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Financial eligibility determination for the Medicaid for the Working Disabled program is a two-step process.
First, the family’s total income must be determined. Family is defined as the applicant, his/her spouse and their minor children, natural or adopted. The total income must not exceed 250% of the Federal Poverty Level for the family’s size after certain deductions are applied.
Determine the family’s composition;
Determine the total income (earned and unearned) of all the family members;
Subtract all applicable SSI deductions and exclusions in the following order:
· Income authorized by other federal laws, (i.e. Agent Orange payments, certain reparations payments, certain payments to Native Americans, etc.);
· Earned Income Tax Credit payments;
· Up to $10 per month of infrequent or irregular earned income;
· Up to $1,700 per month in 2012 (up from $1,640 from 2011), but not more than $6,840 in 2012 (was $6,600 in 2011) in each calendar year, of the earned income of a blind or disabled student child (the Student Earned Income Exclusion);
· $65 of earned income in a month;
· Earned income of disabled individuals used to pay Impairment Related Work Expenses;
· One-half of the remaining earned income in a month;
· Earned income of blind individuals used to pay Blind Work Expenses;
· Any earned income used to fulfill an approved PASS (Plan to Achieve Self-Support);
The second step determines if the individual would be eligible for SSI if his earned income is not counted.
· Measure the family’s total combined income, after the above stated deductions, against 250% of the Federal Poverty Level for the family’s size;
· If the family’s net income is more than 250% of the FPL for the family’s size, the applicant is not eligible. If family’s income is less than 250% of the FPL for the appropriate poverty level, proceed.
· Determine the amount of unearned income for the individual. Do not count any of the individual’s earned income and do not count any income received by other family members;
· Subtract $20 from unearned income.
If the individual’s unearned income is less than the SSI limit, he/she is income eligible for Medicaid.
The rules for valuing In-Kind Support and Maintenance are not applied. Each applicant is considered an individual in the second step, and deeming rules do not apply.
Medicaid Program - Optional Group Coverage
Medicaid Program - Non-Financial Eligibility
Some information for this topic was drawn from the Social Security Administration at:
http://www.ssa.gov/pressoffice/factsheets/colafacts2010.htm
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