Deeming is the process by which the income and resources of a nonapplicant Legally Responsible Relative (LRR) who is living in the home are counted when deciding on the eligibility of an applicant/recipient group for Medical Assistance (MA). 55 Pa. Code § 178.1 55 Pa. Code § 181.1
NOTE: Healthy Horizons Cost-Sharing, SLMB, and QI-1 recipients are considered nonrecipients for deeming purposes, because they do not receive MA coverage. SLMBs who also receive MNO are considered MA recipients on the basis of their eligibility for MNO.
Income and resources are deemed available from an LRR who:
Is not eligible for MA for any reason, including his or her refusal to apply for a possible benefit, refusal to apply for a Social Security number, or status as an undocumented noncitizen or legal temporary noncitizen.
Chooses not to be included in the applicant/recipient group.
NOTE: People with Special SSI Recipient status are treated as full SSI recipients, specifically in categories PA/PJ/PM/ with program status code 85. These people are excluded from deeming income and resources to other budget group members applying for or getting MA.
For SSI-related categories, income and resources are deemed available from a spouse, including a common-law spouse, who lives with the client and:
55 Pa. Code § 178.91 55 Pa. Code § 181.110
Exception: There is no deeming of resources to a pregnant woman, a child under age 21, or families with children under age 21.
Per Act 144 of 2004, Pennsylvania will no longer recognize a common-law marriage entered into after January 1, 2005. If an applicant states she has a common-law spouse, the CAO must obtain proof that the couple presented themselves to the community as a married couple before January 1, 2005. The CAO must obtain proof which includes, but is not limited to, the deed to their residence, income tax records, bank records, leases, utility bills, or statements from knowledgeable persons. In the case of recipients whose record indicates that they have been presenting themselves to be married under common law prior to January 1, 2005, the CAO should continue to recognize the common-law marriage.
For TANF-related/GA-related categories: 55 Pa. Code § 181.285
Income is deemed available from the following persons who live with the client and do not get TANF, GA, SBP, SSI, or MA.
A spouse, including a common-law spouse.
The biological or adoptive parent of a child under age 21.
NOTE: Deeming of income is not affected by whether or not the client is emancipated or married.
Resources are deemed available from a spouse, including a common-law spouse, who lives with the client and does not get TANF, GA, SBP, SSI, or MA.
55 Pa. Code § 178.151(a) 55 Pa. Code § 178.1(e)
Exception: There is no deeming of resources to a pregnant woman, a child under age 21, or families with children under age 21.
Income and resources are deemed available to the applicant/recipient group no matter whether they are actually made available.
Exception: For MNO, only the income actually contributed by a parent to a child over age 18 and under age 21 is counted.
Income and resources are not deemed from a stepparent or sponsor of an alien.
Deeming does not apply to MAGI MA. MAGI MA eligibility is determined based on tax rules. Refer to Chapter 312, Affordable Care Act/Modified Gross Income (MAGI) for more details.
Updated June 10, 2015, Replacing February 14, 2012