The applicant or recipient must report changes in earned income of more than $100 and of any changes more than $50 for unearned income. However, if the individual reports a change in income the CAO still must take action. 55 Pa. Code § 125.24(d)(1)
After MNO is approved, the individual must report and prove any changes in income by the tenth day of the month after the individual receives it.
Exception: Individuals receiving LTC services in the community or in an institutional setting must report all changes within 10 calendar days.
A change in the income available to the applicant/recipient group may make them ineligible for continued MNO. When the CAO has proof of a change in income or expenses, it will decide whether the change will lead to an increase or a decrease in the total net income for the six-month period.
Note: Whether the individual was required to report a change or not, the CAO must act on all reported income changes.
The CAO must act on a change in income right after receiving proof of the change.
An increase in total net income takes place if: 55 Pa. Code § 181.23
The applicant/recipient group's gross income increases.
The applicant/recipient group's earned or unearned income deductions decrease.
The CAO must estimate calendar month income for the month of the change as soon as it receives proof of an increase in income.
For all categories of MNO, the CAO will figure out eligibility again, using the rules of Section 369.4, Continuing MNO. The eligibility of the applicant/recipient group is affected for the rest of the six-month period. If the change is reported timely, there is no overpayment.
When deciding on eligibility, the CAO will use the best estimates of work expenses based on local tax rates plus work expenses in Chapter 361, MNO Deductions. The CAO will require the applicant/recipient to supply the first pay stub showing the change before figuring out eligibility again. The CAO must not require the applicant/recipient to appear for an interview.
For child care expense deductions, the CAO will use the stated expense without proof if the expense seems reasonable for the situation. If the expense seems unreasonable, the CAO will ask for proof.
The CAO will figure out eligibility again for the current six-month period by using the following income and expenses:
The countable monthly gross income (average weekly income times four) and work and personal expenses for the first month of the six-month period up to the date of the change
The countable monthly gross income (average weekly income times four) and work and personal expenses expected for the rest of the six-month period
The actual allowable medical expenses for the first month of the six-month period up to the date of the change
The expected allowable medical expenses for the rest of the six-month period
If the increased income makes the applicant/recipient group ineligible, the CAO will stop MNO after giving proper notice.
When MNO is closed, the client may reapply for MA at any time. The CAO will set a new period of eligibility for NMP or MNO when the client reapplies.
Example: Ms. Duncan is approved for MNO and her two children are approved in category PS, effective January 12. Her eligibility is based on her income of $210 biweekly from unemployment compensation (UC). On March 25, she reports that she will start a job on April 9. She expects to receive $200 gross per week, with the first pay check expected on April 20. Ms. Duncan proves her pay on April 20. The CAO figures out eligibility again for the six-month period using the following actual and expected income:
|
Actual Months |
|
Estimated Months |
||||||
|
Jan. |
1/10 |
UC |
$210 |
|
April |
4/4 |
UC |
$210 |
|
|
1/24 |
UC |
+210 |
|
|
4/20 |
Wage |
200 |
|
|
|
|
|
|
|
4/27 |
Wage |
+200 |
|
Countable income |
$420 |
|
Countable income |
$610 |
||||
|
Feb. |
2/7 |
UC |
$210 |
|
May |
5/4 |
Wage |
$200 |
|
|
2/21 |
UC |
$210 |
|
|
5/11 |
Wage |
$200 |
|
|
|
|
|
|
|
5/18 |
Wage |
$200 |
|
|
|
|
|
|
|
5/25 |
Wage |
$200 |
|
Countable income |
$420 |
|
Countable income |
$800 |
||||
|
March |
3/7 |
UC |
$210 |
|
June |
6/1 |
Wage |
$200 |
|
|
3/21 |
UC |
$210 |
|
|
6/8 |
Wage |
$200 |
|
|
|
|
|
|
|
6/15 |
Wage |
$200 |
|
|
|
|
|
|
|
6/22 |
Wage |
$200 |
|
|
|
|
|
|
|
6/29 |
Wage |
$200 |
|
Countable income |
$420 |
|
Countable income |
$800 |
||||
Ms. Duncan is eligible for the earned income incentive, because she has received MNO in the previous four months.
If income decreases or is stopped, the CAO will review the record for eligibility in a category with better benefits. 55 Pa. Code § 181.23
Note: An increase in earned or unearned income deductions is considered a decrease in income.
The CAO will include a note about the change in the case record.
An individual must report changes by the tenth day of the month after the individual receives it. Persons receiving LTC must report changes within 10 calendar days. (See Chapter 370, Reporting Changes.) 55 Pa. Code § 125.24(d)(1)
If the individual does not report a change within the required time period and the CAO cannot close MNO for the months that are left in the six-month period, there may be an overpayment. The CAO will fill out an overpayment referral. 55 Pa. Code § 255.71
Updated February 14, 2012, Replacing December 24, 2008