Get Latest WorkWORLD

VA Deeming Income and Resources - Medicaid

This topic discusses spouse-to-spouse and parent-to-child deeming rules for both Aged, Blind and Disabled (ABD) and Families and Children (F&C) Assistance units. Use the links below to jump directly to a specific section:

·             Overview of Medicaid Deeming

·             Deeming - ABD Assistance Units

o    ABD Spouse-to-spouse deeming

o    ABD Parent-to-child deeming

·             Deeming - F&C Assistance Units

o    F&C Spouse-to-spouse deeming

o    F&C Parent-to-child deeming

Overview of Medicaid Deeming

When someone in the household is not a part of the Medicaid Assistance Unit but is financially responsible for someone in that unit, the income and resources of the financially person may be deemed as available to the Assistance Unit and counted in determining the eligibility of those in the unit.

Generally, parents are financially responsible for children under age 21 and spouses are responsible for their spouses.

The rules for those in ABD (Aged, Blind and Disabled) groups for calculating how much is deemed are different from the rules for those in F&C (Families and Children) groups. See Medicaid Covered Groups for information about these groups.

Deeming -- ABD Assistance Units

The rules for deeming income and resources to those in ABD Assistance units are generally the same as the federal Supplemental Security Income (SSI) deeming rules.

Spouse-to-spouse deeming:

Resources: The resources of a spouse living in the same household are always taken into account and the combined resources can not be more than the couple Resource Limit.

NOTE: In addition to the Resource Exclusions applied to the ABD individual, pension funds belonging to the Non-ABD spouse or parent are excluded from deeming.

Income: The income of the non-ABD spouse (a spouse who either is not aged, blind or disabled, or who has not applied for Medicaid) can be deemed if the spouse does not receive a cash benefit based on need from a government agency.

NOTE: Government benefits based on need include SSI, TANF, Veterans Administration pensions, General Relief payments, etc., but do not include food stamps, fuel assistance, or any benefit based on the entire household's needs.

Generally, the amount that is deemed to the ABD spouse is calculated by subtracting from the non-ABD spouse's gross income an amount equal to the "deeming standard" for each non-ADB dependent child in the household. (The "deeming standard" is the difference between the SSI payment limit for a couple and the limit for an individual.) The allocation for each child is reduced by the amount of any countable income that the child has.

Also excluded is any portion of the non-ABD individual's income paid as court-ordered or Division of Child Support Enforcement (DCSE) ordered support for children not in the household.

Also excluded are the same exclusions that apply to an ABD individual's own income as well as some additional exclusions. For example, one-third of child support payments from an absent parent is excluded for a BD (blind or disabled) child, but is NOT excluded from a non-BD child's income in the deeming calculation.

If the non-ABD spouse's remaining income amount is greater than the deeming standard, then the couple's income is calculated according to SSI rules for countable income. That income is then compared against the income limits (for an assistance unit of two) for the applicable ABD Covered Group.

The deemed amount is counted as unearned income in determining the ABD individual's income eligibility for Medicaid.

NOTE: For details on ABD Spousal deeming, see M0530.202 & 203 in the Department of Social Services (DSS) Medicaid Manual.

Parent-to-child deeming:

Resources: The resources of the parent(s) are deemed to the child to the extent that they exceed the Resource Limit for an individual (if only one parent is present) or a couple (if both parents are living in the same household). If there is more than one child, the excess resources are divided among the children equally.

NOTE: In addition to the Resource Exclusions applied to the ABD individual, pension funds belonging to the Non-ABD spouse or parent are excluded from deeming.

Income: Assuming that the child is not eligible under F&C group criteria (which are more liberal than ABD criteria for a child) then the resources and income of natural parents (not step-parents) are deemed to the child if the parents are not eligible for Medicaid. The purpose is to determine the eligibility and spenddown under the Medically Needy category.

The rules for determining the amount to be deemed are too complex to be summarized here.

NOTE: For details on ABD Parental deeming, see M0530.301-303 in the Department of Social Services (DSS) Medicaid Manual.

Deeming -- F&C Assistance Units

Spouse-to-spouse deeming:

In most cases the spouse is included in the F&C budget unit, so deeming is not an issue. If the spouse receives SSI or Foster Care/Adoption assistance, the spouse would not be in the budget unit, but no deeming is necessary. Deeming spouse-to-spouse is only necessary in two cases:

·             The F&C spouse is a Medicaid minor parent and they are living with his/her parent(s);

·             The F&C spouse's spouse is under age 21 and they are living with the spouse's parent(s).

Resources: Resources of the spouse over the resource standard of $1,000 are deemed to the assistance unit.

Income: For deeming purposes the income of the spouse is reduced by:

·             The standard earned income exclusion of $90; and

·             Any child/incapacitated adult care exclusion; and

·             The appropriate "deeming standard." (The "deeming standard" is the100% Standard of Assistance amount for the geographic area and the number in the budget unit plus any of the F&C spouse's dependents who do not get Medicaid; and

·             Any support payments the F&C spouse may make to dependents not living in the household.

The remaining income is deemed to the F&C spouse.

NOTE: For details on F&C Spousal deeming, see M0520.300 in the Department of Social Services (DSS) Medicaid Manual.

Parent-to-child deeming:

A parent's resources and income are considered available (either counted in the unit or deemed) to a child under age 21 living with a parent. The parent's resources and income are deemed to the child when the child is in a separate budget unit from the parent, unless:

·             The parent is an SSI recipient or has a 1619b status; or

·             The parent receives foster care or adoption assistance; or

·             The child is living away from home (other than temporarily); or

·             The child is a foster care child placed in the home for a trial visit of 3 months or less.

Deeming Standard: The deeming standard is the portion of the parent's countable resources or income that is not considered available to the child who is in a separate Budget Unit from the parent. The resource deeming standard is the F&C resource limit of $1,000. The income deeming standard is the 100% Standard of Assistance amount for the geographic area and the number of people in the Budget Unit of the parents whose income is being deemed plus any excluded children.

Except in the simplest of cases, the actual amount that is deemed is too complex to describe here. It depends on whether there is a step-parent with shared resources and/or whether the parent and step-parent have children in common. It also depends on whether parents are in the same or different Budget Units.

NOTE: For details on F&C Parental deeming, see M0520.400 in the Department of Social Services (DSS) Medicaid Manual.

See Also:

VA Medicaid Income Limits

VA Medicaid Resource Limits

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Information for this topic was drawn from Chapter M05 of the Department of Social Services (DSS) Medicaid Manual.

WorkWORLD™ Help/Information System

   Share/Save: Click the button or link at left to select your favorite bookmark service and add this page.

This is one topic from the thousands available in the WorkWORLD™ software Help/Information System.
Complete information about the software is available at: http://www.WorkWORLD.org