A individual who has countable income, whether it is earned or unearned, is entitled to certain deductions from that income. The CAO must count the net income (the income after deductions) when determining a individual's eligibility for Medically Needy Only (MNO) MA.
When determining the net income of an applicant/recipient group, the CAO must allow the following deductions:
From gross earned income, expenses related to employment and the earned income incentive
NOTE: See Chapter 352, Self-Employment, for allowable deductions in computing profit from self-employment.
From gross unearned income, the expenses of receiving the income
The CAO must allow deductions for certain medical expenses of members of the applicant/recipient group if those deductions are needed for MA eligibility. (See Section 361.5, Medical Expense Deduction) 55 Pa. Code § 181.14(c)
A individual must show proof of medical expense deductions used to determine his or her eligibility for MA. Child care expenses and any other information related to eligibility may also need to be proven, if they are in doubt. Proof includes, but is not limited to, the following: 55 Pa. Code § 181.3
Pay stubs or pay envelopes
A statement of an employer
Business records
Invoices, bills, receipts, or statements that identify the type, amount and date of a medical service or an income-related expense.
NOTE: For dependent care expenses, the caseworker must use the stated, unproven amount if it is less than or equal to the NMP limit. If the amount is over the NMP limit and the caseworker thinks the amount is “questionable,” the caseworker can ask for proof of the dependent care expense.
The CAO must not deny MA as long as the individual cooperates in trying to obtain proof.
Updated February 14, 2012, Replacing January 13, 2009