Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 10 - Other Eligibility Factors for Families With Children and Pregnant Women › Part 5 - INCOME › Section 317:35-10-26 - Income

Current through Vol. 41, No. 20, July 1, 2024
(a)
General
				  provisions regarding income.
(1) The
				  income of categorically needy individuals who are related to the children,
				  parent/caretaker relative, SoonerPlanfamily planning program, Title XIX and XXI
				  pregnancy eligibility groups or expansion adults does not require verification,
				  unless questionable. If the income information is questionable, it must be
				  verified. If there appears to be a conflict in the information provided, the
				  worker must investigate the situation to determine if income verification is
				  necessary.
(2) All available
				  income, except that required to be disregarded by law or Oklahoma Health Care
				  Authority's (OHCA's) policy, is taken into consideration in determining need.
				  Income is considered available both whenit is actually available and when the
				  applicant or member has a legal interest in a liquidated sum and has the legal
				  ability to make such sum available for support and maintenance. When an
				  individual's income is reduced due to recoupment of an overpayment or
				  garnishment, the gross amount before the recoupment or garnishment is counted
				  as income. The member is responsible for reporting all income, the source,
				  amount and how often received.
(A) Income
				  received on behalf of a member of the benefit group by another individual such
				  as, but not limited to, a guardian or conservator, is considered available to
				  the benefit group.
(B) Money
				  received and used for the care and maintenance of a third party who is not
				  included in the benefit group is not counted as income if it can be identified
				  and verified as intended for third party use.
(C) If it appears any member of the benefit
				  group or an individual whose income is considered when determining eligibility
				  is eligible for any type of income or benefits, the benefit group must be
				  notified in writing by the OHCA. The notice must contain the information that
				  failure to apply for and take all appropriate steps to obtain such benefits
				  within ten (10) days from the date of the notice will result in a determination
				  of ineligibility. An application for Supplemental Security Income (SSI) is not
				  required.
(D) If the member and
				  spouse are living together or they are living apart but there has not been a
				  clear break in the family relationship, income received by either spouse and
				  income received jointly is considered as family income. Income cannot be
				  diverted to a household member who is not included in the household size for
				  health benefits. Consideration is not given to an SSI recipient's income in
				  computing eligibility for the AFDC or Pregnancy related unit. The Modified
				  Adjusted Gross Income (MAGI) methodology rules determine whose income is
				  considered in a particular household for MAGI eligibility groups as defined in
				  Oklahoma Administrative Code (OAC)
				  317:35-6-1.
(E) Income which can reasonably be
				  anticipated to be received is considered to be available for the month its
				  receipt is anticipated.
(F) Income
				  produced from resources must be considered as unearned income.
(3) Income that must be verified
				  is verified by the best available information such as pay stubs presented by
				  the member or an interview with the employer. If OHCA is unable to verify
				  income through the Oklahoma Employment Securities Commission, then pay stubs
				  may only be used for verification if they have the member's name and/or social
				  security number indicating that the pay stubs are in fact the member's wages.
				  The stubs should also include the date(s) of the pay period and the amount of
				  income before deductions. If this information is not included, employer
				  verification is required. The worker verifies medical insurance which may be
				  available at the same time that income is verified. When a member of the
				  benefit group accepts employment and has not received any wages, verification
				  (if necessary) of the amount of income to be considered and the anticipated
				  date of receipt must be obtained from the employer and provided to OHCA within
				  ten (10) days. Income which is expected to be received during a month is
				  considered available to the benefit group and is counted in determining
				  eligibility for the month of receipt.
(4) Monies received in a lump sum from any
				  source are considered income in the month received, with the exception of
				  certain lottery or gambling winnings as specified in OAC 317:35-6-55. Changing
				  a resource from one form to another, such as converting personal property to
				  cash, is not considered a lump sum payment. Exception: lump sum payments used
				  to establish dedicated bank accounts by representative payees in order to
				  receive and maintain retroactive SSI benefits for disabled/blind children under
				  age eighteen (18) are excluded as income. The interest income generated from
				  dedicated bank accounts is also excluded.
(A)
				  Whether a source of income is countable for MAGI eligibility groups is
				  determined in accordance with Part 6 of Subchapter 6 of this Chapter.
(B) Whether a source of income is countable
				  is determined in accordance with Part 6 of Subchapter 6 of this
				  Chapter.
(C) When a lump sum is
				  received by a stepparent not included in the household size, only the
				  stepparent's contribution is considered in accordance with the stepparent's
				  liability policy. Income received by a stepparent is considered in accordance
				  with MAGI household and income counting rules.
(D) When a third party reveals that a lump
				  sum payment has been received or is expected to be received by the applicant or
				  member, adverse action notification is given or mailed to the applicant/member
				  and appropriate action taken.
(E)
				  Recurring lump sum income received from any source for a period covering more
				  than one (1) month, that is received in a lump sum recurrently (such as annual
				  rentals from surface or minerals, Windfall Profits tax refund, etc.) is
				  prorated over a period of time it is intended to cover, beginning with the
				  month of receipt of a lump sum payment.
(F) Net income from oil and gas production
				  (gross minus production taxes withheld), received in varying amounts on a
				  regular or irregular basis for the past six (6) months, will be averaged and
				  considered as income for the next six (6) months. In instances where an
				  applicant or a member receives new income from oil and gas production and
				  verification for the past six (6) months is not available, the worker accepts
				  the available verification and averages over the period of time intended to
				  cover. Net income may be verified by seeing the individual's production check
				  stub, or by contacting the oil and gas company. Whether a source of income is
				  countable is determined in accordance with Part 6 of Subchapter 6 of this
				  Chapter.
(5) Income that
				  is based on the number of hours worked, as opposed to income based on regular
				  monthly wages, must be computed as irregular income. The income received
				  irregularly or in varying amounts will be averaged using the past two (2)
				  months to establish the amount to be anticipated and considered for prospective
				  budgeting.
(6) MAGI household rules
				  are used to determine whether a caretaker relative or stepparent is included in
				  a household.
(A) MAGI household and income
				  counting rules are used to determine whether a caretaker relative and his/her
				  spouse or a stepparent are included in the household and whether their income
				  is considered for the children.
(B)
				  MAGI household and income counting rules are used to determine whose income is
				  considered and whether that income is counted. If an individual is eligible in
				  the parent or caretaker relative group, his/her spouse, if living with him/her,
				  is also related to the parent or caretaker relative group.
(7) A stepparent, if living with the parent
				  or caretaker relative, can also be related to the parent or caretaker relative
				  group, regardless of whether the parent is incapacitated or not in the
				  home.
(8) MAGI household and income
				  counting rules are used to determine whose income is considered and whether
				  that income is counted.