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MassHealth Countable Income

Strictly speaking, MassHealth regulations use the term "Countable Income" for the income amount used to calculate eligibility and deductible amounts for those individuals who are aged 65 or over or who receive medical services through one of a few specialized programs. (See: Countable Income for HCBS Waiver, below.)

For most MassHealth members, the income that is counted in determining eligibility and deductible and co-payment amounts is actually Gross Non-Excluded Income. (The regulations for this are in 130 CMR 506.003.)

NOTE: The Code of Massachusetts Regulations is available at:
http://www.lawlib.state.ma.us/cmr.html.

Gross Non-Excluded Income

MassHealth eligibility and the amounts that members have to pay for deductibles and premiums are based on the family group's gross earned income and unearned income plus any rental income minus the family group's excluded (non-countable) income.

Gross Earned Income:

·     The total amount of compensation received for work or services performed without regard to any deductions;

·     For the self-employed it is the total amount of business income listed or allowable on a U.S. Tax Return;

·     Seasonable income is treated as follows: Annual gross income is divided by 12 to obtain a monthly gross income. (If the applicant or member has a disabling illness or accident during or after the seasonal employment period that prevents the person's continued or future employment, only current income will be countable.)

Gross Unearned Income:

·     The total amount of income that does not directly result from a family member's own labor;

·     Unearned income includes, but is not limited to, social security benefits, railroad retirement benefits, pensions, annuities, federal veterans' benefits, and interest and dividend income.

See the topic MassHealth Unearned Income for additional information.

Rental Income:

·     The total amount of gross income list any deduction listed or allowable on the member or applicant's U.S. Tax Return.

The "Gross Non-Excluded Income" is the sum of the above minus any Excluded Income. (See: MassHealth Excluded Income.)

Countable Income for HCBS Waiver and other special groups

A different method of calculating income eligibility is used for individuals aged 65 and older, institutionalized individuals, and those who would be institutionalized without community-based services.

The phrase "Individuals Who Would Be Institutionalized" is defined in 130 CMR 519.007 to be:

·   Children under the age of 18 who are served under the Kaileigh Mulligan Program;

·   Individuals who have a disability, are over age 60 and receive services through a Home and Community Based Services (HCBS) Waiver that is administered by the Executive Office of Elder Affairs; and

·   Individuals who have a disability and are aged 55 thru 64 (or who are aged 65 or older) and who have medical services provided in a community-based Program of All-Inclusive Care for the Elderly (PACE).

"Countable Income" for these groups is calculated by subtracting from gross income the above exclusions plus the following "Standard Income Deductions" (which do not apply to the income of a community spouse as described in 130 CMR 520.016(B)):

·   $20 general exclusion

·   $65 a month of earned income; and

·   One-half of the remaining earned income.

·   Additional deductions from the earnings of a long-term-care-facility resident.

NOTE: The current version of WorkWORLD does not calculate the income and asset eligibility for this population. If you would like WorkWORLD to do such calculations, go to http://www.workworld.org and contact us.

Additional Information

The Code of Massachusetts Regulations is available at:
http://www.lawlib.state.ma.us/cmr.html.

See Also:

MassHealth Income Limits

MassHealth CommonHealth Premiums and Deductible

MassHealth Income Verification

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