All income and resource changes that are effective in 2017 should be reflected by March 1 following the Federal adjustment of the Federal Poverty Level. The following are changes that are effective 1/1/2017:
3005.25.00 RESOURCE LIMITS (MED 4) The resource limits for the QMB, SLMB, QDW, and QI categories are: $7,390 effective 1/01/17 for an applicant/recipient who is unmarried or not living with his spouse; $11,090 effective 1/01/17 for an applicant/recipient and his spouse if the couple is living together.
3046.00.00 SUBSTANTIAL GAINFUL ACTIVITY AMOUNT (MED 1) Substantial Gainful Activity (SGA) is the limitation on gross earnings that is used to determine categorical eligibility. The amount is $1,170 effective January 1, 2017
3405.10.30 Annual Budget Method – The amount of money that an individual, business, or asset will earn over the course of a year. Annualized income can be calculated with less than 12 months of income because in some cases the client only works 8-9 months a year and the income is intended to meet the household’s needs for the entire year. To calculate the annual income for the household you would add all the income received for the specific calendar year and then divide by 12 months. An example can be found in the Medicaid Policy Manual.
ClaimAid 201 Training scheduled for April, May and June will dig deeper into budgeting principles and methods. The following provides a December 2016 update to the Medicaid Policy Manual:
Updated MAGI Budgeting
3405.00.00 INCOME BUDGETING PRINCIPLES
Financial eligibility is based on the best estimate of income and circumstances which will exist in the month for which the assistance is being considered. This estimate should be founded upon the most complete information available to the DFR as of the authorization date. This eligibility determination requires knowledge of an individual’s and/or AG’s current, past or anticipated future circumstances. A presumption that current or historical trends will continue in the future cannot be made. Use of historical trends is appropriate if there is reason to believe, with supporting documentation, that the trends will continue. Prospective budgeting rules require that the AG’s assistance for a given month be based on the income expected to be received during that month.
- Actual income is budgeted for each of the three retroactive months prior to the month of application.
- For MAGI-based income methodology, when determining eligibility at initial application, financial eligibility is based upon current monthly income and family size. When determining current monthly income, the DFR will include a prorated portion of the reasonably predictable increase in future income and/or family size. The DFR must also account for a reasonably predictable decrease in future income and/or family size. At all other times (ex: Redeterminations), MAGI income should be annualized as much as possible. To calculate monthly amounts, the frequency and budgeting method of the income must first be determined.