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DE Medicaid - Countable Income

When determining Income Eligibility for Medicaid, the details about what income is counted depends on the Covered Group under which you or your family are covered.

SSI-Related Covered Groups

See SSI Countable Income for detailed explanation of the income that is counted, excluded and disregarded in determining income eligibility related to Supplemental Security Income (SSI). These are the rules that apply unless you receive Medicaid under one of the SSI-Related groups below. Each of those groups has a small variation in the rules that may be important to you.

·      Adult Disabled Children: For Adult Disabled Children who have lost their SSI eligibility because of Social Security income from an aged, blind, disabled, or deceased parent, their SSA income is disregarded in determining Medicaid eligibility.

NOTE: DAC or ADC? The Social Security Administration (SSA) uses the terminology "Disabled Adult Child (DAC)" rather than the "Adult Disabled Child (ADC)" terminology used by Delaware. WorkWORLD uses both terms, depending on the context -- DAC for federal topics, and ADC for Delaware state topics.

·      MAT Medicaid: For individuals who lose their SSI because of receiving SSDI, but who are not yet eligible for Medicare, all earned and unearned income is disregarded during their two-year Transition to Medicare.

·      Pickle Amendment - Loss Of SSI Due To SSA Increases: For individuals who lose their SSI due to an increase in Social Security benefits, their Countable Income disregards the SSA increase that caused them to lose SSI eligibility and all SSA increases since they lost SSI.

·      SSI Except for OASDI Increase: These are individuals who were receiving Old Age, Survivors, and Disability Insurance (OASDI) and would be SSI recipients now if the July 1972 increase in OASDI were deducted from their incomes. Their Countable Income disregards the July 1972 increase.

NOTE: OASDI is now called RSDI (Retirement, Survivors and Disability Insurance).

·      1619(b): For the 1619(b) Covered Group, only earned income is compared to the State Threshold or Individualized Threshold.

·      Home and Community Based Waiver: Countable Income under this group is very similar to SSI Countable Income, but the income eligibility details are spelled out in DE Medicaid Long Term Care Financial Eligibility.

Medicare-Related Covered Groups

·      Countable Income under these four groups (QMB, SLMB, QDWI, and QI-1) is very similar to SSI Countable Income, but the income eligibility details are spelled out in DE Medicaid - Income Eligibility for Medicare Related Medicaid.

AFDC-TANF Related Covered Groups

For Countable Income the largest AFDC-TANF Related Covered Group with Income-Eligibility criteria, Low Income Families with Children - Section 1931, and those which use Section 1931 criteria, use the TANF Income Eligibility rules with variations and additions that are explained in the topic for Low Income Families with Children - Section 1931.

Of special note are the following exclusions:

·      Do not count any earned income of dependent under 18 years of age or of full-time students age 18 who are expected to graduate before age 19;

·      If earned income makes family ineligible for Section 1931 Medicaid, exclude all earned income for one year.

Special Rules for Specific TANF-Related Medicaid programs:

·      Transitional Medicaid: Transitional Medicaid disregards all income for the first six months. (Note that Transitional Medicaid starts after the year during which earned income is disregarded.) During the second six months, only earned income is counted. Any expenses for childcare needed to enable the recipient to work are subtracted from earned income. (This countable income cannot be greater than 185% FPL.)

·      Prospective Medicaid: Prospective Medicaid disregards for four months an increase in child support payments that would make a family ineligible for Section 1931 Medicaid.

·      Two of the groups, Pregnant Women and Foster Children, use the TANF Gross and Net Income rules as explained in TANF - Income Eligibility without the Section 1931 variations and additions.

·      One group, Infants Awaiting Adoption, uses the TANF Gross Income definition (see TANF - Income Eligibility) and compares that income to the TANF Payment Amount.

·      0-17 year-old recipients of General Assistance (GA) are classified as an AFDC-TANF Related Covered Group, but their income-eligibility for GA is determined using the more restrictive GA Earned-Income-Disregard rules.

Federal Poverty Level (FPL) Related Covered Groups

Countable Income for FPL Related groups is slightly different from that for AFDC-TANF Related groups and vastly different from that for SSI-Related groups.

·      One difference between the definition for countable income for those receiving Medicaid in an AFDC-TANF Related Group and those in an FPL Related Covered Group is that the $30 plus 1/3rd Earned Income Disregard IS NOT subtracted from earned income. The $90 disregard, however, is subtracted.

·      Also subtracted are actual monthly dependent care expenses for the care of each dependent child or incapacitated adult living in the same home (up to $175 for each dependent child age two and older and for each incapacitated adult, and up to $200 for each dependent child under age two).

·      As in AFDC/TANF Related groups, the earned income of dependent children under age 18 is excluded. The income of students age 18 is also excluded - but the definition of student is different. Instead of excluding the income of full-time students who will graduate before age 19, FPL-Related groups exclude the earnings of any full or part-time students age 18 who do not work full time.

·      There is a special income disregard for pregnant teens. One-half of the gross parental income (includes earned and unearned income) is excluded in the income-eligibility determination for the pregnant teen.

·      Earnings of children under 18 are not counted.

·      Earnings of 18 year-old students who are not working full time are not counted.

NOTE: Although Medicaid eligibility for 18-year-old recipients of General Assistance (GA) is determined using the Countable Income criteria for FPL Related Covered Groups, their income-eligibility for GA is determined using the more restrictive rules for the GA Earned-Income-Disregards. Even if they become ineligible for GA because of income, they may be income-eligible for Medicaid. See Medicaid Income Limits - FPL Related.

See also:

DE Medicaid - Resource Eligibility

DE Medicaid - Covered Groups

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual (Sects. 15120.2, 15130.1, 15150.1, 15160.1, 17802)

Back to:

DE Medicaid - Income Eligibility

DE Medicaid - Financial Eligibility

DE Medicaid - Eligibility

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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