reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-001 - RELATIVE RESPONSIBILITY

Current through June 17, 2024
1. Spouse for
  spouse; and
2. Parent (biological,
  adoptive, or step) for child if the child is eighteen (18) years old or younger
  and still considered part of the household.
001.01 Child Considered Part of Household
1. If a child is living in the same household
  with his/her parent(s), the parent(s)' income must be included.
2. If a child is temporarily absent from the
  home (generally ninety (90) days or fewer) but is still considered part of the
  household, the parent(s)' income must be included. Temporary absence includes,
  but is not limited to:
a. School attendance
  where the child returns to the home on a regular basis (weekends, vacations, or
  summers); or
b. Residence in an
  institution for a developmental disability or mental illness for 90 days or
  fewer may be considered temporary absence if the child was living in the
  parent(s)' household before institutionalization and will return to the
  parent(s)' household upon discharge.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-002 - FINANCIAL RESPONSIBILITY

Current through June 17, 2024
002.01 Unmarried Parents
When unmarried parents are living together, the alleged father is not
	 financially responsible unless he has acknowledged paternity or a court has
	 determined that he is the father of the child after the birth.
002.02 Children of a Marriage
Married individuals are considered the parents of any children who are
	 conceived or born during a marriage, even if the couple is separated, has filed
	 for divorce or annulment, or states that one individual is not the parent of
	 the child, unless there is a court order that states
	 otherwise.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-003 - DETERMINATION OF PATERNITY

Current through June 17, 2024
Paternity cannot be established unless an alleged father has signed a
	 written and notarized paternity acknowledgment form or a court has determined
	 him to be the father. Note: Paternity cannot be established for an
	 unborn
003.01 Medical Assistance for
  Individuals 18 or Younger
Children may receive Medicaid if they meet the eligibility requirements
	 outlined in this material. See Appendix 477-000-012 for the applicable federal
	 poverty levels.
1. Newborn child(ren):
  Newborn child(ren) born to Medicaid eligible pregnant women are eligible at the
  time of birth, if the family income equals the applicable federal poverty
  level, through the month of the child's first birthday.
2. Children up to age one: Children up to the
  age of one are eligible if the family income equals the applicable federal
  poverty level.
3. Children age five
  or younger: Children age one through five (through the month of their sixth
  birthday) are eligible if the family income equals the applicable federal
  poverty level.
4. Children ages six
  and older: Children ages 6 through 18 are eligible if the family income equals
  the applicable federal poverty level. Eligibility continues through the month
  of the child's 19th birthday.
5.
  Children's Health Insurance Program (CHIP): Children age 18 or younger who do
  not meet income limits for Medicaid are eligible for CHIP if the family income
  is at or below the applicable Federal Poverty Level and are not covered by
  creditable health insurance.
6.
  Minor pregnant women: Minor pregnant women who do not meet the income limits
  for children's Medicaid are eligible under the Pregnant Woman category if the
  family income equals the applicable federal poverty level. Ongoing Medicaid
  eligibility must be reviewed prior to the end of the 60-day postpartum
  period.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-004 - MILITARY SERVICE

Current through June 17, 2024
004.01 Eligibility Requirements
If a parent is absent due to active duty in the uniformed services of
	 the United States, that parent is still considered part of the assistance unit
	 and his/her income is considered available to the unit. Uniformed service is
	 defined as the Army, Navy, Air Force, Marine Corps, Coast Guard, Environmental
	 Sciences Services Administration, and Public Health Service of the United
	 States. If a client states that separation is due to reasons other than
	 performance in military service, the client must provide proof of bona fide
	 separation.
004.02 Nebraska
  Residence
If a parent in the military is incarcerated, s/he is no longer
	 considered part of the assistance unit.
004.03 Relative Responsibility
Relative responsibility for 599 CHIP has the following
	 exception:
For a pregnant minor, their financially responsible parent(s) income
	 shall not be used in the unborn child(s) 599 CHIP budget.
004.04 Age Requirement
For receipt of 599 CHIP benefits, an individual is considered an unborn
	 child from conception to birth.
004.05 Unborn 599 CHIP Eligibility if
  Parent(s) Does Not Cooperate
If an ineligible pregnant woman or her spouse fails or refuses to
	 cooperate with third party liability, the unborn(s) is ineligible for 599
	 CHIP.
004.06 Effective Date
  of Medical Eligibility
The effective date of eligibility for 599 CHIP is no earlier than the
	 first day of the application month.
Note: There is no retroactive eligibility for the 599 CHIP
	 Program.
004.07 Continuous
  Eligibility
Unborn children are continuously eligible up to six months or through
	 their month of birth, whichever comes first. After the six months of continuous
	 eligibility, a full eligibility review is not required. However, information
	 reported or known to the Department must be acted upon.
Note: The unborn must have at least a 30 day period of ineligibility
	 before they would qualify for another six month period of continuous
	 eligibility.
Following the birth of the child, eligibility will be determined for
	 medical assistance based on any changes reported or known to the
	 Department.
Note: Following the birth, if the newborn is determined eligible for
	 medical assistance, the newborn is eligible for six months of continuous
	 medical eligibility.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-005 - SPECIAL PROVISIONS PERTAINING TO MINOR PARENTS

Current through June 17, 2024
005.01
Minor Parent
If a minor parent has a legal guardian, according to Nebraska law, the
	 guardian has no financial responsibility for the minor.
005.02
Minor's Parent(s)
  Receiving Medicaid
If a minor parent is living with his/her parent(s) who is receiving
	 Medicaid for another child, the minor parent must be in his/her parent(s)'
	 unit.
005.03 Living
  Arrangement
The former ward must continue to be in an out-of-home situation to
	 remain eligible for the program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS › Section 477-18-006 - HOSPITAL PRESUMPTIVE ELIGIBILITY

Current through June 17, 2024
The Department shall provide Medicaid during a presumptive eligibility
	 period to individuals who are determined eligible by a qualified hospital. The
	 determination is on the basis of preliminary information, that the individual
	 has gross income at or below the income standard established for the applicable
	 group, has attested to being a citizen or national of the United States or is
	 in satisfactory immigration status, and is a resident of Nebraska, to be
	 presumptively eligible in accordance with the policies and procedures
	 established by the Department. Determinations are limited to:
1. Children (see 477 NAC
  18-003);
2. Pregnant women (see 477 NAC
  18-001.02);
3. Breast and Cervical
  Cancer (see Women's Cancer Program at 477 NAC
  24-004);
4. Parents and caretaker relatives (see 477
  NAC
  18-002); and
5. Former foster care children (see 477 NAC
  24-006).
A presumptive eligibility determination is limited to no more than one
	 period within two calendar years per person.
A pregnant woman is eligible for ambulatory care only. The qualified
	 provider may authorize a period of presumptive eligibility once per
	 pregnancy.
Notice and fair hearing regulations do not apply to determinations of
	 presumptive eligibility.
006.01 Qualified Entities Responsibilities
1. Notify the appropriate individual at the
  time a determination regarding presumptive eligibility is made, in writing or
  orally if appropriate, of such determination, that:
a. If a Medicaid application on behalf of the
  eligible individual is not filed by the last day of the following month, the
  individual's presumptive eligibility will end on that last day;
b. If a Medicaid application on behalf of the
  eligible individual is filed by the last day of the following month, the
  individual's presumptive eligibility will end on the day that a decision is
  made on the Medicaid application; and
c. If the individual is not determined
  presumptively eligible, the qualified entity shall notify the appropriate
  individual of the reason for the determination and that he or she may file an
  application for Medicaid with the Medicaid agency.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern the services provided under Nebraska's
	 Medicaid program as defined by the Medical Assistance Act, Nebraska Revised
	 Statute §
									68-901
	 et seq.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-002 - PREGNANT WOMEN

Current through June 17, 2024
002.01
PREGNANT WOMEN.
In order to be eligible as a pregnant
  woman, an individual must be pregnant and have income equal to or less than
  194% of the Federal Poverty Level (FPL).
002.01(A)
POST-PARTUM
  ELIGIBILITY.
In order for a pregnant woman to be eligible for the
  post-partum period, she must have been eligible for and enrolled in Medicaid on
  the date her pregnancy ends. If a pregnant woman is found to be retroactively
  eligible for the date her pregnancy ends, she is eligible for the post-partum
  period.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-003 - PARENTS AND CARETAKER RELATIVES

Current through June 17, 2024
003.01
PARENTS AND CARETAKER RELATIVES.
In order to be
  eligible as a Parent or Caretaker Relative, an individual must:
(A) Have a dependent child, see 477 NAC 1,
  and
(B) Have household income equal
  to or less than 58% of the Federal Poverty Level (FPL).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-004 - CHILDREN

Current through June 17, 2024
004.01
MEDICAID FOR CHILDREN
  UNDER AGE 19.
Children may receive Medicaid if they meet one of
  the following the eligibility requirements:
(A)
Newborn
  children
: Newborn children born to Medicaid eligible pregnant
  women are eligible at the time of birth for one year;
(B)
Infants under age
  one
: Children under age one are eligible if their household income
  is equal to or less than 162% of the Federal Poverty Level (FPL);
(C)
Children age one through age
  five
: Children age one through age five are eligible if their
  household income is equal to or less than 145% of the Federal Poverty Level
  (FPL);
(D)
Children age
  six through age 18
: Children age six through age 18 are eligible
  if their household income is equal to or less than 133% of the Federal Poverty
  Level (FPL);
(E)
Children's Health Insurance Program (CHIP)
: Children
  age 18 or younger who do not meet income limits for Medicaid are eligible for
  Children's Health Insurance Program (CHIP) if their household income is equal
  to or less than 213% of the Federal Poverty Level (FPL) and the children are
  not covered by creditable health insurance; or
(F)
Minor pregnant
  women
: Minor pregnant women who do not meet the income limits for
  children's Medicaid are eligible under the Pregnant Women's category if their
  household income is at or below the applicable Federal Poverty Level (FPL).
  Ongoing Medicaid eligibility must be reviewed prior to the end of the 60-day
  postpartum period.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-005 - 599 CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)

Current through June 17, 2024
005.01
ELIGIBILITY
  REQUIREMENTS.
A pregnant womanwho is not otherwise eligible for
  Medicaid or Children's Health Insurance Program (CHIP)may have her unborn
  child's eligibility reviewed under the 599 Children's Health Insurance Program
  (CHIP) program. Eligibility for Medicaid must first be determined before 599
  Children's Health Insurance Program (CHIP) eligibility can be reviewed.
  Eligibility is determined for unborn children from conception through birth, if
  the household income is equal to or less than 197% of the Federal Poverty Level
  (FPL).
005.01(A)
CITIZENSHIP AND
  NON-CITIZEN STATUS.
599 Children's Health Insurance Program (CHIP)
  has no requirement for citizenship or alien status, as the unborn child's
  status is independent of that of the pregnant woman.
005.01(B)
CREDITABLE HEALTH
  INSURANCE.
There is no eligibility for the unbornchild if the
  pregnant woman has creditable health insurance. Health insurance which does not
  provide prenatal or maternity care is not considered creditable coverage. For a
  definition of creditable health insurance, see 477 NAC 1.
005.01(C)
NEBRASKA
  RESIDENCE.
The residency of the unborn child will follow the
  residency of the pregnant woman.
005.01(D)
RELATIVE
  RESPONSIBILITY.
Relative responsibility in the 599 Children's
  Health Insurance Program (CHIP) is determined using relative responsibility
  regulations for modified adjusted gross income (MAGI) programs. For a pregnant
  minor, the income of her financially responsible parents shall not be used to
  determine eligibility for the unborn child.
005.01(E)
AGE
  REQUIREMENT.
For receipt of 599 Children's Health Insurance
  Program (CHIP) benefits, an individual is considered an unborn child from
  conception until birth.
005.01(F)
THIRD PARTY LIABILITY.
If an ineligible pregnant woman
  or her spouse fails or refuses to cooperate with third party liability, the
  unborn child is ineligible for 599 Children's Health Insurance Program
  (CHIP).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-006 - FORMER WARDS

Current through June 17, 2024
006.01
ELIGIBILITY REQUIREMENTS.
In order for an individual
  to be eligible in the former ward program, he or she must:
(A) Meet non-financial eligibility
  requirements for Medicaid;
(B) Be
  age 18 through age 20;
(C) Have
  income equal to or less than 51% of the Federal Poverty Level (FPL);
(D) Be a former ward of the Department;
  and
(E) Be regularly attending a
  school, college, or a course of vocational or technical training designed to
  prepare the individual for gainful employment.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-007 - NON-IV-E SUBSIDIZED ADOPTIONS AND GUARDIANSHIPS FOR YOUNG ADULTS

Current through June 17, 2024
007.01
ELIGIBILITY
  REQUIREMENTS.
In order for an individual to be eligible for
  Medicaid in this program, he or she must:
(A)
  Be age 19 through age 20;
(B)Have
  entered into a subsidized guardianship agreement or a subsidized adoption
  agreement after reaching age 16;
(C)Meet at least one of the following
  criteria:
(i) The individual is completing
  secondary education or in an educational program leading to an equivalent
  credential;
(ii) The individual is
  enrolled in an institution that provides postsecondary or vocational education;
(iii)The individual is employed
  for at least 80 hours per month;
(iv)The individual is participating in a
  program or activity designed to promote employment or remove barriers to
  employment; or
(v) The individual
  is incapable of doing any part of these activities due to a medical condition.
  Incapacity must be supported by regularly updated information in the case plan
  of the individual; and (D) Have income equal to or less than 23% of the Federal
  Poverty Level (FPL).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 19 - MODIFIED ADJUSTED GROSS INCOME (MAGI) BASED PROGRAMS › Section 477-19-008 - PRESUMPTIVE ELIGIBILITY

Current through June 17, 2024
008.01
ELIGIBILITY REQUIREMENTS.
To be presumptively eligible
  in accordance with the policies and procedures established by the Department, a
  presumptive eligibility determination must be made by a qualified provider on
  the basis of preliminary information indicating the individual has gross income
  at or below the income standard established for the applicable group, has
  attested to being a citizen or national of the United States or is in
  satisfactory non-citizen status, and is a resident of Nebraska.
008.02
EFFECTIVE
  DATE.
Presumptive eligibility begins on the date the provider
  completes a presumptive eligibility determination.
008.03
ELIGIBILITY
  PERIOD.
If the individual files an application for Medicaid by the
  last day of the month following the month in which the qualified provider made
  the determination of presumptive eligibility, the presumptive eligibility ends
  on the day the Department makes the determination of Medicaid eligibility based
  on that application. If the individual does not file an application for
  Medicaid by the last day of the month following the month in which the
  qualified provider made the determination, the presumptive eligibility ends on
  that day. A presumptive application approved in error will be closed by the
  Department upon discovery of the error.
008.04
NOTICES.
Notice and fair hearing regulations do not apply to determinations and closures
  of presumptive eligibility.
008.05
RESPONSIBILITIES OF QUALIFIED ENTITIES.
An entity
  qualified to make presumptive eligibility determinations must:
(A) Notify the appropriate individual at the
  time a determination regarding presumptive eligibility is made, in writing or
  orally if appropriate, of such determination, and of the presumptive
  eligibility period, and
(i) If a Medicaid
  application on behalf of the eligible individual is not filed by the last day
  of the following month, the individual's presumptive eligibility will end on
  that last day;
(ii) If a Medicaid
  application on behalf of the eligible individual is filed by the last day of
  the following month, the individual's presumptive eligibility will end on the
  day that a decision is made on the Medicaid application;
(iii) If the individual is not determined
  presumptively eligible, the qualified entity must notify the appropriate
  individual of the reason for the determination and he or she may file an
  application for Medicaid with the Department;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 20 - DEFINITIONS PERTAINING TO NON-MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS › Section 477-20-001 - APPLICABILITY

Current through June 17, 2024
Chapters 477 Nebraska Administrative Code (NAC) 20 through 28 apply to
	 the following: Aged, Blind, and Disabled (ABD); Medically Needy (MN); Medicaid
	 Insurance for Workers with Disabilities (MIWD); Women's Cancer Program;
	 Transitional Medical Assistance (TMA); Former Foster Care; Emergency Medical
	 Services Assistance (EMSA); and Children and Young Adults Eligible for IV-E
	 Assistance
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 20 - DEFINITIONS PERTAINING TO NON-MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS › Section 477-20-002 - SCOPE AND AUTHORITY

Current through June 17, 2024
The regulations govern the services provided under Nebraska's Medicaid
	 program as defined by the Medical Assistance Act (Nebraska Revised Statute
	 §
									68-901
	 et seg).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 21 - HOUSEHOLD OR UNIT SIZE FOR NON-MAGI PROGRAMS › Section 477-21-001.01 - Determination of Unit Size

Current through June 17, 2024
The unit size shall be based on the number of family members. Except
	 for ABD programs, this number shall include unborn(s). The principles of
	 relative responsibility apply, see 477 NAC
	 24-001.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 22 - INCOME FOR NON-MODIFIED ADJUSTED GROSS INCOME (NON-MAGI) PROGRAMS › Section 477-22-001 - APPLICABILITY

Current through June 17, 2024
This chapter applies to the following Non-Modified Adjusted Gross
	 Income (Non-MAGI) programs: Aged, blind, and disabled (ABD); medically needy
	 (MN); medical insurance for workers with disabilities (MIWD); women's cancer
	 program; transitional medical assistance (TMA); former foster care (FFC);
	 emergency medical services assistance (EMSA); and children and young adults
	 eligible for IV-E assistance.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 22 - INCOME FOR NON-MODIFIED ADJUSTED GROSS INCOME (NON-MAGI) PROGRAMS › Section 477-22-002 - INCOME

Current through June 17, 2024
002.01
DEFINITION.
Income is a gain or recurrent benefit received in money or in-kind from
  employment, business, property, investments, gifts, benefits, or annuities, at
  regular or irregular intervals of time. Unless otherwise stated in this
  chapter, income is defined and counted according to 20 Code of Federal
  Regulations (CFR) Part 416 Subpart K.
002.02
VERIFICATION.
Income must be verified at least every 12 months. Verification of
  income consists of at least the following:
(i) The source of the payment or
  benefit;
(ii) The date the payment
  or benefit was received;
(iii) The
  person entitled to receive the payment or benefit;
(iv) The period covered by the payment or
  benefit; and
(v) The gross amount
  of payment or benefit.
002.02(A)
VERIFICATION SOURCES.
Electronic data sources will
  be used to verify income, if available. Paper documentation is required when
  electronic data sources are either unavailable or are not reasonably compatible
  with a client's attestation.
002.02(A)(i)
STABLE INCOME.
One month's income is verified when a
  client's income is stable.
002.02(A)(ii)
FLUCTUATING
  INCOME.
When a client's income fluctuates, the most recent three
  months income is verified, when available.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 22 - INCOME FOR NON-MODIFIED ADJUSTED GROSS INCOME (NON-MAGI) PROGRAMS › Section 477-22-003 - EARNED INCOME

Current through June 17, 2024
003.01
DEFINITION.
Earned income is money received from
  wages, tips, salary, commissions, bonuses, holiday pay, or profits from
  activities in which an individual is engaged as a self-employed person or as an
  employee. Earned income does not include reimbursement for employment-related
  expenses such as fuel, mileage, lodging, or meals.
003.02
IN-KIND INCOME.
For programs in which age, blindness, or disability is an
  eligibility requirement, earned income includes any food, clothing, shelter, or
  other items provided in lieu of wages.
003.03
SELF-EMPLOYMENT.
Self-employment is an activity or
  work effort performed by the individual for the purpose of generating income.
  Passive receipt of income from a resource does not constitute self-employment.
  For self-employed individuals, the net amount of income, after payment of
  expenses, is used to determine eligibility. Gross income and expenses must be
  verified. If the self-employed individual files taxes on this source of income,
  then the taxable amount of income from the self-employment may be used.
003.03(A)
OFFSET OF INCOME.
Losses from self-employment may be used to offset other earned
  income of the individual or a financially responsible spouse or relative.
  Self-employment losses cannot be used to offset unearned income.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 22 - INCOME FOR NON-MODIFIED ADJUSTED GROSS INCOME (NON-MAGI) PROGRAMS › Section 477-22-004 - UNEARNED INCOME

Current through June 17, 2024
004.01
DEFINITION.
Unearned income is any cash benefit that
  is not the direct result of labor or services performed by the individual as an
  employee or a self-employed person. Unearned income includes, but is not
  limited to:
(A) Retirement, Survivors, and
  Disability Insurance (RSDI) benifits;
(B) Railroad retirement benefits;
(C) Child, cash, and medical
  support;
(D) Military service
  benefits;
(E) Veteran's Affairs
  (VA) benefits;
(F) Civil service
  benefits;
(G) Unemployment
  compensation;
(H) Gifts or
  inheritance;
(I) Disability
  insurance benefits;
(J) Workers'
  compensation payments;
(K)
  Disability benefits, other than sick leave, paid by an employer;
(L) Returns from certain
  investments;
(M) Payments from an
  annuitized annuity; or
(N) Income
  from a life estate in real property.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 22 - INCOME FOR NON-MODIFIED ADJUSTED GROSS INCOME (NON-MAGI) PROGRAMS › Section 477-22-005 - INCOME DISREGARDS

Current through June 17, 2024
005.01
EARNED INCOME DISREGARDS.
Specific portions of earned income are
  disregarded in determining eligibility. The amounts below are only disregarded
  from the earned income received by the client or a financially responsible
  relative and do not apply to unearned income.
005.01(A)
AMERICORPS INCOME.
Income earned by participants in the AmeriCorps program is
  disregarded.
005.01(B)
INCOME FROM EMPLOYMENT.
Earned income from employment is
  disregarded according to the category of eligibility.
005.01(B)(i)
AGED, BLIND, AND
  DISABLED (ABD) CLIENTS.
For categories of eligibility where age,
  blindness, or disability are an eligibility factor, earned income receives the
  following disregards:
(1) Aged or disabled
  clients deduct $65 from the gross amount of earned income. The remainder is
  divided by two to arrive at the countable amount used to determine eligibility;
  or
(2) Blind or blind-aged clients
  deduct $85 from the gross amount of earned income. The remainder is divided by
  two to arrive at the countable amount used to determine eligibility.
005.01(B)(ii)
MEDICALLY NEEDY FAMILIES AND CHILDREN.
Medically needy families
  and children categories of eligibility are allowed the following disregards
  from earned income to determine the countable amount used to determine
  eligibility:
(1) One-hundred dollars ($100)
  is deducted from the gross amount of earned income of each employed individual
  whose income is used to determine eligibility;
(2) Child care expenses as billed or paid are
  deducted if the parent whose income is used to determine eligibility requires
  child care in order to participate in education, training, or employment;
  and
(3) Any earned income of a
  child is disregarded.
005.01(C)
EARNED INCOME TAX
  CREDITS (EIC).
The amount of an individual's earned income tax
  credits (EIC) are not counted as income. This includes any advanced earned
  income tax credits (AEIC).
005.01(D)
JURY PAY.
Income received from serving on a jury is disregarded.
005.01(E)
INCOME FROM THE
  NATIONAL COMMUNITY SERVICE TRUST ACT.
Income earned from programs
  funded by the National Community Service Trust Act of 1993 are not counted as
  income for eligibility. This includes the following programs:
(i) Volunteers in Service to America (VISTA
  or AmeriCorps VISTA);
(ii)
  University Year for Action;
(iii)
  Special and Demonstration Volunteer Programs;
(iv) Retired Senior Volunteer Program
  (RSVP);
(v) Foster Grandparent
  Program; and
(vi) Senior Companion
  Program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 23 - RESOURCES FOR NON MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS › Section 477-23-001 - APPLICABILITY

Current through June 17, 2024
Chapters 477 Nebraska Administrative Code (NAC) 20 through 28 apply to
	 the following: Aged, Blind, and Disabled (ABD); Medically Needy (MN); Medicaid
	 Insurance for Workers with Disabilities (MIWD); Women's Cancer Program;
	 Transitional Medical Assistance (TMA); Former Foster Care; Emergency Medical
	 Services Assistance (EMSA); and Children and Young Adults Eligible for IV-E
	 Assistance
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 23 - RESOURCES FOR NON MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS › Section 477-23-002 - SCOPE AND AUTHORITY

Current through June 17, 2024
The regulations govern the services provided under Nebraska's Medicaid
	 program as defined by the Medical Assistance Act (Nebraska Revised Statute
	 [Neb. Rev. Stat.l §
									68-901
	 et seg).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 23 - RESOURCES FOR NON MODIFIED ADJUSTED GROSS INCOME (MAGI) PROGRAMS › Section 477-23-003 - RESOURCES

Current through June 17, 2024
003.01
RESOURCES.
The total equity value of available non-excluded resources of the client or
  client and responsible relative is determined and compared with the established
  maximum for available resources the client may own and still be considered
  eligible. If the total equity value of available non-excluded resources exceeds
  the established maximum, the client is ineligible.
003.02
VERIFICATION OF RESOURCES.
As a condition of both retroactive and prospective eligibility,
  all countable resources must be verified and documented in the case record. See
  the Medicaid Resource Verification Plan for verification sources.
003.02(A)
EXCEPTIONS.
(i) For Aged, Blind,
  and Disabled clients who receive Supplemental Security Income, including
  individuals in 1619(b) status, verification of resources is not required.
(ii) If it is unknown whether or
  not a resource is countable, verification will be required.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-001 - RELATIVE RESPONSIBILITY

Current through June 17, 2024
In determining eligibility, the Department must consider as available
	 to a client the income and resources of
1. A parent (biological, adoptive, or step)
  for a child if the child is eighteen (18) years old or younger and is still
  considered part of the household; and
2. One spouse for another spouse.
001.01 Parent for Child Relative
  Responsibility
24-001.01A
Child
  Considered Part of Household
: If a child is living in the same
  household with his/her parent(s), the parent(s)'s income and resources must be
  considered available to the child.
24-001.01A1
Exceptions
: A parent(s)'s income and resources are not
  considered available to
i. A pregnant minor
  who, pursuant to Neb. Rev. Stat. section
  71-6903,
  is denied financial support by her parents, guardians, or custodians due to her
  refusal to obtain an abortion, and is therefore considered emancipated for
  purposes of public assistance;
ii.
  A child receiving Home and Community-Based Waiver;
iii. A child receiving Developmental
  Disability Waiver; or
iv. A child
  approved for Katie Beckett Medicaid. See 477 NAC
  24-001G2b(1) and 477
  NAC 27-009.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-002 - SPONSOR DEEMING FOR ALIENS

Current through June 17, 2024
002.01 Sponsors for Aliens
One hundred (100) percent of the income and resources of a sponsor (and
	 sponsor's spouse, if they are living together) shall be considered when
	 determining the eligibility of an alien who applies for Medicaid if the sponsor
	 has signed an affidavit of support under Section 213A of the Immigration and
	 Nationality Act. Alien status must be verified by electronic data sources. The
	 sponsor's income and resources will be considered available to the alien until
	 one or more of the following circumstances apply:
1. The individual becomes a U.S.
  citizen;
2. The individual has
  worked 40 qualifying quarters of coverage as defined under Title II of the
  Social Security Act or can be credited with the qualifying quarters as provided
  under Section 435, and the alien did not receive any federal means tested
  public benefit during that time period. This provision does not apply to
  restricted Medicaid;
3. The
  individual is pregnant (including 60 days post-partum); and/or The individual
  is under age 19.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-003 - MEDICAID INSURANCE FOR WORKERS WITH DISABILITIES (MIWD)

Current through June 17, 2024
003.01 Medicaid Insurance for Workers with
  Disabilities
Working individuals who meet the necessary disability criteria, have
	 income within income guidelines, and are working, are eligible for Medicaid.
	 After application of income disregards, individuals with income less than 200
	 percent of the Federal Poverty Level (FPL) are eligible for Medicaid with no
	 premium; individuals with income of 200 through 249 percent of the FPL are
	 eligible for Medicaid with a monthly premium payment. See Appendix 477-000-046
	 for procedures.
003.02
  Eligibility Requirements
In order to receive Medicaid, the individual(s) must:
1. Qualify for Medicaid except for
  income;
2. Not be eligible for
  AABD/MA, but may be a share of cost;
3. Meet Social Security or State Review Team
  definition of disability;
4. Be
  working;
5. Using a two-part income
  test have income within income guidelines;
6. Meet Medicaid resource limits;
  and
7. Pay a premium, if
  required.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-004 - WOMEN'S CANCER PROGRAM

Current through June 17, 2024
004.01 Women's Cancer Program
The Breast and Cervical Cancer Prevention and Treatment Act of 2000
	 allows Medicaid for women who need treatment for breast or cervical cancer.
	 Section
	 68-1020,
	 Neb. Rev. Stat. authorizes this coverage in Nebraska.
004.02 Eligibility Requirements
In order to receive Medicaid, the woman must:
1. Be screened for breast and cervical cancer
  by Every Woman Matters;
2. Be found
  to need treatment for breast and/or cervical cancer, including a precancerous
  condition or early stage cancer;
3.
  Be age 64 or younger;
4. Not be
  otherwise eligible for Medicaid;
5.
  Not be covered by creditable health insurance;
6. Be a Nebraska resident; and
7. Be a U.S. citizen or a qualified
  alien.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-005 - MEDICALLY NEEDY

Current through June 17, 2024
005.01 Individuals Ineligible for Medicaid
  Due to Income
Parents/caretaker relatives, children, pregnant women, and AABD/MA
	 individuals with a medical need whose income exceeds the guidelines for
	 Medicaid eligibility may be eligible for a share of cost if all other
	 eligibility requirements are met. Once excess income is met for the month
	 Medicaid eligibility is established for that month. Each month is determined
	 separately and continuous eligibility does not apply. See Appendix 477-000-045
	 for examples.
005.02 Medical
  Insurance Disregards
The cost of medical insurance premiums is deducted if the client or
	 responsible relative is responsible for payment. The Medicare Part B premium
	 which the client or responsible relative is responsible for paying is included
	 in this disregard. Exception: The cost of premiums for income-producing
	 policies is not allowed as a medical deduction. See Appendix
	 477-000-026.
005.03 Age
Medically needy children are eligible through the month of his/her
	 19th birthday if s/he is a U.S. Citizen or is a
	 qualified alien.
24-005.03A
Exception
: A Medically needy child may be found
  eligible under this category if they are receiving impatient care in an
  Institution for Mental Disease (IMD). If an individual is an inpatient in an
  IMD when s/he reaches 21 years of age, s/he may remain eligible either until
  discharge or until s/he reaches 22, whichever comes first.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-006 - FORMER FOSTER CARE CHILDREN

Current through June 17, 2024
006.01 Former Foster Care Children
Individuals under age 26 who were in foster care and receiving Medicaid
	 when the individual attained age 18 or such higher age at which Nebraska's
	 federal foster care assistance ends.
These individuals are exempt from income and resource tests.
24-006.01A
Eligibility
  Requirements
: In order to receive Medicaid, the individual must:
1. Be under age 26;
2. Have received Medicaid at the time they
  aged out;
3. Have been in foster
  care under Nebraska or a Nebraska tribe's responsibility; and
4. Not be eligible for and enrolled in
  mandatory Medicaid coverage through Parent/Caretaker relatives, Pregnant Women,
  Children, or AABD/MA.
For Former Ward, see 477 NAC
	 18-005.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 24 - RELATIVE RESPONSIBILITY AND SPONSOR DEEMING FOR ALIENS FOR NON-MAGI PROGRAMS › Section 477-24-007 - EMERGENCY MEDICAL

Current through June 17, 2024
007.01 Emergency Medical Assistance for
  Undocumented and Ineligible Aliens
An emergency medical condition is defined as a medical condition
	 (including emergency labor and delivery) manifesting itself by acute symptoms
	 of sufficient severity (including severe pain) where the absence of immediate
	 medical attention could reasonably result in:
1. Serious jeopardy to the patient's
  health;
2. Serious impairment to
  bodily functions; or
3. Serious
  dysfunction of any bodily organ or part.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 25 - BUDGETING FOR THE MEDICALLY NEEDY › Section 477-25-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern services provided by the Nebraska Medicaid
	 program as defined by the Medical Assistance Act, Nebraska Revised Statutes
	 (Neb. Rev. Stat.) §§
									68-901 et seq.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 25 - BUDGETING FOR THE MEDICALLY NEEDY › Section 477-25-002 - ELIGIBILITY FOR THE MEDICALLY NEEDY

Current through June 17, 2024
002.01
WHEN APPLICABLE.
Children, parents or caretaker
  relatives, pregnant women, and the aged, blind, and disabled who have income
  above the limit for categorical eligibility may be eligible for Medicaid with a
  share of cost if a medical need exists or can be reasonably expected to exist.
  A medical need exists if medical costs for the financial unit exceed the
  Medically Needy Income Limit (MNIL) for the unit size.
002.02
BUDGET.
A
  budget or system must be used to determine eligibility for medically needy
  individuals. Each month is determined separately. If an individual is eligible
  for one day of the month, then that person is considered to be eligible for the
  entire month. If at any time factors change that affect eligibility, then
  eligibility must be re-determined.
002.03
METHODOLOGY
  USED
. The methodology used for the medically needy is based upon
  the most closely related cash assistance methodology. Income is counted in
  accordance with 477 NAC 22. Resources are counted in accordance with 477 NAC
  23.
002.03(A)
MEDICALLY NEEDY
  CHILDREN, FAMILIES, AND PREGNANT WOMEN.
The treatment of income
  and resources for medically needy children, parents or caretaker relatives, and
  pregnant women is based on § 1931 of the Social Security Act.
002.03(B)
MEDICALLY NEEDY AGED,
  BLIND, AND DISABLED.
The treatment of income and resources for
  individuals who are aged, blind, or disabled is based on the methodology of the
  Supplemental Security Income (SSI) program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 25 - BUDGETING FOR THE MEDICALLY NEEDY › Section 477-25-003 - CALCULATING THE SHARE OF COST

Current through June 17, 2024
003.01
MEDICALLY NEEDY NOT RECEIVING LONG-TERM CARE SERVICES AND
  SUPPORTS.
Medically needy individuals who are not residing in a
  medical institution or who do not receive Home and Community-Based Services
  (HCBS) have a share of cost (SOC) calculated according to the factors below.
  When countable income is reduced to at or below the appropriate Medically Needy
  Income Limit (MNIL), the individual is eligible to receive Medicaid.
003.01(A)
MEDICAL
  EXPENSES.
The individual must obligate payment for medical and
  remedial care expenses incurred by the individual or another person in the
  individual's financial unit. This may include medical costs not covered by
  Medicaid or medical premiums paid by the members of the unit. See 477-000-045
  for the process by which these expenses are counted and recorded. Expenses are
  used to meet the share of cost (SOC) obligation in the order in which the
  expenses are received.
003.01(B)
EFFECTIVE DATE.
The individual is eligible for
  Medicaid on the first day of the month in which the share of cost (SOC)
  obligation is met, and remains eligible for the entire month.
003.01(C)
COSTS NOT
  COVERED.
Medical and remedial care costs used to meet the share of
  cost (SOC) obligation will not be covered by Medicaid.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 26 - SPOUSAL IMPOVERISHMENT MEDICAID PROGRAM (SIMP) › Section 477-26-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations establish the conditions for eligibility for the
	 spousal impoverishment Medicaid program. These regulations are promulgated
	 under the authority of the Medical Assistance Act, Nebraska Revised Statutes
	 (Neb. Rev. Stat.) §§
									68-901 et seq. and §1924 of
	 the Social Security Act 42 United States Code (U.S.C.) §
	 1396r-5.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 477 - MEDICAID ELIGIBILITY › Chapter 26 - SPOUSAL IMPOVERISHMENT MEDICAID PROGRAM (SIMP) › Section 477-26-002 - DEFINITIONS

Current through June 17, 2024
For the purposes of these rules and regulations, the following
	 definitions apply.
002.01
COMMUNITY SPOUSE.
The spouse of an institutionalized
  spouse, as defined below. A community spouse may not reside in a medical
  institution, nursing facility, receive Home and Community-Based Services
  (HCBS), or participate in Program for All-inclusive Care for the Elderly
  (PACE).
002.02
DEPENDENT FAMILY MEMBERS.
Minor children residing with
  a community spouse, dependent parents, or siblings of the community spouse or
  institutionalized spouse who reside with the community spouse and could be
  claimed as dependents for tax purposes.
002.03
EXCESS SHELTER
  COSTS.
The amount by which the combined rent or mortgage; property
  taxes; homeowner's insurance; and condominium or cooperative fees, if
  applicable, exceed 30% of the minimum maintenance needs amount.
002.04
FAMILY MAINTENANCE
  ALLOWANCE.
The amount deducted from an institutionalized spouse's
  income to meet the maintenance needs of the community spouse and family
  members.
002.05
INSTITUTIONAL LEVEL OF CARE.
The level of care, based
  on medical and functional criteria, which is normally required by the
  Department to reside in a nursing facility, intermediate care facility for the
  developmentally disabled, or to receive Home and Community-Based Services
  (HCBS).
002.06
INSTITUTIONALIZED SPOUSE.
An individual who is in a
  medical institution, nursing facility, intermediate care facility for the
  developmentally disabled, or meets the requirements to receive Home and
  Community-Based Services (HCBS) for at least 30 consecutive days and who is
  married to a spouse who does not reside in a medical institution, nursing
  facility, intermediate care facility for the developmentally disabled, or meet
  the requirements to receive Home and Community-Based Services.
002.07
MAINTENANCE NEED
  STANDARD.
The income standard to which the community spouse's and
  other dependent family members' income is compared for the purpose of
  determining the amount of allowance that may be made from the institutionalized
  spouse's income. The maintenance need standard is determined by need and is
  subject to a minimum and maximum amount.