After NMP is approved, the individual must report and prove changes in earned income of more than $100 and changes in unearned income of more than $50 by the tenth day of the month after the individual receives the income. A change in the income available to the applicant/recipient group may make them ineligible for continued NMP. When the CAO has proof of a change in income or expenses, it will determine whether the change will lead to an increase or a decrease in the total net income. 55 Pa. Code § 181.23
NOTE: If a SAR form for cash or food stamps shows a possible change in MA eligibility, the CAO will determine MA eligibility again.
NOTE: However, if the individual reports a change in income, the CAO must still take action.
The CAO will act on a change in income right after receiving proof of the change.
An increase in total net income takes place if:
The applicant/recipient group's gross income increases.
The applicant/recipient group's earned or unearned income deductions decrease.
NOTE: This includes the end of the earned income incentive deduction for the PD category.
The CAO will estimate calendar month income for the month of the change as soon as it receives proof of an increase in income. The client must prove the increase by the tenth day of the month after the increase.
The CAO will determine eligibility again, using the rules of Section 368.3, Continuing NMP, and Section 368.4, NMP Spend-Down.
NOTE: When determining net income in the calendar month of the change, the CAO will apply income deductions, earned income incentive deductions and dependent care expense deductions on the basis of the latest changes in that calendar month.
If the increased income leads to ineligibility that is expected to last more than one month, the CAO will take the following actions: 55 Pa. Code § 181.11(a)
1. Send an advance notice to the applicant/recipient group.
2. Stop NMP effective the day after the advance notice period ends.
3. Determine eligibility for Healthy Beginnings, MAWD, if appropriate, or MNO.
NOTE: The CAO worker will enter the right code in the “MAWD Req” (MAWD request) field on CADISB in CIS, or the Individual Non-Financial Disability screen in eCIS to review eligibility for MAWD.
If the increased income leads to ineligibility that is expected to last only one month, the CAO will take the following actions: 55 Pa. Code § 181.11(a)
1. If the increase was expected:
Send an advance notice in time to stop benefits for the month of ineligibility.
NOTE: The client must report the increase in income, but the CAO may know in advance when the income will be received. The CAO will create an alert to make sure of timely action.
Approve NMP after the month of ineligibility if all rules are met. 55 Pa. Code § 181.23
NOTE: A new application is not required.
2. If the increase was not expected (for example, pay for overtime or a bonus):
Stop NMP if there is enough time to send an advance notice to close for the month of ineligibility.
Do not stop NMP if there is not enough time to send an advance notice to close for the month of ineligibility.
3. If NMP is stopped, determine eligibility for EMC, Healthy Beginnings, MAWD, if appropriate, or MNO.
NOTE: If the family was receiving NMP-F and meets the rules for EMC, the CAO will approve EMC for the month of ineligibility. If the applicant/recipient group is ineligible or does not receive MNO in the month of NMP ineligibility, it must turn in a new application to get MA benefits in future months.
Exception: For monthly NMP spend-down, a new application is not required unless the client does not become eligible or is ineligible for three months in a row.
The CAO will not determine eligibility again when the change does not increase the countable net income and the same or higher net income limit is used.
If a change does not require a review of eligibility, the CAO will include a note about the change in the case record.
The CAO will review the new income and decide whether the change will affect the individual. If the change in income will lead to a change of category or a lowered spenddown amount, the CAO will determine eligibility using the new income.
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.
The individual must report changes by the tenth day of the month after the change. (See Chapter 370, Reporting Changes.) 55 Pa. Code § 125.24(d)(1)
Exceptions: A change in income must be reported by the tenth day of the month after the individual actually receives it.
Individuals receiving LTC services in the community or in an institution must report all changes within 10 days.
Example: Mary's child moves from her household on April 28. On the same day, Mary starts a new job. She expects to receive her first paycheck on May 12. Mary must report her child's move by May 10. She does not need to report the change in income until June 10, as she will not receive the income until May.
If the individual does not report a change on time and the CAO cannot close NMP for the month of ineligibility, there may be an overpayment. If so, the CAO will fill out an overpayment referral. 55 Pa. Code § 255.71
The CAO will fill out the referral even if the applicant/recipient group is eligible for MNO for the month of NMP ineligibility. An overpayment may still have taken place if the individual received a service not covered by the MNO program. The CAO will include MNO eligibility information on the overpayment referral.
Updated February 14, 2012, Replacing October 25, 2008