The CAO will consider the total countable earned and unearned income of all applicant/recipient group members when determining eligibility for Non money Payment (NMP) and Medically Needy Only (MNO) Medical Assistance (MA). 55 Pa. Code § 181.2
State and federal laws exclude certain types and sources of income. Excluded sources of income for TANF-related, GA-related, and SSI-related categories are listed in this chapter and are not counted in the eligibility decision.
The applicant/recipient must apply for or obtain any possible source of income available to him or her. An individual who, without good cause, does not cooperate in obtaining possible benefits is ineligible for MA. 55 Pa. Code § 181.1(d)
For TANF-related and SSI-related categories, the individual is ineligible until he or she cooperates.
For GA-related categories, the individual is ineligible for 60 days. After 60 days, the individual stays ineligible until they cooperate.
If a non applicant parent might be eligible for possible benefits, the parent must apply for the possible benefits. If the individual who might be eligible is an unemancipated minor child, the child is ineligible until the parent or other adult member cooperates. 55 Pa. Code § 181.1(d)
Possible benefits include, but are not limited to, the following: 55 Pa. Code § 181.302
Retirement benefits.
Unemployment compensation.
Workers compensation.
State or county retirement or disability benefits.
Veteran's Affairs (VA) benefits.
The CAO will not make an individual apply for an increase in nonservice-related VA benefits that are available under the Veterans Pension Act of 1959.
Pensions and annuities.
Note: Support is not considered a possible benefit. (See Section 350.31, Support Payments.)
Reminder: Resources are excluded for any individual who has a child under age 21 in the household if the individual is the mother or father of the child or the individual is taking care of and in charge of the child. In these cases, if the possible benefit is a resource that would not make any income, the parent would not have to apply.
The individual, or a individual acting for him or her, must report and show proof of all earned and unearned income used to determine MA eligibility.
An applicant or recipient may not be turned down for MA for not having proof, if he or she cooperates in trying to obtain the proof.
NOTE: If the individual has cooperated, the CAO will help the individual obtain the proof.
The CAO will clearly explain to the individual what proof is needed to determine his or her eligibility for MA. Approval of MA will not be delayed while waiting for proof for other programs.
Sources of proof include, but are not limited to, the following: 55 Pa. Code § 181.3(b)
Bank statements showing deposits.
Court orders.
Pay stubs or pay envelopes.
NOTE: Individuals can provide one pay stub that is representative of their income and deductions. This representative pay can be received up to 60 days before the application date.
An employer's statement of past or expected earnings.
Internal Revenue Service (IRS) Form 4070 (used to report tips).
Tax returns.
Award letters.
Statements of earned or unearned income.
Business records.
Benefit checks or check stubs.
Income Eligibility Verification System (IEVS).
Reminder: Benefit checks do not always show the gross amount of the income. Add in any deductions taken for medical insurance, support payments, etc.
Updated February 14, 2012, Replacing July 2, 2008