: Lifetime Limits.)

Determining Applicant Eligibility

The following should be used to determine whether a group applying for benefits is eligible for TANF:

  • Determine gross countable earned and unearned income (see Chapter 4: Determining Countable Income in this Part).
  • Apply applicable applicant disregards to calculate net countable income (consisting of net countable earned income and countable unearned income). Applicant disregards consist only of the $160 Work Expense Deduction (per employed group member) and the Child Care Disregard based on out-of-pocket child care expenses (see Section 6.3: Income Disregards and Deductions in this Part).
  • Compare net countable income to the appropriate Payment Level. If net countable income exceeds the payment level, the group is ineligible for TANF.
Example

Ms. Dawes and her two children apply for TANF. Ms. Dawes earns $350 per month and receives $200 per month in child support. No group member receives any other income. Ms. Dawes spends $120 per month on child care for her two-year-old son.

Gross Earned Income =

$350  

Gross Unearned Income =

$200  
     

Unearned Income=

$200  

-

$150 Child Support Disregard

Countable Unearned Income =

$50  
     

Earned Income =

$350 Gross Earned Income

$160 Work Expense Deduction

$120 Child Care Disregard

Countable Earned Income =

$ 70  
     

Net Countable Income =

$ 70 Net Earned Income

+

$ 50  
  $ 120  

Ms. Dawes has received TANF in the past for a total of 40 months.

The payment level for a group of three is $428 (as of January, 2009.) Since the group's net countable income is less than the payment level, the group is income-eligible for TANF.

Determining On-Going Recipient Eligibility

To determine whether a group that received TANF in the prior month remains income-eligible for TANF assistance, determine the following:

  • Determine gross countable earned and unearned income. Generally, a TANF recipient must assign the child support rights of his/her children to the District of Columbia government. Child support collected by CSED does not count as unearned income (see Section 4.9: Child Support in this Part).
  • Apply applicable recipient disregards to calculate net countable income (consisting of net countable earned income and countable unearned income). Recipient disregards consist of the $160 Work Expense Deduction (per employed group member), the two-thirds (2/3) Earned Income Disregard (two-thirds of earnings not already disregarded), and the Child Care Disregard based on out-of-pocket child care expenses (see Section 6.3: Income Disregards and Deductions in this Part).
  • Compare net countable income to the appropriate Payment Level (see Exhibit VI-4: TANF Standard of Assistance and Payment Levels) for the appropriate group size. If net countable income exceeds the payment level, the group is ineligible for TANF.
Example

Ms. Roberts and her daughter receive TANF. Ms. Roberts has found a job since receiving TANF and now earns $500. She does not have out-of-pocket child care expenses.

Gross EarnedIncome =

$500  
Gross Unearned Income = $0  
     

Net Earned Income =

$500 Gross Earned Income

$160 Work Expense Deduction

$227 two thirds of $340 (earnings not already disregarded)
  $113  
     

Net Countable Income =

$113 Net Earned Income

+

$ 0

Unearned Income
  $113  

Ms. Roberts has received TANF in the past for a total of 63 months.

The Reduced Payment Level for a family of two is $269 (as of April, 2011.) Since the group's income is below this level, the group is income-eligible for TANF.

GC

Since a GC child's earnings are not counted when determining eligibility, net and gross income in the GC program are generally the same. If, however, a GC child is married, applicable earned income disregards and dependent care deductions must be applied to his/her earnings. To determine income-eligibility for GC, compare the sum of countable earned and unearned income to the payment level (see Exhibit VI-4: TANF Standard of Assistance and Payment Levels) for the appropriate group size. If the income is less than the payment level, the group is eligible for GC.

FS

For categorically eligible groups in which all members receive TANF or SSI, no income-eligibility determination needs to be made. Groups with expanded categorical eligibilitydue to receiving a prescribed TANF-funded service are subject to a gross income test, unless they include a disabled or elderly person. Information on determining the level of benefits for these groups is provided in Section 8.5: Determining Benefits Level / Amount of Assistance in this Chapter.

For most other groups, there are one or two 'tests' a group (regardless of whether it is an applicant or recipient group) must pass in order to be found income-eligible for FS; the gross income test and the net income test. Groups that include an elderly (a person age 60 or over) and/or a disabled person do not have to meet the gross income test nor the net income test once, once they qualify for expanded categorical eligibility by receiving a prescribed TANF-funded benefit. There is one exception: a household with an elderly or disabled member where any member is disqualified for fraud or Intentional Program Violation (IPV) cannot qualify as an expanded-categorically eligible household and is subject to the net income test. Exhibit VI-5: FS Income Standards shows the standards for each test by household size.

Gross Income Test

To pass the gross income test, gross countable income (that is, the sum of gross earned and gross unearned income before any deductions are taken) must be less than the gross income limit for the relevant group type and size. The gross income limit is set at 200% of the FPL for expanded-categorically-eligible groups and at 130 percent of the FPL for other groups subject to the Gross Income Test.

The following groups are not subject to the Gross Income Test:

  • Categorically eligible groups in which all group members receive TANF or SSI; and
  • Groups that include an elderly person (age 60 or over) or a disabled person.

Expanded-categorically eligible groups that do not contain an elderly or disabled person and all other groups must pass a Gross Income Test See Exhibit VI-5: FS Income Standards for the current gross income limits and other FS parameters (maximum benefit, etc).

Net Income Test

Some groups that pass the gross income test, or are not subject to the Gross Income Test, must pass a Net Income Test. To determine if a group passes the net income test, compare the group's net countable income to the net income test level for the appropriate group size. The net income test levels for each group size are set by the federal government at 100 percent of the FPL.

Net Countable Income =

Gross Countable Earned Income

Earned Income Deduction (20 percent of gross countable earnings)

+

Gross Countable Unearned Income

Standard Deduction

Excess Medical Deduction (only applies to groups w/ an elderly or disabled group member)

Dependent Care Deduction

Child Support Deduction

Excess Shelter Deduction

The following groups are not subject to the net income test:

  • Categorically-eligible groups where all members receive TANF or SSI:
  • Expanded-categorically eligible groups that have received a prescribed TANF-funded service

Other groups must meet the net income test to be eligible for FS benefits.

Future Ineligibility Based on Receipt of a Lump Sum or Accrued Benefit 8.4.1

MA

N/A

TANF

A lump sum/accrued benefit received in the month of application is considered in determining ineligibility in future months. Receipt of a lump sum or accrued benefit by anyone in the household will cause future ineligibility or a reduction in payment if it together with other income exceeds the standard of assistance (see Exhibit VI-4: TANF Standard of Assistance and Payment Levels).

Consider a lump sum as income in the month received.

Calculate the period of ineligibility by dividing the lump sum/accrued benefit plus the group's countable income after disregards in the month the lump sum was received (see Section 6.3: Income Disregards and Deductions in this Part) by the standard of need based on the group's size. The result of this calculation is the number of months the group is ineligible. Any remainder is considered available income in the month following the final month of ineligibility.

Example
A group of three receives a lump sum of $3,000 and also has earnings of $200 (after disregards) in the month. Its need standard is $712. Consequently, the group is ineligible for four months and $352 is considered available income in the 5th month (3,000/712 = 4 with 352 remaining).

Recalculate the period whenever a group reapplies for assistance before the end of the period or whenever the group requests it.

The period of ineligibility will be shortened if:

  • The need standard increases.
  • The number of people in the group increases.
  • The lump sum becomes unavailable to the group for a reason beyond its control.
  • The group incurs and pays for medical expenses.

'Unavailable' means that the funds are no longer in the possession of the group. 'A reason beyond the group's control' means that the funds were either stolen or spent for any of the following:

  • Back rent or mortgage after threatened with eviction.
  • Repair or replacement of essential appliances such as stoves or refrigerators.
  • Funeral or burial expenses for a spouse, child, or parent.
  • Travel costs related to the death of a spouse, parent or person in that role, or child.
  • Overdue utility bills after threatened with cut off.
  • Court judgements including legal fees.
  • Repair of motor vehicle essential for employment.
  • Replacement of essentials lost due to fire, flood, or other natural disaster or theft.
  • Essential repairs to owner-occupied homes.

The following should be used to recalculate a period of ineligibility.

  • Determine the number of months of ineligibility already used.
  • Multiply the number of months of ineligibility already used by the need standard originally used to calculate the period to arrive at the amount of income already used.
  • Subtract the amount of income already used, any unavailable portions of the original lump sum, and any medical expenses from the original income used to calculate the period to arrive at a revised income amount.
  • Determine the need standard for the current group, adding new members if any and excluding original members now absent.
  • Divide the revised income amount by the need standard.

The result is the number of remaining months of the ineligibility period. Any remainder is considered available income in the month following the final month of ineligibility. If the calculation results in no period of ineligibility, assistance begins with the date of re-application or request for re-calculation. No underpayments exist for prior months.

A person who joins the group, such as a newborn, may not establish a separate group. Instead, re-calculate the period of ineligibility.

Example

A group of two receives a lump sum of $10,000. Its need standard is $560. The group is ineligible for 17 months with $480 available in the 18th month. After five months of ineligibility, the family re-applies. Twins were born during this time, and the family paid $1,000 in medical expenses.

 

$ 560

x 5

$2,800

$10,000

- $2,800

- $1,000

$ 6,200

$ 870

 

original need standard for 2

number of months of ineligibility already used

amount of income already used

original income

amount of income already used

medical expenses

revised income amount

new need standard for 4

The group is ineligible for 7 more months including the month of re-application with $110 available for the 8th month.

Do not apply this lump-sum/accrued benefit policy to the deemed income of a person who is not required to be in the group (see Section 5.4: Deeming Income in this Part). It is available for only one month. Apply the policy to lump sum/accrued benefits received by mandatory group members who are disqualified. Compute the period of ineligibility by including their needs in the need standard amount.

GC

See TANF

FS

N/A

Determining Retroactive Eligibility 8.4.2

MA

AR: When a person applies for Medicaid, s/he can also apply for three months of retroactive eligibility. In order to determine retroactive eligibility, determine the group's countable income (including income deemed from individuals outside the group) after applying applicable disregards (see Section 6.3: Income Disregards and Deductions in this Part) in each month of the three-month retroactive period. Compare countable income to the income standards listed in Exhibit VI-3: MA Income Standards.

In each month in which the group's income is below the relevant income standard, the group meets all non-financial eligibility criteria, and, if applicable, the asset limit, the group is eligible for MA. If the group is ineligible for retroactive MA based on its income exceeding the income-eligibility criteria, the group may be eligible for retroactive MA through the spend-down provisions which enable individuals with substantial medical bills to 'spend down' their income to qualify for Medicaid coverage (see Chapter 7: Spend-Down in this Part).

AX: See AR.

SR: See AR.

QM: QMBs are not eligible for retroactive eligibility. For SLIMBs, QDWIs, QI-1s, and QI-2s, see AR.

MC: N/A

TANF

N/A

GC

N/A

FS

N/A

Determining Benefits Level/Amount of Assistance 8.5

MA

See Chapter 7: Spend-Down in this Part for a description of how to determine a group's spend-down liability. Groups eligible for Medicaid under the QM categories (and not otherwise eligible for Medicaid) are eligible only for full or partial reimbursement for Medicare premiums, deductibles and co-payments. Otherwise, groups determined eligible for MA are eligible for the full range of services without co-payments, premiums, or deductibles.

TANF

If an applicant/recipient has been found to meet all non-financial eligibility criteria, the asset test, and the income-eligibility criteria (the calculation to determine whether a group is income-eligible for TANF differs depending on whether the group is an applicant or recipient group; see Section 8.4: Determining Income-Eligibility in this Chapter), the group is eligible for TANF. The level of monthly benefits for which the group is eligible must now be determined by taking the following steps (information on how to prorate the first month's benefits based on date of application is found in Section 8.5.1: Prorating Benefits for New Applicants in this Chapter).

  • Determine gross countable earned and unearned income. Generally, a TANF recipient must assign the child support rights of his/her children to the District of Columbia government. Child support collected by CSED does not count as unearned income. Child support received by the family in the first two months of TANF receipt (prior to the assignment becoming effective) does count as unearned income (see Section 4.9: Child Support in this Part). After two months, the SSR should assume that CSED is collecting and retaining the group's child support. If the SSR learns that this is not the case, the SSR should inform CSED that child support is being paid to the family. The SSR should not, however, count the child support received unless the adult failed to cooperate with CSED requirements and the group is under a CSED sanction with respect to the child on whose behalf support is being received directly.
  • Apply applicable recipient disregards to calculate net countable income (consisting of net countable earned income and countable unearned income). Recipient disregards consist of the $160 Work Expense Deduction (per employed group member), the two-thirds (2/3) Earned Income Disregard (two-thirds of earnings not already disregarded), and the Child Care Disregard based on out-of-pocket child care expenses (see Section 6.3: Income Disregards and Deductions in this Part). In cases in which a group fails, without good cause, to report its earnings in a timely manner, the two-thirds (2/3) earned income disregard is disallowed.
  • Subtract net countable income from the appropriate Payment Level for the appropriate group size. Round the result to the next lowest whole dollar. If the group is eligible for benefits of less than $10 but more than $0, the group will remain eligible (and its case will remain 'open') but TANF EBT benefits will not be issued. In such a circumstance, the group remains categorically eligible for Medicaid under the TANF Standard category in AR.
Example

Ms. Berry and her three children receive TANF. Ms. Berry works and is paid bi-weekly. She expects to earn $250.50 per pay period. One of her children receives $150 per month in Social Security Survivor's benefits.

Countable Gross Monthly Earned Income = $250.50 *2.15 = $537.50
Countable Gross Monthly Unearned Income = $150

Total Gross Countable Monthly Income = $687.50

Net Earned Income

=

$537.50

Gross Earned Income

 

$160

Work Expense Deduction

   

$377.50

 
 

$251.67

two-thirds (2/3) of remaining earnings

    $125.83  
       

Net Countable Income

= $125.83

Net Earned Income

  + $150 Unearned Income
    $275.83  

Ms. Berry has received TANF for a

total of 43 months, so the Full Payment Level is used

     

Monthly Benefit Level

= $528 Full Payment Level for a Group of Four
  - $275.83  
    $252.17 This must be rounded down to the nearest dollar.
       

Ms. Berry and her children are eligible for $252 per month in TANF benefits.

GC

Since a GC child's earnings are not counted when determining eligibility or benefit levels, net and gross income in the GC program generally are the same (the only exception is when a GC recipient is married). To determine GC benefits, subtract countable earned and unearned income from the payment level for the appropriate group size. Round the result to the lowest whole dollar. If the group is eligible for less than $10, the group will not receive GC benefits, but remains eligible for Medicaid under the AR - TANF Standard. The same payment level is used in GC as in TANF. See Section 8.5.1: Prorating Benefits for New Application in this Chapter for information on how to prorate benefits.

FS

If a group is categorically eligible for FS, or found to meet all criteria of expanded-categorical-eligibility, or a group is found to meet all non-financial eligibility criteria, the asset test, the gross income test, and the net income test, the group is usually eligible for FS benefits. To determine the FS benefit level for which a group is eligible, follow these steps (see Section 8.5.1: Prorating Benefits for New Applicants in this Chapter for information on how to prorate benefits):

  • Calculate net countable income (see Section 6.3: Income Disregards and Deductions in this Part; this is the same calculation used to determine whether the group meets the net income test).

Net Countable Income =

Gross Countable Earned Income

Earned Income Deduction (20 percent of gross countable earnings)

+

Gross Countable Unearned Income

Standard Deduction

Excess Medical Deduction (only applies to groups w/ an elderly or disabled group member)

Dependent Care Deduction

Child Support Deduction

Excess Shelter Deduction
  • Multiply net countable income by 30 percent. If 30 percent of the group's income ends in cents, round the figure up to the next dollar.
  • FS Benefits = Maximum Allotment – 30 percent of net countable income (see Exhibit VI-5: FS Income Standards for a table that lists the Maximum Allotment by group size).
Example
Ms. Akers, her two children (18 months and four years), and Ms. Akers' mother (68) live together and meet all the non-financial and financial criteria for FS. Ms. Akers works and is paid weekly. Ms. Akers expects to earn $156.20 per pay period and has no other earned income. Ms. Akers' mother receives $200 per month in alimony from her ex-husband. Ms. Akers rent is $420 per month, including utilities. Ms. Akers attends school two evenings a week under a Pell Grant which pays her tuition of $200 per month. In order for Ms. Atkins to work, she pays $100 per month for daycare for her four-year-old child. Her mother takes care of the 18-month-old baby.

Ms. Akers' household should receive the following disregards and deductions when calculating the FS benefit level:

  • Earned Income Deduction
  • Standard Deduction
  • Dependent Care Deduction
  • Excess Shelter Deduction

Because the group has an elderly member, it does not have to meet the gross income test.

Monthly Countable Gross Earned Income = $156.20 * 4.3 = $671.66
Monthly Countable Gross Unearned Income = $200
Excluded Income = $200 (Pell Grant)

Monthly Countable Gross Earned Income

$671.66

Earned Income Deduction (20% of $671.66)

– $134.33

 

$537.33

Monthly Countable Gross Unearned Income

+ 200.00

 

$737.33

Standard Deduction

– $139.00

 

$598.33

Dependent Care Deduction

– $100.00

 

$498.33

Excess Shelter Deduction (Elderly/Disabled)
($420 - ½ *$498.33)
– $170.83
Net Countable Income

$327.50

$334.99 * 30% = $98.25 (round up to $99)

 

FS Benefits = $518 (Maximum Allotment for a Household of Four) – $99 = $419

Effective November 1, 2013, all groups of two or fewer members that meet all financial and non-financial eligibility requirements will receive a minimum monthly allotment of $15 (except in the first month when benefits are pro-rated).

Groups of three or more persons may meet non-financial and gross income and net income criteria, but be determined to be eligible for $0 in FS benefits. Deny FS in this situation.

Example

Mr. Jones and his three children apply for FS. Mr. Jones works, and has monthly gross earnings of $3,600. He is given the TANF Domestic Violence brochure and under Expanded Categorical Eligibility, his income is less than 200 % FPL, $3,676. He only pays $100 in rent, is eligible for the Heating/Cooling Utility Allowance because he received LIHEAP, and does not pay any dependent care or child support.

Mr. Jones’ household should receive the following disregards and deductions when calculating the FS benefit level:

  • Earned Income Deduction
  • Standard Deduction

Because the group has Expanded Categorical Eligibility, it does not have to meet the net income test.

Monthly Countable Gross Earned Income $3,600.00

Total Monthly Countable Gross Income

$3,600.00

Earned Income Deduction (20% of $3,600)

– $720.00

 

$2,880.00

   
   

Standard Deduction

– $153.00

 

$2,727.00

   
   

Excess Shelter Deduction
(1/2*$2127) –($100+300)

– $0.00

Net Countable Income

$2,727.00

$2,727.00 * 30% = $818.10 (round up to $819)

 

FS Benefits = $668 (Maximum Allotment for a Household of Four) – $819 = $0

This household meets the gross and net income tests but is not eligible for an allotment. Deny the application.

Other groups eligible for less than $10 receive the amount for which they are actually eligible, except that groups eligible to receive $1, $3, and $5 allotments receive $2, $4, and $6 allotments respectively.

A FS allotment cannot be increased when a household's income has been reduced as a result of a penalty imposed under another assistance program. If a group's income is lower due to a penalty, such as a TANF sanction, compute the group's FS benefits as if no sanction were imposed.

Applicant groups consisting of residents of public institutions who apply jointly for SSI and FS prior to release from the public institution will have their eligibility determined for the month in which the applicant group was released from the institution. For these groups, the benefit level for the initial month of certification shall be based on the date of the month the group member is released from the institution and benefits are received from the date of release from the institution to the end of the month. Recertification shall be processed in accordance with Chapter 4: Recertification in Part VIII.

Groups applying for FS who are migrant and seasonal farm workers after a break in benefit receipt are not always treated the same as other FS applicants. In such cases, the IMA Administrator's office should be contacted.

Prorating Benefits For New Applicants 8.5.1

MA

N/A

TANF

When a new applicant group is determined eligible, its first month's benefits are prorated based on the date of application. To prorate benefits, ACEDS will do the following calculations:

  1. Calculate benefits as if the group would be eligible for a full month of benefits.
  2. Determine the number of days between the date of application and the end of the month, including the date of application:
    Number of Days in the Month – Application Date + 1
  3. Divide the result in (2) above by the number of days in the month and multiply the result by the full-month benefits for which the group would have been eligible (see (1) above). Benefits are rounded down to the nearest dollar. If benefits are less than $10, no benefits are issued (even if the group would generally receive a $10 minimum benefit).
Example

Ms. Smith applies for benefits on June 17 and is found eligible. Based on her income, she would have been eligible for a $200 TANF grant in June, had she applied on June 1. Her June benefits must be prorated. There are 30 days in June. Since her eligibility is effective on the date of application, June 17, she is eligible for 14 days of benefits in June.

Full-month benefits = $200

Days left in the month

= 30

Days in June
 

– 17

Date of application
 

+ 1

 
 

14

 

Prorate Benefits

0.4667

14 divided by 30

x $200

full-month benefits

$93.33

This must be rounded down to the nearest dollar.

 

The group will receive $93 in TANF benefits for the month of June.

GC

See TANF

FS

See TANF. In months in which benefits are pro-rated, the $16 minimum monthly benefit guaranteed to certain FS groups does not apply.

Verification 8.6

Requirements 8.6.1

MA

AR/AX D.C. Healthy Families Application Users: Only verification of gross income and out-of-pocket dependent care expenses is required.

AR/AX Combined Application Users: Verify income prior to authorizing benefits at application, at redetermination, and whenever a change affecting income occurs.

Verify all countable earned and unearned income.

Verify disabled applicant's claim that s/he receives no disability benefits. The last known employer is a suggested contact.

Any income change must be verified when reported.

Document excluded income in the case record. Verification is not normally required because excluded income does not affect eligibility. The SSR may request it if there is not enough information to determine whether the income can be excluded. The SSR must verify income that is only partially excluded or when the amount affects allowable expenses.

There might be unreported income such as SSI, SSDI, UCB, educational income, or public assistance. Request verification if the case is questionable, and document your reasons in the case record. Some situations which might indicate unreported income are:

  • Beneficiary Data Exchange (BENDEX) indicates receipt of SSI, Railroad Retirement Board Benefits, or Black Lung Benefits.
  • Shelter payments are higher than reported income.
  • An employable applicant reports no income.
  • The client is attending school and might receive educational income.

The usual source of verification of income is the pay envelopes or paycheck stubs that the employed individual receives with each paycheck. Request recent consecutive pay stubs representing at least four weeks of earnings at the outset, and then ask for additional stubs if the four are not representative of average earnings. A statement from the employer may also be accepted.

SR: See AR/AX Combined Application Users.

QM: See AR/AX Combined Application Users.

MC: See AR/AX Combined Application Users.

TANF

See AR/AX Combined Application Users.

GC

See AR/AX Combined Application Users.

FS

Gross non-exempt income must be verified. However, do not deny an application or close a case solely because the source of the income is uncooperative. After trying all other means to verify the income, consult the client and use the best available information. The SSR must document in the case record the attempts to verify and why they were unsuccessful.

Budgetable educational income from the school must be verified. A Student Financial Aid statement may be used for this purpose. Other forms of verification provided by the school may be used if complete.

Since categorically eligible households include only members who receive TANF and/or SSI and income is verified in these programs, verification of income for categorically eligible FS groups is not required unless needed to determine benefit level.

The following expenses must be verified, at least at initial certification, if they result in a FS deduction: medical expenses, shelter costs, and child support payments. Dependent care expenses only need to be verified if questionable.

  • Medical Expenses: All medical expenses that result in a deduction must be verified during the initial application process. At recertification or when a change is reported, the SSR will verify the expense if it results in a deduction and only if:
    • The source of the expense has changed
    • The amount of the expense has changed by more than $25 monthly
    • The information provided is incomplete or inconsistent.

If the eligibility of the person claiming medical expenses is questionable, the SSR may request verification of age or disability. Other factors, such as allowability of services, do not have to be verified unless questionable.

If there is any question whether a medical service was performed, prescribed, or approved by a licensed practitioner, qualified health professional, or recognized facility, the SSR may request verification.

  • Shelter Expenses: Shelter expenses (other than heat, utilities, and telephone) must be verified at initial application and at redetermination. In addition, reported changes in shelter expenses must be verified if the source or amount changes and the change would result in an increase in benefits.

When the SUA is used, the heat and/or utility obligation does not have to be verified unless questionable. When the group chooses to use actual expenses, the expenses must be verified prior to inclusion in the budget. Changes in actual utility expenses must be verified if the source or amount changes and the change would result in an increase in benefits. Actual heat and/or utility expenses for an unoccupied home must always be verified as the utility standard cannot be used. If verification of utility costs is not received within the applicable timeframes, the SSR should use the SUA provided the unit pays for heating and/or cooling.

The SSR is not required to assist FS groups to obtain verification of shelter costs for an unoccupied home in another state.

  • Child Support Payments: The SSR must obtain verification of each group member's legal obligation to pay child support, the amount of the obligation, and the monthly amount of child support the group actually pays.

Verification Sources for Unearned Income 8.6.2

ALL

The client is the primary source to verify income. Verification may be from the following sources:

  • Documents (such as pay stubs or award notice)
  • Written statements from persons with knowledge of the group's income (such as an employer or agency issuing benefits).

You may verify most types of unearned income by a written statement from the agency, organization, or person administering the payment. The verification must confirm:

  • The monthly benefits amount
  • Amount of deductions
  • Whether deductions are mandatory

A recipient award notice is acceptable if it is dated within the past 60 days and there is no reason to suspect the amount has changed.

The following provides a list of common forms of unearned income and verification sources:

  • Educational Income can be verified through the educational institution. If verification of a Bureau of Indian Affairs Higher Education Grant is not available from the institution, the Indian tribe's Education Director can furnish it. A student financial aid award notice can also verify educational benefits.
  • Court-Ordered Child Support and Spouse Support can be verified by information from the court (verification of public records, other written statement, or contract). CSED may also be able to provide verification of support received.
  • SSDI and SSI can be verified by:
    • BENDEX report
    • SSDI/SSI award notice
  • Unemployment Compensation (UCB) can be verified by a UCB check stub or award letter.
  • Voluntary Support can be verified by:
    • Wwritten statement from the absent parent
    • Payment records
    • Client's statement if the absent parent refuses to cooperate and the payments are in cash

For all unearned income, a copy of the benefits check(s) or check stub(s) is adequate if:

  • It clearly shows the benefit amount and deductions
  • It is dated within the past 60 days
  • You have no reason to believe the amount has changed

Verification of Earned Income 8.6.3

ALL

The client is the primary source to verify income. Verification may be from the following sources:

  • Documents (such as pay stubs or award notice)
  • Written statements from persons with knowledge of the group's income (such as employer or agency issuing benefits).

Verify the following types of income with one of the stated sources or it equivalent:

  • Child Care, Child Services, and Adult Foster Care Income
    • Statement from the person receiving the service
    • Written statement from the worker who authorizes payment for the service
    • Bills or statements from the provider stating the cost of care, the period for which the care was provided, and the nature of the care
  • Earnings from Employment
    • Income tax returns
    • Pay stubs
    • Other written statement, signed by the employer, giving the necessary information
  • Property-Related Income (this could be earned or unearned income depending on the extent to which the individual serves in a property management capacity; see Section 4.37: Rental Income in this Part).
    • Mortgage or land contract
    • Bills or receipts
  • Rental and Room and Board Income (this could be earned or unearned income depending on the extent to which the individual serves in a property management capacity; see Section 4.37.1: Room and Board in this Part).
    • Written statement from the boarder/renter
    • Accounting or other business records
    • Lease or contract
    • Rent receipt book
    • Request for rental information statement if the boarder/renter receives public assistance
  • Self-employment
    • Business receipts
    • Accounting or other business records
    • Clients
  • Tips
    • Pay stubs if the employer confirms that they reflect actual tips (tips shown on pay stubs are usually a percentage for tax purposes); or, if not available,
    • Client's statement.

Verification of Expenses 8.6.4

ALL

The applicant/recipient is the primary source for verification. Verification may be from the following sources:

  • Documents (such as receipts)
  • Written statements from persons with knowledge of the group's income (such as employer or agency issuing benefits).

Verify the following types of expenses (when needed to determine eligibility or benefit levels) with one of the stated sources or its equivalent:

  • Medical bills and receipts for prescriptions and medically necessary OTC medication can serve as verification for medical expenses. For the excess medical deduction in the FS program, you may have to verify age. Examples of acceptable verification of age include:
    • Records of birth or baptism
    • Adoption records
    • Hospital or physician's records
    • Social security records
    • School records
    • Marriage certificates
    • Insurance policies
    • Enrollment records of voting districts

The SSR also may have to verify if the service was provided by an appropriate source. Acceptable verification includes, but is not limited to:

    • Copies of prescriptions
    • Statements or bills from physicians, pharmacists, or other certified providers.
  • Dependent Care Expenses can be verified by a bill from the provider, canceled checks showing payment, or a written statement by the provider.
  • Shelter Expenses can be verified with:
    • Lease
    • Canceled rent/mortgage checks
    • Statement from lender or landlord
    • Bill or receipt
  • Utility Costs can be verified with bills from utility providers. If the utility bills show unpaid past liabilities, the SSR must determine usual utility costs incurred each month.

FS

Effective January 1, 2010, every Food Stamp recipient is expected to receive a LIHEAP payment. For active FS cases, no verification of utility costs is needed. Applicants may need to document utility costs if the applicant would not be eligible for FS without a utility allowance.


Exhibit VI-3 MA Income Standards

Policy Category Eligibility Criteria Subtype

Group Size

Income Standard (effective February 2013)

AR TANF Standard Individuals receiving TANF

All

None—Categorically Eligible

    Individuals who meet the TANF payment standard but are not receiving TANF (categorically needy standard)  

See
Exhibit VI-4: TANF Standard of Assistance and Payment Levels

 

Foster Care/Department Wards/Adoption Assistance Recipients

 

All

None—Categorically Eligible

  Medically Needy Families and Children (MNIL)  

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$613.94

$646.25

$813.75

$981.25

$1,148.75

$1,316.25

$1,483.75

$1,651.25

$1,818.75

$1,986.25

$2,153.75

$2,321.75

$2,488.75

$2,656.25

$2,823.75

$2,991.25

$3,158.75

$3,326.25

$3,493.75

  Poverty Level Families and Children Pregnant women and children under age one (185 percent of FPL)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$1,771.38

$2,391.13

$3,010,88

$3,630.63

$4,250.38

$4,870.13

$5,489.88

$6,109.63

$6,729.38

$7,349.13

$7,968.88

$8,588.63

$9,208.38

$9,828.13

$10,447.88

$11,067.63

$11,687.38

$12,307.13

$12,926.88

    Children under age six (133 percent of FPL)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$1,273.48

$1,719.03

$2,164.58

$2,610.13

$3,055.68

$3,501.23

$3,946.78

$4,392.33

$4,837.88

$5,283.43

$5,728.98

$6,174.53

$6,620.08

$7,065.63

$7,511.18

$7,956.73

$8,402.28

$8,847.83

$9,293.38

 

Policy Category Eligibility Criteria Subtype

Group Size

Income Standard (effective

February, 2013)

AR (cont.) Poverty Level Families and Children (cont.) Children ages six and over who were born after September 30, 1983 (100% of FPL)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

 

$957.30

$1,292.50

$1,627.50

$1,962.50

$2,297.50

$2,632.50

$2,967.50

$3,302.50

$3,637.50

$3,972.50

$4,307.50

$4,642.50

$4,977.50

$5,312.50

$5,647.50

$5,982.50

$6,317.50

$6,652.50

$6,987.50

    Children 19 and 20 (200% of FPL, effective May 1, 2008)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$1,915.00

$2,585.00

$3,255.00

$3,925.00

$4,595.00

$5,265.00

$5,935.00

$6,605.00

$7,275.00

$7,945.00

$8,615.00

$9,285.00

$9,955.00

$10,625.00

$11,295.00

$11,965.00

$12,635.00

$13,305.00

$13,975.00

AX Parents, except for Pregnant Women (200% of the FPL)  

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$1,915.00

$2,585.00

$3,255.00

$3,925.00

$4,595.00

$5,265.00

$5,935.00

$6,605.00

$7,275.00

$7,945.00

$8,615.00

$9,285.00

$9,955.00

$10,625.00

$11,295.00

$11,965.00

$12,635.00

$13,305.00

$13,975.00

 

 

Children Under 19 and Pregnant Mothers (300% of the FPL, effective June 1, 2007)

 

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

$2,872.50

$3,877.50

$4,882.50

$5,887.50

$6,892.50

$7,897.50

$8,902.50

$9,907.50

$10,912.50

$11,917.50

$12,922.50

$13,927.50

$14,932.50

$15,937.50

$16,942.50

$17,947.50

$18,952.50

$19,957.50

$20,962.50

Policy Category Eligibility Criteria Subtype

Group Size

Income Standard (Effective February 1, 2013)

SR

SSI Recipients

 

All

None—Categorically Eligible

  Aged/Disabled (100% of FPL)    

See AR: Poverty Level Families and Children—Children age six or over who were born after September 30, 1983.

 

Individuals in a LTC facility

 

See Section 2.4 in Part VII

  Medically Needy (MNIL)  

1

2

$613.94

$646.25

 

QMB

 

QMB (300% of FPL, effective February 1, 2007)

 

 

1

2

 

$2,872.50

$3,877.50

 

SLIMB (at least 100%of the FPL and less than 300% of the FPL, effective February 1, 2007) (Note that effective July 1, 2005, SLIMB eligibility applies only to the month of application and the three months prior to the month of application.)

 

1

2

$2,872.50

$3,877.50

 

QWDI (300% of the FPL, effective February 1, 2007)

 

1

2

$2,872.50

$3,877.50

MC

DC Healthcare Alliance (200% of the FPL)

 

   

See AX: Parents, except for Pregnant Women.

  Childless Adult Medicaid (200% of the FPL)    

See AX: Parents, except for Pregnant Women

 

Exhibit VI-4 TANF Standard of Assistance and Payment Levels

Group Size

Standard of Assistance

Full Payment Levels (effective January 1, 2009)

Reduced Payment Levels For Families Receiving TANF over 60 Months (effective October 1, 2013)

1

$450

$270

$162

2

$560

$336

$202

3

$712

$428

$257

4

$870

$528

$314

5

$1,002

$602

$362

6

$1,178

$708

$425

7

$1,352

$812

$488

8

$1,494

$897

$539

9

$1,642

$987

$593

10

$1,786

$1,072

$644

11

$1,884

$1,131

$679

12

$2,024

$1,216

$730

13

$2,116

$1,271

$763

14

$2,232

$1,340

$804

15

$2,316

$1,391

$835

16

$2,432

$1,461

$877

17

$2,668

$1,602

$962

18

$2,730

$1,639

$983

19

$2,786

$1,673

$1,004

 

Exhibit VI-5 FS Income Standards

Household Size

Maximum Gross Monthly Income Eligibility Standard for Expanded Categorically Eligible Households (effective October 1, 2013)

200% FPL

Maximum Gross

Monthly Income Eligibility

Standard (effective October 1, 2013)

130% FPL

Maximum Net Monthly Income

Eligibility Standard (effective October 1, 2013)

100% FPL

Maximum Allotment

(effective November 1, 2013)

1

$1,915

$1,245

$958

$189

2

$2,585

$1,681

$1,293

$347

3

$3,255

$2,116

$1,591

$497

4

$3,925

$2,552

$1,963

$632

5

$4,595

$2,987

$2,298

$750

6

$5,265

$3,423

$2,633

$900

7

$5,935

$3,858

$2,968

$995

8

$6,605

$4,294

$3,303

$1,137

Each Additional Member

+$670

+$436

+$335

+$142