Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.57 - Income

Current through Register Vol. 47, No. 3, July 24, 2024
When determining initial and ongoing eligibility for the
				  family medical assistance program (FMAP) and FMAP-related Medicaid coverage
				  groups, all unearned and earned income, unless specifically exempted,
				  disregarded, deducted for work expenses, or diverted as defined in these rules,
				  shall be considered.
1. Unless
				otherwise specified at rule
				441-75.1 (249A),
				the determination of initial eligibility is a three-step process. Initial
				eligibility shall be granted only when (1) the countable gross nonexempt
				unearned and earned income received by the eligible group and available to meet
				the current month's needs is no more than 185 percent of living costs as
				identified in the schedule of needs at subrule 75.58(2) for the eligible group
				(Test 1); (2) the countable net earned and unearned income is less than the
				schedule of living costs as identified in the schedule of needs at subrule
				75.58(2) for the eligible group (Test 2); and (3) the countable net unearned
				and earned income, after applying allowable disregards, is less than the
				schedule of basic needs as identified at subrule 75.58(2) for the eligible
				group (Test 3).
2. The
				determination of continuing eligibility is a two-step process. Continuing
				eligibility shall be granted only when (1) countable gross nonexempt income, as
				described for initial eligibility, does not exceed 185 percent of the living
				costs as identified in the schedule of needs at subrule 75.58(2) for the
				eligible group (Test 1); and (2) countable net unearned and earned income is
				less than the schedule of basic needs as identified in the schedule of needs at
				subrule 75.58(2) for the eligible group (Test 3).
3. Child support assigned to the department
				in accordance with 441-subrule 41.22(7) shall be considered unearned income for
				the purpose of determining continuing eligibility, except as specified at
				paragraphs 75.57(1)
"e, '15.51(6) "u, "
and 75.57(7)
"o.
				"
Expenses for care of children or disabled adults, deductions, and
				diversions shall be allowed when verification is provided.
(1)
Unearned income.
Unearned income is any income in cash that is not gained by labor or service.
				When taxes are withheld from unearned income, the amount considered will be the
				net income after the withholding of taxes (Federal Insurance Contribution Act,
				state and federal income taxes). Net unearned income shall be determined by
				deducting reasonable income-producing costs from the gross unearned income.
				Money left after this deduction shall be considered gross income available to
				meet the needs of the eligible group.
a.
				Social security income is the amount of the entitlement before withholding of a
				Medicare premium.
b. Financial
				assistance received for education or training. Rescinded lAB 2/11/98, effective
				2/1/98.
c. Rescinded lAB 2/11/98,
				effective 2/1/98.
d. When the
				client sells property on contract, proceeds from the sale shall be considered
				exempt as income. The portion of any payment that represents principal is
				considered a resource upon receipt as defined in subrule 75.56(4). The interest
				portion of the payment is considered a resource the month following the month
				of receipt.
e. Support payments in
				cash shall be considered as unearned income in determining initial and
				continuing eligibility.
(1) Any nonexempt
				cash support payment, for a member of the eligible group, made while the
				application is pending shall be treated as unearned income.
(2) Support payments shall be considered as
				unearned income in the month in which the IV-A agency (income maintenance) is
				notified of the payment by the IV-D agency (child support recovery unit).
The amount of income to consider shall be the actual amount
				  paid or the monthly entitlement, whichever is less.
(3) Support payments reported by child
				support recovery during a past month for which eligibility is being determined
				shall be used to determine eligibility for the month. Support payments
				anticipated to be received in future months shall be used to determine
				eligibility for future months. When support payments terminate in the month of
				decision of an FMAP-related Medicaid application, both support payments already
				received and support payments anticipated to be received in the month of
				decision shall be used to determine eligibility for that month.
(4) When the reported support payment,
				combined with other income, creates ineligibility under the current coverage
				group, an automatic redetermination of eligibility shall be conducted in
				accordance with the provisions of rule
				441-76.11
				(249A). Persons receiving Medicaid under the family medical assistance program
				in accordance with subrule 75.1(14) may be entitled to continued coverage under
				the provisions of subrule 75.1(21). Eligibility may be reestablished for any
				month in which the countable support payment combined with other income meets
				the eligibility test.
f.
				The client shall cooperate in supplying verification of all unearned income and
				of any change in income, as defined at rule
				441-75.50 (249A).
(1) When the information is available, the
				department shall verify job insurance benefits by using information supplied to
				the department by Iowa workforce development. When the department uses this
				information as verification, job insurance benefits shall be considered
				received the second day after the date that the check was mailed by Iowa
				workforce development. When the second day falls on a sunday or federal legal
				holiday, the time shall be extended to the next mail delivery day.
(2) When the client notifies the department
				that the amount of job insurance benefits used is incorrect, the client shall
				be allowed to verify the discrepancy. The client must report the discrepancy
				before the eligibility month or within ten days of the date on the Notice of
				Decision, Form 470-0485, 470-0485(8), 470-0486, or 470-0486(8), applicable to
				the eligibility month, whichever is later