5101:1-39-19 Medicaid: deeming of income.

(A) When an eligible individual resides in the same household with his or her ineligible spouse, or a child under age eighteen resides in the same household with his or her parent(s), the income and resources of such spouse or parent are included in determining the individual’s eligibility and payment amount.

(B) The basis for deeming lies in the concept that husband and wife and parents of children, under age eighteen, who are individuals related by blood, marriage or adoption and living together have a responsibility for each other to share income and resources. However, it is unrealistic and inequitable to assume that all of one individual’s income and resources are totally available to the other person. This deeming provision recognizes some measure of relative responsibility as it applies from spouse-to-spouse or parent-to-child. It is utilized instead of determining support and maintenance in accordance with rule 5101:1-39-17 of the Administrative Code.

(C) The following definitions and terms apply to the deeming provisions:

(1) “Deemed income” – income attributed to another whether or not the income is actually available to the second person.

(2) “Spouse” – the husband or wife of an eligible individual who is living with the eligible individual.

(3) “Parent” – a natural or adoptive parent (father or mother) living in the same household as the eligible child. If the natural or adoptive parent is deceased and the eligible child is living with a stepparent, the stepparent is not a parent or spouse for deeming purposes. If the natural or adoptive parent divorces a stepparent and the child is living with a stepparent, the stepparent is not a parent or spouse for deeming purposes.

(4) “Child” – for deeming purposes, a child is an individual under age eighteen who lives in a household with one or both parents and is neither married nor head of household. The deeming of parental income applies through the month in which the child becomes eighteen years old. An eligible or ineligible child’s income and/or resources are never deemed to parent(s) or sibling(s).

(5) “Sponsor” – a sponsor is an individual who signs an affidavit of support agreeing to support an alien as a condition of the alien’s admission for permanent residence in the U.S. An alien may have more than one sponsor. For deeming purposes, a sponsor does not include an organization such as the congregation of a church or a service club, or an employer who only guarantees employment for an alien upon entry but does not sign an affidavit of support.

(6) “Deemor” – a deemor is an individual whose income and resources are subject to deeming. Such individuals include ineligible parents, sponsors of aliens, ineligible spouses, and essential persons. It does not matter whether these individuals have sufficient income or resources to deem; they are still considered to be deemors. The type of income such an individual receives (e.g., OWF, VA pension based on need, etc.) does not exclude him or her from this definition.

(7) “Allocation” – an amount deducted from income subject to deeming, which is considered to be set aside for the support of certain individuals other than the eligible individual.

(8) “Household” – a household is a person, or group of persons sharing common living quarters and facilities, living in a residence under such domestic arrangements and circumstances as to create a single economic unit. A household does not exist if a person or a group of persons does not have a residence. For deeming purposes a household comprises the eligible individual, and the spouse, or any of the couple’s children or the children of either member of the couple; or, the eligible child and the eligible child’s parent(s) and other children of the parent(s) or the eligible individual and his essential person.

(9) If a child is born in an institution (e.g., a hospital) he is considered a member of the household at the time of birth unless the parents have completed the required paperwork to have the child given up for adoption or the child has been placed in the temporary custody of a public childrens services agency.

(10) An eligible individual or an ineligible spouse or parent who is temporarily away from home for economic (employment) or emergency reasons (hospitalization), rehabilitation (e.g., drug or alcohol), or vacations or visits is still considered to be a member of the household for deeming purposes. A temporary absence is one where the individual leaves the home for a specific purpose and the individual intends to return to the home after the purpose for the temporary absence has been accomplished. A child away at school or at a vocational training institute remains a member of the household if the facts in the case indicate that he or she will resume living at home as evidenced by his or her returning home on occasions, weekends, holidays and summer vacations regardless of the duration of absence. If an individual member of the household is absent from the home for a prolonged period, i.e., a period not described above as a temporary absence, for example, military service or confinement in a public institution, etc., he is not considered to be a member of the household for deeming purposes.

(D) When an eligible individual is living in the same household with an ineligible spouse, or when an eligible individual, under age eighteen, is a child living in the same household with an ineligible parent(s), the deeming provision applies. A brief description of the deeming process for income follows:

(1) Determine the income for the calendar month of the ineligible spouse or of the ineligible parent(s) and round down to the nearest whole dollar. Include all earned and unearned income except items listed in paragraph (E) of this rule.

(2) Deduct sixty-five dollars per month from any earned income to cover the expenses of earning the income. In those situations where two parents have earned income, apply only one work expense deduction.

(3) Deduct an income allocation for the ineligible spouse (one hundred sixty-three dollars), for one parent (three hundred twenty-five dollars), for two parents (four hundred eighty-eight dollars), or for a parent and the spouse of the parent (four hundred eighty-eight dollars) from the total of earned and unearned income.

(4) Allocate one hundred sixty-three dollars per month of the income remaining after the deduction in paragraph (D)(3) of this rule for each ineligible child living in the household who is unmarried and who is under age eighteen. If an ineligible child has any income of his own, allocate the amount which is the difference between one hundred sixty-three dollars per month and the child’s income for the month. If the child’s income equals or exceeds one hundred sixty-three dollars per month, make no allocation to the ineligible child.

(5) Deem the remaining income to the eligible individual and treat it as unearned income, regardless of its original source. Combine the deemed income with any other income the eligible individual may have to determine eligibility.

(E) In determining the income of an ineligible spouse or parent, certain items shall be omitted. These items shall also be omitted in ascertaining the income of ineligible children in a household. The items to be omitted include the following:

(1) The earned income of a child who is a student subject to the limitations in rule 5101:1-39-08 of the Administrative Code. However, this provision is applied only to that income which is not made available to the family to meet the daily needs.

(2) Assistance or income based on need which is furnished by any federal agency, state or political subdivision of a state, or the payment made under Title XVI of the Social Security Act, and any of the individual’s own income which was taken into account in determining such assistance or payment (e.g., OWF, DA, SSI, RSS, adoption assistance, etc.).

(3) Financial educational assistance received under the programs in Title IV of the Higher Education Act, or under the Bureau of Indian Affairs student assistance programs. Any portion of any grant, scholarship, or fellowship (other than those paid under the programs in Title IV of the Higher Education Act or under the Bureau of Indian Affairs student assistance programs) used to pay the cost of tuition and fees.

(4) Amounts received for foster care of an ineligible child.

(5) Food stamps and the value of department of agriculture donated foods.

(6) Home produce grown for personal consumption.

(7) Refund of taxes paid on income, real property, or food purchased by the family.

(8) Such income used to comply with the terms of court-ordered child support payments. Do not exclude income used by an essential person or the sponsor of an alien to make support payments.

(9) The value of in-kind support and maintenance furnished to the ineligible spouse, ineligible parent or ineligible spouse of a parent, and ineligible children in the household.

(10) Income otherwise excluded by federal statute.

(11) Income in a pass account.

(12) VA aid and attendance and housebound allowances provided to an eligible individual and paid by the individual to his/her ineligible spouse, parent, or child living in the same household in return for in-home supportive services.

(F) Certain receipts of the ineligible spouse’s or parent’s income do not count as income to the eligible individual. Examples of receipts not counted as income are.

(1) Certain in-kind receipts which are occasional benefits or personal services.

(2) Income received and applied strictly in a capacity as a representative payee.

(3) Medical or services received or income channeled through the person for medical or social services which does not ordinarily represent income that can be diverted to meet daily basic need.

(4) Any portion of income which the ineligible spouse is actually paying under a court order for the support of another person who is not in the household.

(G) There are several instances in which there is no income to be deemed and it is not necessary to apply this provision. The deeming provision is not applied if the ineligible spouse or parent(s) have no income, or if their income is less than the amount which is deducted for a living needs allowance and allocation to any ineligible children.

(H) Spouse-to-spouse and parent-to-child deeming do not apply in situations where a family does not have a residence. For example, if a family lives in a car because they cannot afford shelter, deeming would not apply. Only the eligible individual’s income is used to determine medicaid eligibility.

(I) If the eligible spouse is receiving OWF or the parent(s) is receiving OWF, or SSI payments, then the payments themselves and any of the OWF SSI-eligible individual’s own income that was used to compute eligibility for such payments are not considered available for deeming to the eligible individual or child. The income of a spouse or parent not in receipt of OWF, or SSI is considered available and must be deemed even if the income was used to determine the OWF, or SSI payment for another member of the household.

(J) When an individual is living in the same household with an ineligible spouse who has income, complete the deeming worksheet to compute the income of the individual and ineligible spouse. The following steps are applied in deeming:

(1) Step 1 – total all income of the ineligible spouse and round down to the nearest whole dollar.

(2) Step 2 – deduct sixty-five dollars work expense deduction from any earned income of the ineligible spouse.

(3) Step 3 – deduct one hundred sixty-three dollars per month for an income allocation for the ineligible spouse.

(4) Step 4 – if there are ineligible children in the household, indicate the number of children.

(5) Step 5 – if any ineligible children have no income, indicate no income and deduct the one hundred sixty-three dollars income allocation for each child. This represents an additional amount reserved from the ineligible spouse’s income.

(6) Step 6 – for any ineligible children who have income, compare their income with the one hundred sixty-three dollars income allocation. If the ineligible child’s income is equal to or greater than one hundred sixty-three dollars per month, there is no income allocation for that child. If the child’s income is less than one hundred sixty-three dollars, the difference between the actual amount of such income and the one hundred sixty-three dollars income allocation is deducted from the ineligible spouse’s income.

(7) Step 7 – the balance of the income of the ineligible spouse is rounded down to the nearest whole dollar and deemed to the eligible individual.

(8) Step 8 – combine the deemed income with any income the eligible individual may have. All deemed income shall be treated as unearned income of the eligible individual, regardless of its original source, and is subject to the twenty dollars standard income deduction per month.

(K) When an eligible child (or children), under age eighteen, resides with a parent (or parents), complete the deeming worksheet to compute the income of the parent(s).

The following steps are applied in deeming:

(1) Total all income of the parent(s) and round down to the nearest whole dollar.

(2) Deduct sixty-five dollars work expense deduction from any earned income of the parent(s). If both parent(s) are working, only one sixty-five dollars work expense deduction shall be applied.

(3) Deduct three hundred twenty-five dollars per month for one parent or four hundred eighty-eight dollars for two parent(s) living in the same household as an income allocation for the parent(s). This represents an amount reserved to meet the needs of the parent(s).

(4) If there are ineligible children in the household, indicate the number of children.

(5) If any ineligible child has no income, indicate that he has no income and deduct a one hundred sixty-three dollars income allocation for each child. This represents an additional amount reserved from the parent(s) income.

(6) For any ineligible children who have income, compare their income to the one hundred sixty-three dollars income allocation. If the ineligible child’s income is equal to or greater than one hundred sixty-three dollars per month, there is no income allocation for that child. Also, the ineligible child’s income is not considered in the deeming process. If the child’s income is less than one hundred sixty-three dollars, the difference between the actual amount of such income and the one hundred sixty-three dollars allocation is deducted from the parent(s)’ income.

(7) The balance of the parent(s)’ income is rounded down to the nearest whole dollar and is deemed to the eligible child.

(8) Combine the deemed income with any income the eligible child may have. All deemed income shall be treated as unearned income of the eligible child, regardless of its original source, and is subject to the twenty dollar standard income deduction per month.

(9) If there is more than one eligible child, the determined deemed amount shall be divided equally among the eligible children. Each eligible child’s share of the deemed income shall be combined with his personal income and is subject to the twenty dollar standard income deduction per month.

(L) When the household is comprised of an eligible spouse and one or more eligible children, the ineligible spouse/parent’s income is deemed both to the eligible spouse and the eligible child (or children). In these circumstances, the procedure for deeming of income from an ineligible spouse is used with some additional steps. The amount of income determined to be deemed from the ineligible spouse shall be divided equally between all eligible individuals. The following steps are applied in deeming:

(1) Total all income of the ineligible spouse and round down to the nearest whole dollar.

(2) Deduct sixty-five dollars work expense deduction from any earned income of the ineligible spouse.

(3) Deduct one hundred sixty-three dollars per month for an income allocation for the ineligible spouse.

(4) If there are ineligible children in the household, indicate the number of children.

(5) If any ineligible children have no income, indicate they have no income and deduct a one hundred sixty-three dollars income allocation for each child.

(6) For any ineligible children who have income, compare their income to the one hundred sixty-three dollars income allocation. If the ineligible child’s income is equal to or greater than one hundred sixty-three dollars per month, there is no income allocation for that child. If the child’s income is less than one hundred sixty-three dollars, the difference between the actual amount of such income and the one hundred sixty-three dollars income allocation is deducted from the ineligible spouse’s income.

(7) The balance of the income of the ineligible spouse is rounded down to the nearest whole dollar, divided equally by the number of eligible individuals (spouse and child or children) and appropriately deemed to each individual.

(8) Combine the deemed income with any income the eligible individuals may have. All deemed income shall be treated as unearned income of the eligible individual, regardless of its original source, and is subject to the twenty dollar standard income deduction per month.

(M) Reference rule 5101:1-2-31 of the Administrative Code for the sponsor-to-alien deeming requirements.

Eff 9-3-77; 12-31-77; 3-1-79; 10-1-79; 12-7-79; 1-3-80; 2-15-85 (Emer.); 5-14-85 (Emer.); 6-10-85; 10-1-88 (Emer.); 12-20-88; 1-1-91; 1-1-92; 7-1-92; 8-18-93 (Emer.); 11-1-93; 3-1-94 (Emer.); 4-18-94; 4-1-95 (Emer.); 6-11-95; 10-1-95; 10-1-96 (Emer.); 12-15-96; 10-1-02

Rule promulgated under: RC 111.15

Rule authorized by: RC 5111.011

Rule amplifies: RC 5111.01, 5111.011

R.C. 119.032 review dates: 5/6/2002 and 10/01/2007