319.6 Income

The CAO must look at the actual monthly earned and unearned income of each member of the Healthy Horizons family.          55 Pa. Code § 140.232  

The CAO must determine the excluded and countable gross income as follows:

NOTE:   If the Healthy Horizons applicant or recipient chooses to include the natural or adopted child or stepchild, or the child under age 21, who he or she is exercising care and control of, in the Healthy Horizons Family computation, the child’s income is also counted, including TANF, GA, SBP or SSI income.

The Healthy Horizons applicant or recipient must apply for or obtain any potential source of income that is available. Without good cause, an applicant or recipient who fails to cooperate in an effort to establish eligibility for potential benefits is ineligible for MA until he or she complies.       55 Pa. Code § 181.1(d)

Potential benefits include, but are not limited to, the following:

NOTE:  The CAO must not require an individual to apply for an increase in nonservice-connected VA benefits available under the Veterans Pension Act of 1959.

           NOTE:  Support payments are not considered a potential benefit.

319.61 Earned Income

The CAO must count payments received in return for services as earned income. The CAO must determine the total amount of gross earned income before any deductions such as taxes, individual expenses, and dependent care are taken.        

    55 Pa. Code § 140.232

The CAO must count the following as earned income:          55 Pa. Code § 140.251

             NOTE:  A payment is counted when it is received or is set aside for the individual’s use.

NOTE:  In the initial month an individual receives a lump sum payment, the CAO will count it as a resource, unless it would help the individual more to count it as income. If counted as income, any balance remaining after the initial month must be counted as a resource.

            NOTE:  Royalties received before December 1, 1991, are counted as unearned income.

The CAO must receive proof of all earned income and record all earned income in the case record.          

  55 Pa. Code § 140.311(a)(1)

319.62 Unearned Income

The CAO must look at the total amount of gross unearned income when determining eligibility for MA. If money is taken out of an individual’s unearned income as a deduction to pay for insurance premiums, court-ordered support, recovery of an earlier overpayment, etc., the CAO must count the amount of the benefit before it is reduced by the deductions.             55 Pa. Code § 140.232      55 Pa. Code § 140.261

Exception: When an individual receives reduced unearned income to recover an overpayment, the CAO must only count the amount actually received if the overpaid amount was counted when determining eligibility for cash assistance or MA, during the time the overpayment occurred. (See Section 319.63, Excluded Income.)            55 Pa. Code § 140.273(14)

The CAO must not count the cost of living adjustment (COLA) for Title II income for Healthy Horizons categorically needy, HH cost-sharing, SLMB, or QI applicants or recipients until the second month after the month that the Federal Poverty Income Guidelines (FPIGs) are published. In most years, this means the COLAs are not counted through February, as FPIGs are normally published in January. The CAO must begin using the new FPIGs in March if the FPIGs are published in January.

Unearned income includes, but is not limited to, the following:            55 Pa. Code § 140.261

NOTE:   For a Teachers Insurance and Annuity Association—College Retirement Equities Fund (TIAA-CREF) that is set up as a Transfer Payment Annuity (TPA) paid once a year; the annual payment should be averaged over the 12 months.

NOTE:    SSA rounds the RSDI amount listed in the award letter down to the nearest dollar. The CAO must count the amount the applicant or recipient actually receives in the check. If an individual receives Medicare Part B, the amount of the premium must be added to the check amount.

NOTE:   RSDI income for a disabled child is disregarded when determining income eligibility for PH 95. A disabled child must be reviewed for all other MA categories prior to PH 95, and this income is counted for all other MA categories.

NOTE:  The aid and attendance portion of VA benefits is excluded. If the applicant or recipient uses any of the benefit to support a dependent, that portion must be counted as income of the dependent.

NOTE:   Court-ordered child support for a disabled child is disregarded when determining income for PH 95. A disabled child must be reviewed for all other MA categories prior to PH 95 and this income is counted for all other MA categories. Voluntary child support for a disabled child is counted when determining income eligibility for PH 95.

55 Pa. Code § 140.273(2)    55 Pa. Code § 181.123(2)      55 Pa. Code § 140.271(9)

            NOTE:  Unearned lump sum payments include, but are not limited to, the following:

NOTE:    In the initial month the lump sum payment is received, the CAO must count it as a resource unless it would help the individual more to count it as income. If counted as income, any balance remaining after the initial month must be counted as a resource.

NOTE:   A prize is a cash payment won in a contest, lottery, or game of chance. An individual usually receives an award because of a decision by a court, board of arbitration, or similar legal body. A prize or award may be received as a lump sum or in several payments.

A cash inheritance received as a nonrecurring payment is treated as a lump sum.

(See Chapter 357, Lump Sum.)

The CAO must receive proof of all unearned income and record all unearned income in the case record.        

     55 Pa. Code § 140.311(a)(1)

 

319.621 Support Payments

Support paid by a spouse, whether it is court-ordered, voluntary, or paid directly to the individual, must be counted when determining the individual’s eligibility. The amount of court-ordered support or alimony may be proven by a copy of the court order, a copy of the check, or a written statement from the Domestic Relations Office. If the Healthy Horizons household chooses to include a child in the eligibility determination and that child is receiving support, a $50 disregard is given.               55 Pa. Code § 140.264

           NOTE:  The $50 disregard is given for child support only. Spousal support does not receive the disregard.

           NOTE:  The CAO must not count court-ordered child support payments listed in the Pennsylvania Child Support Enforcement System (PACSES) when determining MA eligibility for a child with a disability. Court-ordered child support from out of state, which may not be in PACSES, must also be excluded if it is verified. To apply this disregard, the child must be found disabled by either the Social Security Administration or DPW’s Medical Review Team (MRT). No other finding of disability will be accepted.

           NOTE:  The CAO must not require the applicant or recipient to pursue support (arrears) as a condition of eligibility.

Money paid to cover support payments that were due in earlier months is considered a lump sum payment. (See Chapter 357, Lump Sum.)

 55 Pa. Code § 140.291  

Example: Mrs. Allen receives MA for herself. She has a court order for $200 a month but receives $600 for the first payment. It includes two months’ past-due payments. The CAO must count $200 as income in the month of receipt. The remaining $400 is treated as a lump sum payment.

319.622 Interest Income

The CAO must count interest income in the calendar month in which it is received, unless it is specifically excluded. (See Section 319.63, Excluded Income.)

55 Pa. Code § 140.261

            NOTE:  The interest income does not need to be withdrawn or actually received by the individual.

The CAO must not count interest income if:

 55 Pa. Code § 140.273(7)

Examples:

319.63 Excluded Income

The CAO must not count income from certain sources when determining eligibility for Healthy Horizons.

The CAO must verify and record the reason for excluding the income. It may be necessary to verify the amount of excluded income.

The CAO must not count the following excluded income:

 55 Pa. Code § 140.241(2)        55 Pa. Code § 140.291  

  55 Pa. Code § 140.271(9)   55 Pa. Code § 140.273(2)     55 Pa. Code § 181.123(2)   

          Example: Property tax rebates or rent rebates.

   55 Pa. Code § 140.273(9)

55 Pa. Code § 140.273(3)

    55 Pa. Code § 140.271(5)   

            NOTE:  If the CAO cannot tell whether a vendor is certified or an organization is registered with DPW,they must contact the area manager. If it turns out that the vendor or organization is not registered, the CAO must count the HEA benefit as unearned income.

  55 Pa. Code § 140.271(15)

            NOTE:   Reverse mortgage payments (whether lump sum, monthly installment, or a combination of both) are considered loans in the month they are received. There is no exclusion for the resource if money from the loan is kept after the month in which it is received.

   55 Pa. Code § 140.271(18)

55 Pa. Code § 140.271(11)

The CAO must not count the following:

 55 Pa. Code § 140.271(16)   

55 Pa. Code § 140.271(17)

            NOTE:  If any portion of the payment is left after the end of the six-month period, the CAO must count it a resource. (See Section 350.63, Excluded Income—SSI Related.)

The CAO must not count earned income of less than $10 a month from a single source if it is received only once in a calendar quarter and on an infrequent or irregular basis to be reasonably anticipated.          55 Pa. Code § 140.272

Example: Mrs. Nguyen does housecleaning on a regular basis and earns $80 a week. On November 20th, a customer pays her $10 for some additional cleaning. On December 22nd, the same customer again requests additional cleaning and pays $10. The CAO doesn’t count the $10 from November 20th but counts the $10 from December 22nd, as Mrs. Nguyen got the earned income more than once in the quarter.

The CAO must not count unearned income of less than $20/month that is received too infrequently or irregularly to be reasonably anticipated . If the amount is over $20 or is received more often than once in a calendar quarter, then the full amount must be counted as income.         55 Pa. Code § 140.273(7)

Example: Mrs. Arnold wins $18.50 in the lottery on February 10th, $20 on March 15th, and $19.30 on May 20th. The CAO does not count the February 10th winnings, because the total was less than $20. The CAO counts the March 15th winnings, because Mrs. Arnold got lottery winnings more than once in a quarter. The CAO does not count the May 20th winnings, because it was less than $20.

The CAO must not count, for 18 months, money received as a result of an event that has been declared a major disaster by the President under the Disaster Relief Act of 1974 or another federal law. All of the following conditions must be met:        55 Pa. Code § 140.273(4)

            NOTE:  The income exclusion begins on the date the disaster assistance is received and ends on the last day of the 18th full month after that.

The CAO must:

Example: As a result of a flood on September 10, 2009, that was declared a disaster by the President, Mr. Burke receives unemployment compensation paid under the Disaster Relief Act of 1974. He receives $60 a week, beginning on October 1st. The CAO excludes the income beginning October 1, 2009, and ending March 31, 2011.

The CAO must not count interest earned on disaster relief assistance for a period beginning the date the assistance was received and ending on the last day of the ninth full month following the month it was received.

The CAO must extend this period to 18 full months if the individual shows good cause for not repairing or replacing the property for which the disaster relief was given.  Good cause is established when circumstances beyond the individual’s control prevent the replacement of a home or other kinds of property within the nine month period.       

  55 Pa. Code § 140.273(5)

             NOTE:  The individual must show proof from at least two contractors to indicate that he or she has made a reasonable effort to have the damaged property repaired or replaced within the initial period. If the disaster has resulted in the need for much work in the area, then the CAO may contact area contractors to find out the minimum time needed to complete the work. An extension is granted only if the individual indicates that he still plans to make the repairs or replacement. The CAO must keep written documentation and record of any information obtained by verbal contact.

The CAO must:

            NOTE:  If this interest income is withdrawn, the CAO must count it as income.

The CAO must:

    55 Pa. Code § 140.273(15)

   55 Pa. Code § 140.271(10)  

     55 Pa. Code § 140.241(3)

    55 Pa. Code § 140.241(4)

              NOTE:  Interest on the money loaned must be counted as income.

        55 Pa. Code § 140.241(6)

Example: An individual’s paycheck is stolen before he is able to cash it, and his employer issues a replacement check. The CAO counts the original paycheck as earned income in the month it was received and excludes the replacement check.

            NOTE:  Any portion of the Aid and Attendance benefit that remains after the month it was received must be counted as a resource.

The CAO must not count money received from any of the following social services:          55 Pa. Code § 140.241(12)

           NOTE:  Examples of these services include homemaker services, attendant care, and chore services.

 55 Pa. Code § 140.273(1)    

The CAO must not count medical care and services if they are:          55 Pa. Code § 140.241(11)

Example: The CAO must not count money paid to the individual from his insurance company to reimburse him for payments for prescription drugs.

            NOTE:  Any portion of the payment that remains after the calendar month when it is received is also excluded as a resource for nine calendar months following the month when it is received.

 

Updated February 14, 2012, Replacing June 20, 2008