The CAO must decide who can receive Healthy Beginnings eligibility as follows: 55 Pa. Code § 140.21
1. Decide who is included in the Healthy Beginnings family. (See Section 318.2.)
2. Figure out the countable gross earned and unearned income available to the Healthy Beginnings family in the month when the family applies. If the income is received weekly or biweekly, figure out the average weekly amount and multiply it by four to get the monthly amount. 55 Pa. Code § 140.32
NOTE: Multiply the average weekly income by four even if an individual gets paid three or five times in a calendar month
NOTE: At application, all anticipated changes that the applicant reports must be taken into account when deciding Healthy Beginnings eligibility. If an applicant reports at application that the applicant or family member will receive a permanent pay raise in the next month, the anticipated income from the pay raise must be used when deciding eligibility. The actual income is used in the initial application month and the anticipated income from the pay raise is used thereafter. 55 Pa. Code § 181.23
3. Figure out each individual's net monthly income by applying the allowable deductions in Section 318.6. 55 Pa. Code § 140.31
Reminder: Do not apply the earned income incentive deduction unless the employed individual qualifies for it.
4. Compare the total net monthly income for all family members with the monthly limit in Appendix A, B, C, or D.
If the net monthly income is less than or equal to the monthly limit, Healthy Beginnings benefits must be approved.
NOTE: If Healthy Beginnings benefits are approved, enter a 12-month renewal date. If a change in income is reported before the scheduled renewal, eligibility must be reviewed.
If the Healthy Beginnings family is not eligible using steps 1 through 4 and the eligibility decision is not due to a temporary increase in income, deny Healthy Beginnings. Decide on eligibility for NMP Spend-Down, MNO, or MNO Spend-Down if appropriate.
If the Healthy Beginnings family is not found eligible in steps 1 through 4 because of a temporary increase in income, the CAO must look at annual eligibility by following steps 5 through 7.
Example: Ms. Adams works part-time at a store. Her daughter is currently getting Healthy Beginnings benefits. For the holiday season, Ms. Adams will work full-time in November and December and then return to part-time in January. A renewal for Healthy Beginnings is due in December. For the renewal, the child is ineligible using steps 1 through 4. Because the ineligibility is due to a temporary increase in income, the CAO looks at annual eligibility.
5. Figure out the countable gross earned and unearned income available to the Healthy Beginnings family for the calendar year beginning January 1 and ending December 31. Use the best available information to figure actual income received in past months (for example, year-to-date amounts on the most recent paystub, IEVS match, statement of an employer). Combine it with the income expected for the rest of the calendar year.
NOTE: If income is from self-employment, use the most recent tax return if it shows income for the current calendar year.
6. Figure out each individual’s net income for the calendar year by allowing the deductions in Section 318.6. Apply the earned income incentive to the earnings of a family member if he qualifies for the incentive in the month when he/she applies.
NOTE: Apply the earned income deductions, including the incentive, after finding the average monthly earned income. Figure out the average income by dividing the total annual earnings by the number of months in which the earnings were received. Deduct the 50 percent earned income incentive deduction.
7. Compare the total net calendar year income for all family members with the annual limit in Appendix A, B, C, or D.
If the calendar year income is equal to or less than the annual limit, approve Healthy Beginnings. Decide on eligibility for NMP or MNO for other family members.
If the calendar year income is more than the annual limit, deny Healthy Beginnings. Decide on the individual’s eligibility for NMP or MNO. (Include spend-down.)
Reminder: The CAO must consider the entire family for NMP eligibility as a single budget group before considering any family members for Healthy Beginnings.
8. If Healthy Beginnings is authorized, enter a 12-month renewal date. If changes in income are reported before the scheduled renewal, determine eligibility again.
Examples:
On August 7, Mr. and Mrs. Smith apply for MA for themselves and one child, age 3. Mrs. Smith is pregnant. She was employed part-time but was forced to quit because of problems with her pregnancy. In August, she will get five paychecks, with a gross pay of $375 for each one. Mr. Smith was recently laid off and will receive unemployment compensation of $300 a week, starting in September. He will get his last four weeks of wages this month. His weekly gross income is $750.
Mrs. Smith qualifies for the incentive (she received TANF within the last four months, during a brief separation from her husband), but Mr. Smith does not. Eligibility for Healthy Beginnings is figured for August.
|
Monthly Computation |
||
|
Mr. Smith’s gross monthly earned income ($750 X 4) Work expense deduction Mr. Smith’s net income |
$3,000
-120 $2,880 |
|
|
Mrs. Smith’s gross monthly earned income ($375 X 4) Work expense deduction
Earned income incentive deduction (50%) Mrs. Smith’s net income |
$1,500
-120 $1,380 -690 $690 +$690 |
|
|
Total income |
$3,570 |
|
|
Healthy Beginnings income limit (2012) for four at 133% /185% of FPIG |
|
$2,555 $3,554 |
The family’s countable net income for August is more than the monthly limit of 133% and 185% of the FPIG. Because the income is expected to decrease in September, the CAO must look at eligibility for the calendar year.
Year-to-date information on the pay stubs and expected earnings for August total $25,219 for Mr. Smith and $5,260 for Mrs. Smith, who began work in February of the calendar year.
|
Annual Computation |
||
|
Mr. Smith’s annual earnings ($750 x4x8)
Work expense deduction (Jan.–Aug.; 120 × 8)
Total net annual earnings
|
$24,000
- 960
$23,040 |
|
|
Mrs. Smith’s annual earnings ($375 x4 x7) Work expense deduction (Feb.–Aug.; 120 × 7) Earned income incentive deduction (50%) |
$10,500 - 840 $9,660 -4,830 $4,830 |
|
|
Total net annual earnings Mr. Smith’s unearned income ($300/wk × 17 wks) Total annual net income = |
$4,830 |
+4,830 +5,100
$32,970 |
|
Healthy Beginnings income limit (2012) for four at 185% |
|
$42,643 |
|
Healthy Beginnings income limit (2012 )for four at 133% |
|
$30,657 |
On the basis of actual and estimated calendar year income, Mrs. Smith and the unborn child are eligible for Healthy Beginnings.
On the basis of actual and estimated calendar year income, the three-year-old child is not eligible for Healthy Beginnings.
Mr. and Mrs. Jones are applying for MA for Mrs. Jones's son from a previous marriage, Todd, age 9, and for Mr. and Mrs. Jones's son, Steven, age 3. Mr. Jones has no income, having used up his unemployment compensation benefits. Mrs. Jones gets $195 a month for support for Todd. Mrs. Jones has $170 in payroll taxes and $50 in transportation costs. Mrs. Jones is employed part-time, earning $974 a month. Mrs. Jones got cash assistance within the last four months.
Steven and Todd are both eligible.
|
Mrs. Jones’s gross monthly earned income Work expense deduction
50% earned income incentive deduction
Countable Support Support Disregard (actual or maximum of $200) Net Income Healthy Beginnings income limit (2012) for four at 133% Healthy Beginnings income limit (2012) for four at 100% |
$974 -120 $854 -427 $427 + 195 - 195
$427
$2,555
$1,921 |
Mr. and Mrs. Jones request MA for themselves. Mr. and Mrs. Jones are not eligible for NMP. Their eligibility for MNO is figured as follows:
|
Mr. Jones’s gross monthly earned income Work and individual expenses Net Income 50% Earned Income Incentive Remainder after earned income incentive deduction Countable Support Support Disregard (actual or maximum of $200) Monthly net income Six months Net income for six months MNO income limit for four |
$974
-220
$754 -377
$377 +195 -195 $ 377 ×6
$2,262
$3,400
|
Todd and Steven are included in the number of individuals for the MNO income limit, but they are not eligible for MNO.
Mr. and Mrs. Jones qualify for MNO benefits and are approved as a TU category, because Mr. Jones is an unemployed principal wage earner.
On February 7, Mr. Nelson was admitted to the hospital. Mrs. Nelson signed an application for MA at the hospital for herself, her husband, and their three children (two sons, ages 10 and 12, and a daughter, age 6 months. Mr. Nelson left the hospital on February 17. The hospital bill was $17,000. Mrs. Nelson's insurance paid $11,000, leaving a balance of $6,000.
Mr. Nelson is unemployed and has no income. Mrs. Nelson is working and earns $2,200 a month. Each month, she pays $200 to the orthodontist, $200 in child care, and $50 for health insurance premiums for her family.
|
Mrs. Nelson’s gross monthly income Work expense deduction Child care Net Income Healthy Beginnings income limit (2012) for five at 185% Healthy Beginnings income limit (2012) for five at 100% |
$2,200 -$120 -200 $1,880 $4,165 $2,251 |
The daughter is eligible for category PS-16. The boys are eligible for category PS-16. Eligibility for the other family members is figured out as follows:
|
Mrs. Nelson’s gross monthly income Work and individual expenses Child care >$859 Standard of Need for 5 individuals. Not eligible for work incentives Six months
Orthodontist bill
Health insurance Net income MNO income limit for five Amount the patient must pay as Patient Pay Liability |
$2,200 -600 -200 $1,400
×6 $8,400 -1,200 $7,200 -300 $6,900 -4,050 $2,850 |
The daughter and sons are included in the number of individuals for the MNO income level, but they are not eligible for MNO.
Mr. and Mrs. Nelson qualify for MNO benefits and are approved in a TC category.
If Healthy Beginnings is approved, the CAO must decide on MA eligibility for the other family members. The family members may qualify for either NMP or MNO.
When deciding on NMP or MNO eligibility, the CAO must count the income of a pregnant woman who receives Healthy Beginnings if she is an legally responsible relative of a member of the applicant/recipient group. A qualified child who receives Healthy Beginnings can be included in the NMP or MNO decision if it helps the applicant/recipient group.
If a Healthy Beginnings recipient is included, the CAO must decide on resource and income eligibility for MA as follows:
Resource eligibility
The CAO must count the resources of individuals included in the applicant/recipient group who do not meet the qualifications for a resource exclusion. (See Chapter 340, Resources.)
NOTE: Resources are excluded for households that include any of the following:
A parent living with a child or stepchild under age 21.
An individual living with and who has care and control of a child under age 21.
A spouse living with a wife who is pregnant.
A spouse living with a wife who is under age 21.
Earned income incentive eligibility.
The CAO must count the individual’s income and include him or her when figuring the standard of need limit. (See Chapter 360, NMP Deductions, Appendix A and Appendix B, and Chapter 361, MNO Deductions, Appendix A.)
The family member of a Healthy Beginnings recipient who is getting TANF-related NMP/MNO or GA-related NMP/MNO with a child or stepchild who is getting TANF, SSI, or MA and begins employment after the month of application for NMP/MNO can get (as a recipient of MA) the 50 percent work incentive deduction when figuring income as a family member of a Healthy Beginnings applicant or recipient.
An employed family member of a Healthy Beginnings applicant or recipient cannot get a work incentive deduction if any of the following conditions exists:
The employed family member is getting Healthy Horizons benefits or GA-related or SSI-related NMP/MNO benefits in the month of the application or renewal eligibility decision for Healthy Beginnings.
The employed family member has not received cash assistance or MA in a GA-related category in one of the four calendar months before the month of application or before the month that the family member is included.
The employed family member has not received cash assistance or MA in a GA-related category in one of the four calendar months before the month of application or before the month when the family member is included, but a child or stepchild of the family member in the household has been getting TANF, SSI, or MA at the same time.
Income eligibility.
The CAO must count the income of the individual and include the individual when choosing the correct applicant/recipient group income limit. The CAO must not approve Healthy Beginnings for the individual.
For TANF-related or GA-related NMP, the CAO must use the Family Size Allowance (FSA) with the Healthy Beginnings client included in the applicant/recipient group. (See Chapter 368, Deciding on Eligibility for NMP, Appendix A and Chapter 360, NMP Deductions, .)
For SSI-related NMP, the CAO must allow a basic living needs deduction for each Healthy Beginnings client included in the eligibility decision for NMP. (The basic living needs deduction is the difference between the amount of money that a couple gets in SSI-related NMP and the amount that a single individual gets in SSI-related NMP.) A one individual SSI-related NMP income limit is used if one spouse or a child is included in the SSI-related NMP applicant/recipient group. A two individual SSI-related NMP income limit is used if a couple is included in the SSI-related NMP applicant/recipient group.
For MNO, use the MNO limit with the Healthy Beginnings clients included in the applicant/recipient group. (See Chapter 369, Deciding on Eligibility for MNO, Appendix A.)
The CAO must allow deductions from the income of the Healthy Beginnings client as if the client were included in the applicant/recipient group. (See Chapter 360, NMP Deductions, and Chapter 361, MNO Deductions.)
NOTE: When Healthy Beginnings is first received in the same month when MA is applied for and when the other family members are applying for or getting NMP/MNO, then the individual meets the qualifications for automatic receipt as a recipient of Healthy Beginnings for the 50 percent work incentive deduction when computing income for NMP and MNO.
Example: Mr. and Mrs. Green get MNO for themselves and their two children, ages 3 and 5, and Mrs. Green’s two children, ages 14 and 15, from a previous marriage. The family cannot get NMP.
During a renewal interview, the CAO reviews Healthy Beginnings eligibility for the two Green children. Mr. Green earns $375 a week and Mrs. Green receives $150 a month for child support. Mr. Green has $200 monthly payroll taxes and $40 monthly transportation costs.
Eligibility for Healthy Beginnings is considered for a six-individual family. Mr. and Mrs. Green must be included, and they choose to have her two children and their income included.
|
Mr. Green’s gross monthly earned income ($ 375 × 4) Work expense deduction
50% earned income incentive deduction Total net earned income Mrs. Green’s countable support Support Disregard (actual or maximum of $200) Total Family Income Healthy Beginnings income limit (2012) for six at 100% and 133% FPIG |
$1,500 -120 $1,380 -690 $ 690 +150 -150 $ 690 $2,581 $3,433 |
All four children are eligible for Healthy Beginnings.
NOTE: The CAO sets an alert to start a review of the case at the income level of 100% of the FPIG for the five-year-old’s sixth birthday.
Eligibility for the other family members for MNO is found as follows:
|
Mr. Green’s monthly earned income Work expense deduction
50% earned income incentive deduction Total net earned income
Total six-month income MNO Income Limit for 2 |
$ 1,500 -120 $ 1,380 - 690 $ 690 x6 $4,140 $2,650 |
Mr. and Mrs. Green. do not qualify for MNO.
Updated February 14, 2012, Replacing October 13, 2009