For SSI-related categories, the CAO must deem income available from a spouse, including a common-law spouse, who lives with the applicant/recipient , and
NOTE: Income must not be deemed from a parent to a child who is getting MA in the Children with Special Needs (PH 95) category.
NOTE: For Healthy Horizons, the applicant and spouse's earned and unearned income must be considered in deciding on eligibility.
When determining the deemed income from an NA (non-applying) member who is an LRR to an SSI-related, TANF-related, or GA-related applicant or recipient in the same applicant/recipient group for MNO, the CAO must:
Treat the NA member as an SSI-related LRR to all applicants and recipients in the group.
Determine the deemed income amount from the LRR to the applicants and recipients.
If the LRR's income, after allowable deductions, is more than 50% of the federal benefit rate, the CAO must increase the MNO income limit by one person, to include the LRR.
NOTE: A spouse and any children included in the applicant/recipient group for MNO are not considered dependents.
The spouse can get the same exclusions from income that apply to an SSI-related MA applicant or recipient. (See Chapter 350, Income.)
Income is deemed available from a spouse who has lived in the individual's household for any part of the calendar month when eligibility is being considered. This includes retroactive months and the month when the individual applies.
Deeming of income ends on the first day of the month following the month of separation or the death of a spouse. Income is deemed available when deciding on retroactive eligibility if the LRR lived in the home for at least one day in the calendar month.
NOTE: Deeming stops in the month a spouse is admitted to a nursing facility or other institutional care facility. (See the Long-Term Care Handbook Chapter 440, Resources for the information on the treatment of resources for an applicant/recipient who is in an institution.)
Deeming continues during temporary separations, such as when the spouse is away from home for economic reasons, an emergency, a job, or a vacation. A temporary separation happens when the spouse leaves the home and returns in the same month or the following month. A spouse who is in the hospital is considered to be living with their spouse.
A temporary separation that goes into the third month is no longer considered temporary. Deeming must end.
Example:
Jane Kline, who receives spend-down, reports on September 21 that Jane's spouse Todd left the home on September 20 to care for Todd's ill parent. The CAO creates an alert for November 1. Jane's spouse Todd is not back home by November 1, meaning that the separation is no longer temporary. Deeming stops on November 1, and the CAO determines a new spend-down amount.
Two types of deductions are allowed when determining income deemed available from the spouse:
A dependent child deduction.
Deductions from the earned income of a blind spouse.
The spouse can get an income deduction for a dependent child who lives with them and who does not get public payments based on need (for example, public assistance, SSI or foster care payments).
To be considered a dependent, the child must:
Be under age 18 or, if a student, under age 22.
Not be married.
Not be the head of the household.
Not be included in the applicant/recipient group.
NOTE: The spouse may claim a child as a dependent if the child is getting MA in a separate applicant/recipient group.
The CAO must determine the dependent child deduction as follows:
1. Confirm that the child lives in the home and is a dependent.
2. Confirm that the child is not part of the applicant/recipient group.
3. Determine the child's countable income, allowing the income exclusions listed in Section 355.412.
4. Exclude the earned income of the dependent child up to the limit for each calendar quarter. (See Appendix B.)
NOTE: If the dependent child is a student, exclude up to the limit for each year. 55 Pa. Code § 181.452(d)(4)(iii)
5. Compare the income that is left over with 50% of the SSI federal benefit rate. (See Appendix A.)
If the child's income is more than 50% of the rate, the spouse cannot get a dependent child deduction.
If the child's income is equal to or less than 50% of the rate, deduct the income from the rate. The difference is the dependent child deduction.
6. Subtract the dependent child deduction from the spouse's unearned income. If the spouse does not have unearned income or the deduction is more than the spouse's unearned income, deduct the rest from the spouse's earned income.
If the LRR spouse has more than one dependent child, the CAO must:
Determine each dependent child's income separately.
Compare each dependent child's income to 50% of the SSI federal benefit rate separately.
Combine the deductions for each child.
The amount that is left is the total dependent child deduction.
Example: Harriet is applying for MA. Jerry Roberts (spouse) and their dependent child, Tara, live in the home and do not want to apply for MA. Tara has countable unearned income of $100 per month.
|
The CAO must deduct $382.55 from Jerry's unearned income. If Jerry's unearned income is less than $382.55, the CAO must subtract the rest of the dependent child deduction from Jerry's earned income.
The following income of a spouse and a dependent child is excluded:
Educational Assistance-For information about educational assistance, see Chapter 314, Students.
Foster Care Payments-The CAO must not count money paid by a public or private placement or childcare agency for providing foster care for a child.
SNAP.-The CAO must not count the value of SNAP that the child gets.
USDA Surplus Food Donation-The CAO must not count the value of food donated by the United States Department of Agriculture.
Home Produce-The CAO must not count the value of home produce, as long as the people living the home eat it themselves.
Tax Refunds-The CAO must not count tax refunds on income, real property, or food purchases.
Support Payments-The CAO must not count the amount of income used to pay court-ordered support or other payments under Title IV-D of
the Social Security Act.
Earned Income Less Than $10-The CAO must not count earned income that is:
Less than $10 a month.
From a single source.
Received once in a quarter.
Received too rarely to be expected on a regular basis.
Unearned Income Less Than $60-The CAO must not count unearned income that is less than $60 monthly and that is received too rarely to be expected on a regular basis. If the amount is more than $60 or is received more than once in a calendar quarter, the full amount must be counted as income.
Disaster Relief Assistance-The CAO must not count, for eighteen months, money that an individual gets because of a situation that is declared a major disaster by the president under the Disaster Relief Act of 1974 or another federal law. All of the following conditions must be met:
The person was living in their own home at the time of the disaster but was forced to leave because of it.
The person began getting the disaster assistance within 30 days after the last day of the disaster.
The person got the disaster assistance while living in a residential facility, including another person’s private home.
NOTE: The income exclusion begins on the date the person got the disaster assistance and ends on the last day of the eighteenth full month after that.
Interest on Disaster Relief Assistance-The CAO must not count interest earned on disaster relief assistance from the time the person got it through the last day of the ninth full month after that.
NOTE: The CAO must extend this period to eighteen full months if the applicant/recipient shows good cause for not repairing or replacing the property for which the disaster relief was given. Good cause includes any situation beyond the individual's control that prevents the repair or replacement of a home or other property within the nine-month period.
Payments to Victims of Nazi Persecution-Passed on August 1, 1994, the Nazi Persecution Victims Eligibility Act (P.L. 103-286) excludes from income and resources any payments made to persons who were victims of Nazi persecution. This includes payments made by the governments of Germany, Austria, and The Netherlands.
Chore, Attendant, or Homemaker Services-The CAO must not count income paid under a federal, state, or local government program to provide a spouse with chore, attendant, or homemaker services.
Support or Maintenance Assistance Benefits-The CAO must not count in-kind support or maintenance assistance (SMA) benefits provided by a private, nonprofit agency. SMA benefits include in-kind provisions of food, clothing, temporary emergency shelter, furniture, appliances, and the like.
Home Energy Assistance Benefits-The CAO must not count home energy assistance (HEA) benefits. These benefits are provided in-kind by a private, nonprofit organization or as cash or in-kind assistance by:
A certified supplier of home heating oil or gas.
A certified agency that provides home energy, gets its revenues on a rate-of-return basis, and is regulated by the Pennsylvania Public Utility Commission.
A certified public utility that provides home energy.
NOTE: HEA benefits may include payments for heating or cooling, storm doors, weatherization services, blankets, and the like. HEA benefits do not include food or clothing.
Value of Free or Reduced-Price Food-The CAO must not count the value of free or reduced-price food that an individual gets under the Child and Nutrition Act or the National School Lunch Act.
Assistance to Prevent Fuel Cutoffs-The CAO must not count money that an individual gets under the Energy Emergency Crisis Assistance Program or the Emergency Energy Conservation Services program.
Fuel Assistance Payments-The CAO must not count benefits that an individual gets for home energy assistance under the Low Income Home Energy Assistance Act (LIHEAP).
Housing Subsidies-The CAO must not count Section 8 housing or utility subsidies, rehabilitation grants, or other federal housing subsidies that an individual gets under the U.S. Housing Act of 1937, the National Housing Act, Section 101 of the Housing and Urban Development Act of 1965, Title V of the Housing Act of 1949, or the Housing and Community Development Act of 1974.
Relocation Assistance and Real Property Acquisitions-The CAO must not count money that an individual gets under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
Workforce Investment Act (WIA) Supportive Services-The CAO must not count money that an individual gets from the Workforce Investment Area Agency (formerly the Job Training Partnership Act).
Alaska Native Claims-The CAO must not count money that an individual gets under the Alaska Native Claims Settlement Act.
Payments Based on Age and Residence-The CAO must not count periodic payments made by a state on the basis only of how long someone has lived in the state and of that person reaching age 65, under a program established before July 1, 1973.
Payments to Indian Tribes-The CAO must not count the following:
Payments to the Blackfeet and Gros Ventre Tribes under the act of March 19, 1972.
Payments to the Grand River Band of Ottawa Indians under the act of October 18, 1976.
The Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation under Section 2 of the act of October 10, 1978.
Tribes or groups under Section 7 of the act of October 9, 1973.
Receipts from land held in trust by the federal government and given out to members of certain Indian tribes under Section 6 of the act of October 17, 1975.
Payment to Volunteers-The CAO must not count payments to volunteers in the Foster Grandparent Program and similar programs.
Older Americans Act Benefits-The CAO must not count any money, other than wages, that a person gets under the Older Americans Act of 1965.
Retroactive SSI and RSDI Payments-The CAO must not a count retroactive SSI or RSDI payment for six calendar months after the month when the person got it.
NOTE: If part of the payment remains after the end of the six-month period, it must be counted as a resource.
Japanese-American and Aleutian Restitution Payments-The CAO must not count payments made under Title I of the Civil Liberties Act of 1988 or Title II of the Aleutian and Pribilof Island Act enacted August 10, 1988, including payments made to survivors.
Interest from Certain Burial Space Arrangements-The CAO must not count interest earned on agreements for the purchase of excluded burial spaces if the interest is left to build up. Interest not left to build up must be counted as income.
Cash Assistance Payment Received by the Spouse-The CAO must not count any income that was counted or excluded in determining the cash assistance payment for the spouse.
Certain Income of the Spouse-The CAO must not count any income of the spouse that was counted in determining the amount of a cash assistance payment for another person.
Census Bureau Income-The CAO must not count income that an individual gets from temporary employment with the Census Bureau.
An employed spouse who is blind can get certain deductions from earned income. These deductions must be given to an employed blind spouse who is:
Under age 65.
Age 65 or older and has received MA benefits as a blind person in at least one of the 12 months before the month of their 65th birthday.
Age 65 or older and should have been found eligible for MA as a blind person in one of the 24 months before their 65th birthday but was denied.
The CAO must allow a deduction for the following proven costs of getting income:
Transportation expenses to and from work, including, but not limited to, the following:
A guide dog and the cost of keeping the dog.
Cane travel instruction.
Public transportation (including taxi fare).
The actual cost, up to 15 cents per mile, for transportation by private car.
Job-performance expenses, including, but not limited to, the following:
Braille instruction.
Translation of materials into Braille.
Childcare costs, if they are not provided in some other way.
Equipment needed on the job for housebound work.
Lunches.
Instruction in grammar, if it is work related.
Licenses.
Professional association dues that are work related.
Prostheses needed for work, no matter whether they are related to blindness.
Optical aids.
Readers.
Safety shoes.
Federal, state, local, FICA and self-employment taxes.
Tools used on the job.
Uniforms and care of the uniforms.
Union dues.
Wheelchair, if it is needed because of disability.
Job-improvement expenses, including, but not limited to, the following:
Stenotype instruction for a blind typist.
Keypunch training.
Computer program training courses.
To determine the amount of the spouse's income that is deemed available, the CAO must take the following actions:
1. Determine if the spouse is living with the applicant/recipient when they client apply. If a separation took place in the month of application, the CAO must do the following:
For NMP, decide on income eligibility for the month of application. Include the income deemed from the spouse. Decide on income eligibility for the following month by taking out the deemed income.
For MNO, decide on income eligibility for a six-month period. Include deemed income for one month (the month of application). Determine the MNO six-month limit by adding the MNO monthly limit for two persons to five months of the MNO monthly limit for one person.
Example:
|
1 person MNO limit ($425/mo. × 5 mos.) |
$2,125 |
|
2 person MNO limit ($442/mo. × 1 mo.) |
+442 |
|
Total MNO limit for 6-month period |
$2,567 |
NOTE: If no income is deemed available, use the six-month MNO limit for one person.
2. Determine the spouse's total countable gross earned and unearned income for the month for which eligibility is being decided on. Exclude income under the SSI-related rules of Chapter 350, Income.
3. Allow a deduction for dependent children, if there are any. (See Section 355.411.)
4. Allow a deduction for expenses related to the employment of a blind spouse, if there is one. (See Section 355.413.)
5. Compare the spouse's remaining income with 50% of the one-person SSI federal benefit rate. (See Appendix A.)
If the income is equal to or less than 50% of the rate, do not deem the income.
NOTE: If there is no income deemed from the spouse, the income limit for the applicant or recipient does not include the spouse.
If the income is more than 50% of the rate, deem the net income from the spouse as follows:
Combine the deemed unearned income with the unearned income of the applicant or recipient.
Combine the deemed earned income with the earned income of the applicant or recipient.
6. Decide on eligibility for MA according to Chapter 368, Determining Eligibility for NMP, or Chapter 369, Determining Eligibility for MNO. Apply the allowable deductions as if the combined income were the applicant/recipient's income.
NOTE: Allow one earned income incentive deduction of $65, and add half of the amount left over to the combined earned income of the spouse and the applicant or recipient.
7. If the applicant or recipient is not eligible for NMP or MNO, decide whether they are eligible for NMP or MNO spend-down.
NOTE: Only medical expenses for an applicant/recipient group member can be used as medical spend-down deductions.
8. If income is deemed, count the spouse when determining the income limit. 55 Pa. Code § 181.110
Example: Tammy Davis applies for MA for Tammy only and is evaluated for NMP MA. Tammy gets $650 a month in Social Security Disability benefits and $100 a month in earned income. Tammy's spouse Samuel Davis lives in the home but does not want to apply for MA. Samuel gets $350 a month in earned income and $400 a month in unearned income. Their ten-year-old child, Tom, also lives in the home. Tom has income of $100 a month. Tom is not included in the applicant/recipient group. Deemed income is figured as followed:
|
50% of the SSI federal benefit rate (2024) |
$482.55 |
|
Tom's income |
-100.00 |
|
Dependent child deduction |
$382.55 |
|
Samuel Davis’s unearned income |
$400.00 |
|
Dependent child deduction |
-$382.55 |
|
Deemed unearned income |
$17.45 |
|
Deemed earned income |
+350.00 |
|
|
$367.45 |
|
50% of the SSI federal benefit rate (2024) |
$482.55 |
Samuel's countable income is less than 50 percent of the SSI federal benefit rate. The CAO will not deem unearned and earned income of Samuel to Tammy Davis.
Revised October 4, Replacing May 29, 2024