907 KAR 20:020. Income standards for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals

Link to law: http://www.lrc.ky.gov/kar/907/020/020.htm
Published: 2015

      907 KAR 20:020.

Income standards for Medicaid other than Modified Adjusted Gross Income (MAGI)

standards or for former foster care individuals.

 

      RELATES TO: KRS 205.520, 38 U.S.C. 5503,

42 U.S.C. 1382a, 1396jj(b), 1397aa, 9902(2)

      STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2),

194A.050(1), 205.520(3), 42 C.F.R. 435, 42 U.S.C. 1396a, 1396b, 1396d, 1397aa

      NECESSITY, FUNCTION, AND CONFORMITY: The

Cabinet for Health and Family Services, Department for Medicaid Services has

responsibility to administer the Medicaid Program in accordance with 42 U.S.C.

1396 through 1396v. KRS 205.520(3) authorizes the cabinet, by administrative

regulation, to comply with any requirement that may be imposed or opportunity

presented by federal law for the provisions of medical assistance to Kentucky's

indigent citizenry. This administrative regulation establishes the income

standards by which Medicaid eligibility is determined, except for individuals

for whom a modified adjusted gross income is the Medicaid eligibility income standard

or former foster care individuals who aged out of foster care while receiving

Medicaid coverage.

 

      Section 1. Income Limitations. (1)(a) Income

shall be determined by comparing adjusted income as required by Section 2 of

this administrative regulation, of the applicant, applicant and spouse, or applicant,

spouse, and minor dependent children with the following scale of income protected

for basic maintenance:



Size of Family





Annual





Monthly







1





$2,600





$217







2





3,200





267







3





3,700





308







4





4,600





383







5





5,400





450







6





6,100





508







7





6,800





567







 

      (b) For each additional family member,

$720 annually or sixty (60) dollars monthly shall be added to the scale.

      (2) For a pregnant woman or child eligible

pursuant to 42 U.S.C. 1396a(e) a change of income that occurs after the

determination of eligibility of a pregnant woman shall not affect the pregnant

woman's eligibility through the remainder of the pregnancy including the postpartum

period which ends at the end of the month containing the 60th day of a period beginning

on the last day of her pregnancy.

      (3) The special income limits and

provisions established in this subsection shall apply for a determination of

eligibility of a qualified Medicare beneficiary, specified low-income Medicare

beneficiary, qualified disabled and working individual, or Medicare qualified individual

group 1 (QI-1).

      (a) A qualified Medicare beneficiary

shall have income not exceeding 100 percent of the official poverty income guidelines.

      (b) A specified low-income Medicare

beneficiary shall have income greater than 100 percent of the official poverty

income guidelines but not to exceed 120 percent of the official poverty income

guidelines.

      (c) A Medicare qualified individual group

1 (QI-1) shall have income greater than 120 percent of the official poverty

income guidelines but less than or equal to 135 percent of the official poverty

income guidelines.

      (d) A qualified disabled and working

individual shall have income not exceeding 200 percent of the official poverty

income guidelines.

      (4) Income shall be limited to the

allowable amounts for the SSI program for:

      (a) A child who lost eligibility for SSI

benefits due to the change in the definition of childhood disability as

established in 42 U.S.C. 1396a(a)(10); or

      (b) A person with hemophilia who received

a class action settlement as established in 42 C.F.R. Part 130.

      (5) Income shall be limited to the

allowable amounts for the mandatory or optional state supplement program for an

individual described in 42 C.F.R. 435.135.

      (6) The following special income factors

shall apply for a Medicaid Works individual:

      (a) Income for a Medicaid Works

individual’s spouse shall not exceed $45,000 per year;

      (b) A Medicaid Works individual’s unearned

income shall be less than the SSI standard plus twenty (20) dollars monthly;

and

      (c) The combination of earned and

unearned income for a Medicaid Works individual shall be less than 250 percent

of the official poverty income guidelines.

 

      Section 2. Income Disregards. In comparing

income with the scale established in Section 1 of this administrative

regulation, gross income shall be adjusted as established in this section.

      (1) In a TANF or family related Medicaid

case:

      (a) The standard work expense of an adult

member or out-of-school child shall be deducted from gross earnings;

      (b) For a person with either full-time or

part-time employment, the standard work expense deduction shall be ninety (90)

dollars per month; and

      (c) Earnings of an individual attending

school who is a child or parent under age nineteen (19) or a child under age

eighteen (18) who is a high school graduate shall be disregarded.

      (2) For an ABD Medicaid case or a Medicaid

Works individual, the applicable federal SSI disregards pursuant to 42 U.S.C.

1382a(b) shall apply.

      (3) For an individual in a Medicaid

eligibility group subject to 42 U.S.C. 1396a(a)(10)(E)(i), (ii), or (iv) or 42 U.S.C.

1396d(p), if an annual Social Security cost-of-living adjustment, Railroad

Retirement cost-of-living adjustment, or federal poverty level cost-of-living

adjustment causes an individual to be ineligible for Medicaid benefits:

      (a) The individual’s most recent Social

Security cost-of-living adjustment, Railroad Retirement cost-of-living

adjustment, or federal poverty level cost-of-living adjustment shall be

disregarded; and

      (b) The disregard referenced in paragraph

(a) of this subsection shall continue until the individual loses Medicaid

eligibility for any other reason for three (3) consecutive months.

      (4)

      (a) An ABD Medicaid case shall be the

applicable federal SSI disregards pursuant to 42 U.S.C. 1382a(b).

      (b) A Medicaid Works individual shall be

the applicable federal SSI disregards pursuant to 42 U.S.C. 1382a(b).

 

      Section 3. Lump Sum Income. Except as

established in Section 8 of this administrative regulation, for a Medicaid

case, lump sum income shall be considered as income in the month received.

 

      Section 4. Income Exclusions. (1) Income

of a person who is blind or disabled necessary to fulfill a plan approved by

the United States Social Security Administration to achieve self support, IRWE

deduction, or BWE deduction shall be excluded from consideration.

      (2) A payment or benefit from a federal

statute, other than SSI benefits, shall be excluded from consideration as

income if precluded from consideration in SSI determinations of eligibility by

the specific terms of the statute.

      (3) A cash payment intended specifically

to enable an applicant or recipient to pay for medical or social services shall

not be considered as available income in the month of receipt.

      (4) A Federal Republic of Germany reparation

payment shall not be considered available in the eligibility or post

eligibility treatment of income of an individual in a nursing facility or

hospital or who is receiving home and community based services under a waiver

program.

      (5) A Social Security cost of living

adjustment on January 1 of each year shall not be considered as available

income for a qualified Medicare beneficiary, specified low-income Medicare

beneficiary, qualified disabled and working individual, or Medicare qualified

individual group 1 (QI-1) until after the month following the month in which

the official poverty income guidelines promulgated by the United States Department

of Health and Human Services are published.

      (6) Any amount received from a victim’s compensation

fund established by a state to aid victims of crime shall be excluded as income.

      (7) A veteran or the spouse of a veteran

residing in a nursing facility who is receiving a Veterans Administration (VA) pension

benefit shall have ninety (90) dollars:

      (a) Excluded as income in the Medicaid

eligibility determination; and

      (b) Excluded as income in the post

eligibility determination process.

      (8) Veterans Administration payments for

unmet medical expenses and aid and attendance shall be excluded in a Medicaid

eligibility determination for a veteran or the spouse of a veteran residing in

a nursing facility.

      (a) Veterans Administration payments for

unmet medical expenses and aid and attendance shall be excluded in the post

eligibility determination for a veteran or the spouse of a veteran residing in

a nonstate-operated nursing facility.

      (b) Veterans Administration payments for

unmet medical expenses and aid and attendance shall not be excluded in the post

eligibility determination process for a veteran or the spouse of a veteran

residing in a state-operated nursing facility.

      (9) An Austrian Social Insurance payment

based, in whole or in part, on a wage credit granted under Sections 500-506 of

the Austrian General Social Insurance Act shall be excluded from income consideration.

      (10) An individual retirement account,

KEOGH plan, or other tax deferred asset shall be excluded as income until

withdrawn.

      (11) Disaster relief assistance shall be

excluded as income.

      (12) Income which is exempted from

consideration for purposes of computing eligibility for the comparable money

payment program (AFDC or SSI) shall be excluded.

      (13) In accordance with 42 C.F.R. 435.122

and Section 4735 of Pub.L. 105-33, a payment made from a fund established by a

settlement in the case of Susan Walker v. Bayer Corporation or payment made for

release of claims in this action shall be excluded as income.

      (14) In accordance with 42 C.F.R. Part

130, any payment received by a person with hemophilia from a class action

lawsuit entitled "Factor VIII or IX Concentrate Blood Products

Litigation" shall be excluded as income.

      (15) Family alternatives diversion

payments shall be excluded as income.

      (16) All monies received by an individual

from the Tobacco Master Settlement Agreement shall be excluded.

      (17) Income placed in a qualifying income

trust established in accordance with 42 U.S.C. 1396p(d)(4) and 907 KAR 20:030,

Section 3(5), shall be excluded.

 

      Section 5. Consideration of Mandatory or

Optional State Supplements. For an individual receiving a mandatory or optional

state supplement, that portion of the individual's income which is in excess of

the basic maintenance standard, established in Section 1(1) of this

administrative regulation, shall be applied to the special need which results

in the supplement.

 

      Section 6. Pass-through Cases. (1)(a) An

increase in a Social Security payment shall be disregarded in determining

eligibility for Medicaid benefits if:

      1. The increase is a cost of living increase;

and

      2. The individual would otherwise be

eligible for an SSI benefit, mandatory state supplement, or optional state

supplement.

      (b) An individual who would otherwise be

eligible for an SSI benefit, mandatory state supplement, or optional state supplement

shall remain eligible for the full scope of program benefits with no spend-down

requirements, as established in Section 7 of this administrative regulation.

      (2) For an individual who applied by July

1, 1988, the additional amount specified in 42 U.S.C. 1383c(b) shall be

disregarded, meaning that amount of Social Security benefits to which a

specified widow or widower was entitled as a result of the recomputation of

benefits effective January 1, 1984, and except for which (and subsequent cost

of living increases) an individual would be eligible for federal SSI benefits.

 

      Section 7. Spend-down Provisions. (1) A

technically eligible individual or family shall not be required to utilize

protected income for medical expenses before qualifying for Medicaid.

      (2)(a) An individual with income in

excess of the basic maintenance scale established in Section 1(1) of this

administrative regulation shall qualify for Medicaid in any part of a three (3)

month period in which medical expenses incurred have utilized all excess income

anticipated to be in hand during that period.

      (b) Medical expenses incurred in a period

prior to the quarter for which spend-down eligibility is being determined shall

be used to offset excess income if the medical expenses remain unpaid at the

beginning of the quarter and have not previously been used as spend-down expenses.

 

      Section 8. Individual Retirement Account.

(1)(a) If an individual reaches the point where the individual is eligible to

begin withdrawing from an IRA without suffering a penalty, the individual shall

begin withdrawing from the IRA at least the minimum amount determined by the

financial institution holding the IRA.

      (b) If an individual does not begin

withdrawing from an IRA pursuant to paragraph (a) of this subsection, the

individual shall be ineligible for Medicaid benefits.

      (2) If an individual withdraws funds from

an IRA prior to reaching the point where the individual would suffer no penalty

for withdrawing funds, the withdrawal shall be considered non-recurring lump

sum income.

      (3) If an individual withdraws income

pursuant to subsection (1)(a) of this section, the income shall be prorated

over the period of time the income covers (for example monthly, quarterly, or

annually).

 

      Section 9. Applicability. The provisions

and requirements of this administrative regulation shall:

      (1) Apply to:

      (a) A child in foster care;

      (b) An aged, blind, or disabled

individual; and

      (c) An individual who receives

supplemental security income benefits; and

      (2) Not apply to an individual

       whose Medicaid eligibility is determined:

      (a) Using the modified adjusted gross

income standard pursuant to 907 KAR 20:100; or

      (b) Pursuant to 907 KAR 20:075. (21 Ky.R. 2879; Am. 22

Ky.R. 296; eff. 7-261995; 25 Ky.R. 444; 865; eff. 9-16-1998; 26 Ky.R. 1255;

1573; eff. 2-1-2000; 28 Ky.R. 965; eff. 12-19-2001. 30 Ky.R. 1117; 1533; eff.

1-2-2004; 34 Ky.R. 1849; 2122; eff. 4-4-2008; Recodified from 907 KAR 1:640, 9-30-2013; 40 Ky.R. 1164; 1768;

2157; eff. 4-4-2014.)
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