reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter A - THE CATEGORICALLY NEEDY HEALTHY BEGINNINGS PROGRAM FOR PREGNANT WOMEN AND QUALIFIED CHILDREN › PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN › Section 140.144 - Appeal rights for presumptive eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
Chapter 275 (relating to appeal and fair hearing and
						  administrative disqualification hearings) does not apply to the denial or
						  termination of presumptive eligibility coverage.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter A - THE CATEGORICALLY NEEDY HEALTHY BEGINNINGS PROGRAM FOR PREGNANT WOMEN AND QUALIFIED CHILDREN › PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN › Section 140.145 - Notice and appeal rights for MA applicants

Current through Register Vol. 54, No. 28, July 13, 2024
The presumptively eligible pregnant woman who applies
						  for ongoing MA is entitled to:
(1)
						Written notice of eligibility/ineligibility from the county assistance office
						under Chapter 125 (relating to application process).
(2) Appeal and fair hearing rights under
						Chapter 275 (relating to appeal and fair hearing and administrative
						disqualification hearings).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter A - THE CATEGORICALLY NEEDY HEALTHY BEGINNINGS PROGRAM FOR PREGNANT WOMEN AND QUALIFIED CHILDREN › PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN › Section 140.146 - Overpayments during the presumptive eligibility period

Current through Register Vol. 54, No. 28, July 13, 2024
No overpayments of medical services occur for the
						  duration of the period of presumptive eligibility when a determination of
						  presumptive eligibility is made by a qualified provider.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › GENERAL PROVISIONS › Section 140.201 - Policy on Healthy Horizons

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
						The Department provides MA under the Healthy Horizons Categorically Needy
						Program to elderly/disabled persons who are otherwise eligible with family
						income up to 100% of the current Federal Income Poverty Guidelines and
						resources not exceeding the SSI resource standard for the appropriate family
						size.
(b) The Department
						participates in QMB Medicare cost-sharing only under the Healthy Horizons
						Medicare Cost-Sharing Program for qualified Medicare beneficiaries with family
						income up to 100% of the current Federal Poverty Income Guidelines and
						resources not exceeding twice the SSI resource standard for the appropriate
						family size.
(c) The Department
						also participates in the Medicare Cost-Sharing for qualified Medicare
						beneficiaries found eligible for benefits under the Healthy Horizons
						Categorically Needy Program.
(d)
						The Department participates in SLMB Medicare Cost-Sharing only under the
						Healthy Horizons Medicare Cost-Sharing Program for SLMBs with family income
						which on or after January 1, 1995, is more than 100% but does not exceed 120%
						of the current Federal Poverty Income Guidelines and resources not exceeding
						twice the SSI resource standard for the appropriate family size. Prior to
						January 1, 1995, for calendar years 1993 and 1994, family income shall be more
						than 100%, but may not exceed 110% of the applicable Federal Poverty Income
						Guidelines and resources may not exceed twice the SSI resource standard for the
						appropriate family size.
(e) The
						Department participates in Medicare cost-sharing under the Healthy Horizons
						Program for qualifying individuals whose family income is at least 120% and
						less than 135% or at least 135% and less than 175% of the current Federal
						Poverty Income Guidelines and whose resources do not exceed twice the SSI
						resource standard for the appropriate family size. These individuals are
						designated as QI-1s and QIs-2s, respectively.
(f) MA is provided under the program which is
						mot advantageous for the client based on individual circumstances. Eligibility
						for MA benefits under both the NMP-MA and MNO-MA Programs is also
						explored.
The provisions of this §
														140.201 amended under sections
							 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
															201(2) and
							 403(b)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › ELIGIBILITY REQUIREMENTS › Section 140.221 - Conditions of eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
Eligibility for MA under the Healthy Horizons Program
						  is based on the following:
(1) An
						individual shall meet the following eligibility requirements:
(i) Chapters 125 and 127 (relating to
						application process; and reserved).
(ii) Chapter 148 (relating to
						residence).
(iii) Chapter 149
						(relating to citizenship and alienage).
(iv) Chapter 155 (relating to
						enumeration).
(v) Chapter 178
						(relating to resource provisions for categorically NMP-MA and
						MNO-MA).
(vi) Chapter 255 (relating
						to restitution).
(vii) Chapter 257
						(relating to reimbursement).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › INCOME REQUIREMENTS › Section 140.231 - Income eligibility limitations

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For the Healthy Horizons Categorically
						Needy and Healthy Horizons QMB Cost-Sharing Programs, net family income after
						applicable deductions and disregards cannot exceed 100% of the current
						Department of Health and Human Services Annual Update of Federal Poverty Income
						Guidelines for the appropriate family size.
(b) For the Healthy Horizons SLMB
						Cost-Sharing Program, on or after January 1, 1995, net income after applicable
						deductions and disregards shall be more than 100% of the current Department of
						Health and Human Services annual update of Federal Poverty Income Guidelines
						for the appropriate family size but may not exceed 120%. Prior to January 1,
						1995, for calendar years 1993 and 1994, net income after applicable deductions
						and disregards shall be more than 100% of the applicable Department of Health
						and Human Services Annual Update of Federal Poverty Income Guidelines for the
						appropriate family size, but cannot exceed 110%.
(c) For the Healthy Horizons Medicare
						Cost-Sharing Program for QI-1s, net income after applicable deductions and
						disregards shall be at least 120% and less than 135% of the current Department
						of Health and Human Services annual update of Federal Poverty Income Guidelines
						for the appropriate family size.
(d) For the Healthy Horizons Medicare
						Cost-Sharing Program for QI-2s, net income after applicable deductions and
						disregards shall be at least 135% and less than 175% of the current Department
						of Health and Human Services annual update of Federal Poverty Income Guidelines
						for the appropriate family size.
The provisions of this §
														140.231 amended under sections
							 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
															201(2) and
							 403(b)).
This section cited in 55 Pa. Code §
														140.202 (relating to
							 definitions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › INCOME REQUIREMENTS › Section 140.232 - Applicable income

Current through Register Vol. 54, No. 28, July 13, 2024
Earned or unearned income of the applicant/recipient,
						  except when designated in this subchapter as being income that is not counted
						  or excluded, is considered when determining eligibility.
(1) Countable net income of the
						applicant/recipient is determined after the allowable deductions listed in
						§§
												140.281-140.285 (relating to deductions
						from income).
(2) If the
						applicant/recipient is residing with a spouse, earned or unearned income of the
						spouse is considered when determining eligibility of the applicant/recipient.
(i) Countable income of the spouse is
						determined under Chapter 181 Subchapter C (relating to the TANF and GA
						categories).
(ii) If countable
						income of the spouse is equal to, or less than, 50% of the Federal Benefit Rate
						for one person, the spouse is not counted as a family member and the income of
						the spouse is not considered when determining eligibility, unless the
						applicant/recipient elects to have the spouse and the income of the spouse
						counted.
(iii) Earned or unearned
						income of the spouse is combined with earned or unearned income of the
						applicant/recipient. The allowable deductions listed in §§
													140.281-140.285 are applied to the
						combined income to determine net countable income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF EARNED INCOME COUNTED › Section 140.251 - Gross earned income

Current through Register Vol. 54, No. 28, July 13, 2024
Gross earned income, including wages, tips, salaries,
						  commissions, severance pay and bonuses from employment is counted as earned
						  income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF EARNED INCOME COUNTED › Section 140.252 - Income from self-employment

Current through Register Vol. 54, No. 28, July 13, 2024
Income from self-employment is counted as earned
						  income. Self-employment includes operating a business, trade or farm,
						  practicing a profession or from renting personal or real property as a trade or
						  business.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF EARNED INCOME COUNTED › Section 140.253 - Payment for services in a sheltered workshop or work activities center

Current through Register Vol. 54, No. 28, July 13, 2024
A payment received for services performed in a
						  sheltered workshop or work activities center is counted when received or when
						  the payment is set aside for the applicant/recipient's use.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF EARNED INCOME COUNTED › Section 140.254 - Earned Income Tax Credit (EITC)

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The advance monthly EITC payment which an
						applicant/recipient actually receives is counted as monthly earned
						income.
(b) An applicant/recipient
						with earned income who is not receiving a monthly advance EITC does not have
						EITC counted as monthly earned income. The EITC counts as a lump sum payment
						when the EITC is refunded.
(c) A
						reconciliation of the EITC is required for a current recipient of Healthy
						Horizons following the end of the tax year if the recipient verifies that the
						total amount of the advance EITC which was counted as earned income received
						during the tax year by the Department differs from the year-end EITC. The
						recipient is responsible for providing the information and documentation
						necessary to complete the reconciliation computation. This information includes
						the recipient's income tax return-IRS Form 1040, 1040A or 1040EZ-and the income
						tax refund check received or a photostatic copy of the income tax refund check.
(1) If the amount of the advance payments
						counted by the Department is less than the EITC verified on the income tax
						return-IRS Form 1040, 1040A or 1040EZ-and the income tax refund check or a copy
						of the income tax refund check, the additional EITC is treated as lump sum
						payment in the month of receipt. The EITC is attributed to the person who was
						employed during the tax year. Each person who was employed is considered to
						have an equal share of the EITC.
(2) If the amount of the advance payments
						counted by the Department is equal to, or more than, the EITC verified on the
						income tax return, no further adjustment is necessary.
(3) If the recipient fails to provide the
						necessary verification, IRS Form 1040, 1040A or 1040EZ and the income tax
						refund check or a copy of the income tax refund check, the entire amount of the
						available EITC-the maximum EITC the recipient could receive less the amount of
						the advance payments counted by the Department-is counted as the EITC refund
						and as a lump sum payment in the month of receipt.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.261 - Benefits, dividends and interest

Current through Register Vol. 54, No. 28, July 13, 2024
Annuities, pensions and other periodic payments which
						  include private pensions, social security benefits including Part B Medicare
						  premiums, disability benefits, veterans benefits, worker's compensation,
						  railroad retirement, unemployment insurance benefits, dividends, interest and
						  royalties are counted as unearned income. In some cases, the amount counted as
						  unearned income is more than the actual amount received by the
						  applicant/recipient. This occurs when the amount received by the
						  applicant/recipient is reduced for a debt resulting from an overpayment of a
						  previously received benefit, or by deduction of an insurance premium. In this
						  situation, the actual amount to count as unearned income is the amount of the
						  unearned income benefit to which the applicant/recipient is entitled before the
						  deduction of an insurance premium or the reduction to recover an overpayment
						  unless §
												140.273(14)
						  (relating to unearned income exclusions) applies.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.262 - Prizes and awards

Current through Register Vol. 54, No. 28, July 13, 2024
A prize, which is generally something won in a contest,
						  lottery or game of chance, is counted as unearned income. An award, which is
						  usually something received as the result of a decision by a court, board of
						  arbitration or something similar, is counted as unearned
						  income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.263 - Inheritances

Current through Register Vol. 54, No. 28, July 13, 2024
An inheritance, which is something received as a result
						  of someone's death, is counted as unearned income. An inheritance can be cash
						  or in-kind, including a right or interest in real or personal
						  property.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.264 - Support

Current through Register Vol. 54, No. 28, July 13, 2024
Child support, spousal support and alimony are counted
						  as unearned income, regardless of whether the payment or support is voluntary
						  or court-ordered.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.265 - Profit from rental property income

Current through Register Vol. 54, No. 28, July 13, 2024
Profit from rental property income is the payment
						  received by the applicant/recipient for the use of real or personal property
						  including payments for room and board and room rent less the deductions in
						  §
												140.285 (relating to deductions
						  from rental income). Profit from rental property income is counted as unearned
						  income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TYPES OF UNEARNED INCOME COUNTED › Section 140.266 - Proceeds as beneficiary of life insurance policy

Current through Register Vol. 54, No. 28, July 13, 2024
Payments received by the applicant/recipient as a
						  beneficiary of a life insurance policy, except for an amount up to $1,500 that
						  the applicant/recipient verifies that he spent on the insured's last illness
						  and burial expense, is counted as unearned income. Illness and burial expenses
						  include related hospital and medical expenses, funeral, burial plot and
						  interment expenses and other related costs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › INCOME EXCLUSIONS › Section 140.272 - Earned income exclusion

Current through Register Vol. 54, No. 28, July 13, 2024
Earned income that does not exceed $10 in a month is
						  excluded if it is irregular or infrequent and received from a single
						  source.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › INCOME EXCLUSIONS › Section 140.273 - Unearned income exclusions

Current through Register Vol. 54, No. 28, July 13, 2024
The following do not count when determining income
						  eligibility for Healthy Horizons and shall be excluded in the order listed:
(1)
Refund or return of taxes
						paid on real property.
A refund or return from a public agency of
						taxes paid on real property.
(2)
Educational expenses.
The amount of a grant, scholarship or
						fellowship used for paying tuition, fees or other necessary educational
						expenses.
(3)
Home
						produce.
The value of food produced by an applicant/recipient which is
						used by the applicant/recipient and his household for their own personal
						consumption and not for sale.
(4)
Disaster relief assistance.
(i) Support and maintenance provided as
						disaster relief assistance, including income-in-kind, received as the result of
						a catastrophe declared by the President as a major disaster under the Disaster
						Relief Act of 1974 (42
						U.S.C.A. §§
														5121-5202) or
						another Federal statute, if the following conditions are met:
(A) At the time of the catastrophe, the
						applicant/recipient was living in and maintaining his own home but discontinued
						living in his home because of the catastrophe.
(B) The applicant/recipient began to receive
						disaster assistance within 30 days after the last day of the
						catastrophe.
(C) The
						applicant/recipient received the disaster assistance while living in a
						residential facility, including a private household maintained by another
						person.
(D) The exclusion applies
						for a period beginning on the date the assistance is received and ending on the
						last day of the 18th full month following the month the cash was
						received.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › DEDUCTIONS FROM INCOME › Section 140.281 - Deductions from unearned income

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Unearned income
						expenses.
For each applicant/recipient, the expenses which the
						applicant/recipient pays to be eligible for, or to receive, unearned income are
						deducted. These unearned income expenses include attorney fees, court costs and
						transportation costs. Personal income taxes are not expenses the
						applicant/recipient had to pay to get this income and are not allowable
						deductions.
(b)
First $20
						of income in a month other than income based on need.
The first $20 of
						income received in a calendar month by an applicant/recipient group is deducted
						after allowable expense deductions in subsection (a) are deducted. The
						application of the deduction is as follows:
(1) The deduction does not apply to unearned
						income based on need and funded in whole or in part by the Federal government
						or by a nongovernment agency.
(2)
						This exception applies to income based on need and funded wholly by the
						State.
(3) This deduction applies
						to veterans benefits received by an applicant/recipient who is a veteran or is
						a dependent of a veteran on the basis of one of the following:
(i) A special act of Congress.
(ii) Service in the Indian Wars (January 8,
						1817-December 31, 1881).
(iii)
						Service in the Civil War (1861-1865).
(iv) Service in the Spanish-American War
						(April 12, 1898-July 4, 1902).
(4) The deduction is first applied to the
						unearned income received by the applicant/recipient.
(5) If the applicant/recipient does not have
						unearned income or has less than $20 of unearned income in a calendar month,
						the remaining portion of the $20 deduction is applied to the earned income
						received in the calendar month under §
													140.282(1)
						(relating to deductions from earned income).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › DEDUCTIONS FROM INCOME › Section 140.282 - Deductions from earned income

Current through Register Vol. 54, No. 28, July 13, 2024
The following amounts are deducted from earned income
						  in the order listed in determining income eligibility:
(1)
Portion of $20 monthly deduction
						not deducted from unearned income.
The portion of the $20 monthly
						deduction in §
												140.281(b)
						(relating to deductions from unearned income) which has not been deducted from
						unearned income is deducted from earned income in the same month for each
						applicant/recipient group.
(2)
Sixty-five dollars of earned income in a month.
An employed
						applicant/recipient is entitled to an earned income deduction of $65 of his
						gross earned income per month.
(3)
Earned income of a disabled applicant/recipient used to pay
						impairment-related work expenses.
Earned income used by an
						applicant/recipient who is disabled and 64 years of age or younger to pay
						impairment-related work expenses is excluded. Impairment-related work expenses
						include:
(i) Payments for attendant care
						services if assistance is needed by the applicant/recipient in traveling to and
						from work, while at work, and at home because of impairment.
(ii) Payments for a medical device if the
						applicant/recipient's impairment requires use of the device to work.
(iii) Payments for a prosthetic device if the
						applicant/recipient's impairment requires the use of the prosthetic device to
						work.
(iv) Payments for impairment
						related nonmedical appliances and equipment and residential modifications
						needed by the applicant/recipient for employment.
(v) Payments for drugs, medical services and
						prescribed medical supplies if necessary to the applicant/recipient to control
						the impairment.
(vi) Payments for
						installing, maintaining and repairing the items listed in subparagraphs (i)-(v)
						that are necessary for the applicant/recipient's employment.
(vii) Payments for similar items and services
						not listed in subparagraphs (i)-(vi) which are directly related to the
						applicant/recipient's impairment and needed by the applicant/recipient to
						work.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › DEDUCTIONS FROM INCOME › Section 140.283 - Deductions from self-employment

Current through Register Vol. 54, No. 28, July 13, 2024
For each self-employed person, the verified costs to
						  produce or continue the income are deducted. The deductible costs include
						  expenses reported on the Federal income tax return except depreciation,
						  personal business, entertainment expenses and depletion.
This section cited in 55 Pa. Code §
														140.232 (relating to applicable
							 income).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › DEDUCTIONS FROM INCOME › Section 140.284 - Guardian fee deductions

Current through Register Vol. 54, No. 28, July 13, 2024
Guardian fees are deducted from earned or unearned
						  income if having a guardian is a requirement for receiving the income.
This section cited in 55 Pa. Code §
														140.232 (relating to applicable
							 income).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › DEDUCTIONS FROM INCOME › Section 140.285 - Deductions from rental income

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Expense deductions from rental income
						include:
(1) Necessary expenses paid for the
						production or collection of the rental income.
(2) Real estate insurance costs related to
						the rental property, whether or not the mortgage holder requires the
						insurance.
(3) The interest portion
						of a mortgage payment.
(4) A repair
						which is an incidental correction to an existing structure, or to a piece of
						equipment.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › TREATMENT OF LUMP SUM PAYMENTS › Section 140.291 - Treatment of lump sum payments

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A lump sum payment is a nonrecurring
						payment. Types of lump sum payments include delayed wages, bonuses, earned
						income tax credit (EITC), cash prizes, cash lottery winnings, life insurance
						benefits, cash inheritances, personal injury and other damage awards and
						settlements and retroactive benefits, such as retirement, survivors and
						disability insurance, delayed unemployment compensation and workers
						compensation.
(b) A lump sum
						payment is counted as a resource under Chapter 178, Subchapter A (relating to
						general provisions for MA resources common to all categories of MA) unless it
						would be more helpful to the applicant/recipient group to have the lump sum
						treated as income.
(c) If the lump
						sum is treated as income, it is counted as income in the calendar month
						received.
(1) An earned lump sum such as
						delayed wages, bonuses and EITC is treated as earned income and is added to
						other earned income received in the calendar month. The deductions listed under
						§
													140.282 (relating to deductions
						from earned income) are applied to determine countable net earned
						income.
(2) An unearned lump sum
						such as cash prizes, cash lottery winnings, life insurance benefits, cash
						inheritances and personal injury is treated as unearned income and is added to
						other unearned income received in the calendar month. The deductions listed
						under §
													140.281 (relating to deductions
						from unearned income) are applied to determine countable net unearned
						income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › RESOURCE REQUIREMENTS › Section 140.301 - Resource eligibility limitations

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An applicant/recipient is resource
						eligible for the Health Horizons Categorically Needy Program if his total
						resources considered in accordance with Chapter 178, Subchapters A and B
						(relating to general provisions for MA resources common to all categories of
						MA; and aged, blind and disabled categories of MA), do not exceed the SSI
						resource standard for the appropriate family size.
(b) An applicant/recipient is resource
						eligible for the SLMB, QMB, QI-1, and QI-2 Healthy Horizons Medicare
						Cost-Sharing Programs if total resources considered under Chapter 178,
						Subchapters A and B do not exceed twice the SSI resource standard for the
						appropriate family size in Chapter 178, Appendix A, Part (a) (relating to
						NMP-MA resource limits).
The provisions of this §
														140.301 amended under sections
							 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
															201(2) and
							 403(b)).
This section cited in 55 Pa. Code §
														140.202 (relating to
							 definitions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › RESOURCE REQUIREMENTS › Section 140.305 - Resources of children under 21 years of age and families with children under 21 years of age

Current through Register Vol. 54, No. 28, July 13, 2024
The resources of the Healthy Horizons child under 21
						  years of age and the Healthy Horizons applicant/recipient immediate families
						  with children under 21 years of age are excluded. If the child who is under 21
						  years of age is living with a care-taker who is not immediate family as defined
						  in §
												140.202 (relating to definitions)
						  and who exercises care and control of the child, the resources of the caretaker
						  are excluded.
The provisions of this §
														140.305 issued under sections
							 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
															201(2) and
							 403(b)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › VERIFICATION REQUIREMENTS › Section 140.311 - Verification requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
						Verification requirements under Healthy Horizons are as follows:
(1)
Verification of income.
Verification of income is required prior to the authorization of Healthy
						Horizons benefits. However, an applicant/recipient may not be denied MA under
						the Healthy Horizons Program for lack of verification if the
						applicant/recipient has cooperated in the verification attempt under Chapter
						125 (relating to the application process) and §
													133.73 (relating to
						requirements).
(2)
Verification of resources.
Verification of ownership, the
						value of resources and the disposition of resources is required of an
						applicant/recipient or the person acting on behalf of the applicant/recipient
						including guardians and trustees under §
													178.3 (relating to resource
						reporting and verification for all categories of MA).
(3)
Verification of qualified
						Medicare beneficiary status.
The Medicare Part A Card is considered
						verification of qualified Medicare beneficiary status.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › REDETERMINATION/REAPPLICATION REQUIREMENTS › Section 140.321 - Redetermination/reapplication requirements

Current through Register Vol. 54, No. 28, July 13, 2024
The redetermination/reapplication requirements in
						  Chapter 133 (relating to redetermining eligibility) apply.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.331 - Benefit coverage

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
						Department will provide the following under the Healthy Horizons Categorically
						Needy Program:
(1) Full categorically needy
						benefits.
(2) Qualified Medicare
						beneficiaries are also eligible for the following:
(i) Buy-in of the Medicare Part A premium if
						the individual is enrolled in Medicare Part A and paying the Part A premium.
(ii) Buy-in of the Medicare Part B
						premium.
(iii) Payment of the
						Medicare Part A and Part B deductibles and coinsurances. The combined Medicare
						and Medicaid payment will not exceed the Department's Medicaid fee for the
						service provided.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.332 - Category designation

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
						Elderly/disabled persons who are eligible to receive Healthy Horizons
						Categorically Needy benefits are designated as "PS" category and are identified
						by the appropriate program status code.
(b) Elderly persons who are eligible for
						Medicare Cost-Sharing only are designated as "PG" category.
(c) Disabled persons who are eligible for
						Medicare Cost-Sharing only are designated as "PL" category.
(d) Elderly disabled persons who are eligible
						for SLMB Medicare Cost-Sharing are designated as TA/TJ category and the
						appropriate program status code.
(e) Elderly/disabled persons who are eligible
						under the Healthy Horizons Medicare Cost-Sharing Program for QI-1s and QI-2s
						are designated as TA/TJ category and are identified by the appropriate program
						status code.
The provisions of this §
														140.332 amended under sections
							 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
															201(2) and
							 403(b)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.333 - Eligibility begin date

Current through Register Vol. 54, No. 28, July 13, 2024
The eligibility begin date may be the date the
						  application is signed or the date the signed application is date stamped by the
						  CAO.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.334 - Eligibility end date

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
						Eligibility ends, following proper notification, on the date that eligibility
						conditions are no longer met.
(b)
						When benefits are terminated due to increased income or resources, or because
						the applicant/recipient is no longer considered disabled, eligibility for
						continuing MA coverage under the MNO-MA Program is explored. If the individual
						is determined eligible, MA benefits are continued under the MNO Program with no
						interruption in MA coverage.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.335 - Retroactive eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
						earliest possible date for retroactive Healthy Horizons Categorically Needy
						benefits to begin is the first day of the third month preceding the month of
						application. The period of eligibility for retroactive Healthy Horizons
						Categorically Needy benefits begins the first day of the month in which the
						first medical service was incurred if the applicant was otherwise eligible
						during that month.
(b) There is no
						retroactive coverage under the Healthy Horizons QMB Medicare Cost-Sharing
						Program, but eligibility for the SLMB Medicare Cost-Sharing Program may be
						retroactive for up to 3 months.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.336 - Notification of eligibility/ineligibility

Current through Register Vol. 54, No. 28, July 13, 2024
The applicant is notified in writing regarding
						  eligibility/ineligibility for benefits under the Healthy Horizons Categorically
						  Needy Program.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › BENEFIT COVERAGE › Section 140.337 - Notification of termination

Current through Register Vol. 54, No. 28, July 13, 2024
The recipient is given advance notice in writing issued
						  at least 10 days prior to the termination date.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter B - ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED › RIGHT TO APPEAL/FAIR HEARING › Section 140.341 - Appeal and fair hearing

Current through Register Vol. 54, No. 28, July 13, 2024
The applicant/recipient is entitled to the appeal and
						  fair hearing rights under Chapter 275 (relating to appeal and fair hearing and
						  administrative disqualification hearings).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › POLICY › Section 140.401 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department
						provides EMC for up to 12 months under the Categorically Needy Program to
						AFDC/AFDC-U families whose Cash Assistance is discontinued due to new
						employment, increased hours of employment, increased income from employment or
						loss of the 4-month $30 and one-third disregard or the 8-month $30
						disregard.
(b) Initial coverage
						under EMC shall be continuous from the date of the AFDC/AFDC-U closing,
						regardless of the earned income amount. A separate application is not required
						for EMC benefits. A recipient will be given notice of EMC eligibility or
						ineligibility, the reporting requirements and conditions of continued EMC
						eligibility in conformance with section 303 of the Family Support Act
						(42 U.S.C.A. §§
													602,
						606,
						1396r and
						1396s).
(c) EMC continues for the first 6 months
						regardless of income or employment as long as the budget group includes a child
						who meets the AFDC age requirements.
(d) EMC continues for the second 6 months as
						long as:
(1) Average gross monthly earned
						income, less child care costs, does not exceed the allowable Federally
						established percentage of the Federal Poverty Income Guidelines updated
						annually by the Department of Health and Human Services and published in the
Federal Register
.
(2) The specified relative maintains
						employment in every month during this extended EMC period.
(3) The budget group includes a child who
						meets the AFDC age requirements.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › POLICY › Section 140.402 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
						  subchapter, have the following meanings, unless the context clearly indicates
						  otherwise:
Budget group
-Recipients living
						  together who received AFDC/AFDC-U at the time the Cash Assistance case was
						  closed.
EMC
-Extended medical coverage.
Gross earned income
-Earned income of
						  the recipients who are included in the EMC budget group and received
						  AFDC/AFDC-U at the time of the Cash Assistance closing and LRRs who return to
						  the home during the EMC 12-month period. The term does not include earned
						  income in §
												181.261 (relating to gross
						  earnings of a child).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › GENERAL ELIGIBILITY REQUIREMENTS › Section 140.421 - Conditions of eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
Eligibility for EMC is based on the following:
(1) A family shall meet the appropriate
						eligibility conditions in this chapter. The specific eligibility conditions
						which shall be met are the following:
(i)
						Chapter 148 (relating to MA residence provisions for categorically needy NMP-MA
						and MNO-MA).
(ii) Chapter 149
						(relating to citizenship and alienage).
(iii) Chapter 155 (relating to
						enumeration).
(iv) Chapter 255
						(relating to restitution and reimbursement).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › INCOME REQUIREMENTS › Section 140.431 - Income eligibility limits

Current through Register Vol. 54, No. 28, July 13, 2024
Gross monthly earned income, less child care costs, may
						  not exceed the allowable Federally established percentage of the Federal
						  Poverty Income Guidelines for the appropriate family size in Appendix A.
						  Revisions to the percentage that is required by Federal law or regulation will
						  be published as a notice in the
Pennsylvania Bulletin
,
						  recommending codification in Appendix A.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › INCOME REQUIREMENTS › Section 140.432 - Applicable income

Current through Register Vol. 54, No. 28, July 13, 2024
The earned income of budget group members who were part
						  of the AFDC/AFDC-U budget group at the time the Cash Assistance case was
						  closed, including the earned income of an LRR who returns to the household, is
						  considered when determining EMC eligibility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart C - Eligibility Requirements › Chapter 140 - SPECIAL MA ELIGIBILITY PROVISIONS › Subchapter C - ELIGIBILITY PROVISIONS FOR EMC UNDER THECATEGORICALLY NEEDY PROGRAM FOR TANF-RELATED CATEGORIES › TYPES OF INCOME NOT COUNTED › Section 140.441 - Income not counted

Current through Register Vol. 54, No. 28, July 13, 2024
The following income is excluded:
(1) Unearned income including income exempt
						in §§
												181.262-181.264 (relating to educational
						loans, grants and work-study income; other types of income not counted for the
						TANF and GA categories; and income and benefits not counted by Federal and
						State statutes for the TANF and GA categories).
(2) The Earned Income Tax Credit (EITC)
						received as an advance monthly payment or year-end payment.
(3) Earned income in §
												181.261 (relating to gross
						earnings of a child).