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Medicaid Program - Working Disabled Financial Eligibility - South Carolina

Financial eligibility determination for the Medicaid for the Working Disabled program is a two-step process.

Step 1

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.

Procedure for Step 1:

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);

Step 2

The second step determines if the individual would be eligible for SSI if his earned income is not counted.

Procedure for Step 2:

·      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.

See also:

Medicaid Program - Optional Group Coverage

Medicaid Program - Non-Financial Eligibility

Medicaid Program - Services

Medicaid Program - Overview

Source

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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