5101:1-40-20 Covered families and children (CFC) medicaid: income.

(A) Availability of income

(1) Income received by the covered families and children medicaid assistance group must be considered in determining need. Certain types of income are excluded from consideration and there are some disregards of income.

(2) “Income” is any benefit which is received by the individual during a calendar month as a result of current or past labor or services, business activities, interests in real or personal property, or as a contribution from persons, organizations, or assistance agencies. While an increase in income must be reported within ten calendar days from the date of the increase, the budget adjustment does not become effective until the first day of the month following the month in which the assistance group receives the increased income. Reference rule 5101:1-40-20.3 of the Administrative Code for information regarding unearned income. Reference rule 5101:1-40-20.4 of the Administrative Code for information regarding earned income.

(3) The determination of eligibility for covered families and children medicaid is dependent in part upon the amount of income available to the assistance group. Since covered families and children medicaid is a need-oriented program, there must be an established need for assistance. Those persons who have substantial income in excess of established need are not eligible for covered families and children medicaid even though the other eligibility requirements are met.

(4) It may be necessary in certain instances to apportion income to future months. Such income is current income for the month to which it is apportioned. For example, an employee under a contract of employment shall have the income from such contract averaged over the number of months covered under the contract. This is done regardless of whether the employee chooses to receive the income in fewer months than the contract covers or whether it is paid in fewer months at the convenience of the employer. Income apportioned toward future months is not counted as a current resource. Income apportioned to past months is considered a resource as long as it remains available.

(5) Income received by a member of the covered families and children medicaid assistance group is considered available to all members of the assistance group unless the income is earmarked as defined in rule 5101:1-40-01 of the Administrative Code. Reference rule 5101:1-40-20.7 of the Administrative Code for information regarding earmarked income.

(6) When a Title II beneficiary is a minor, benefits are usually paid through a representative payee. If the beneficiary is a member of the covered families and children medicaid assistance group, it is necessary to determine if the Title II benefits in their entirety are countable as income to the assistance group. Reference rule 5101:1-40-20.7 of the Administrative Code regarding the earmarking of income.

(a) The determination is first made by establishing whether or not the representative payee resides in the same household (i.e., residence) as the assistance group.

(b) If the representative payee resides in the same household, the total amount of Title II benefits received for the beneficiary is countable income.

(c) If the representative payee does not reside in the same household as the beneficiary, only that portion made available to the beneficiary and/or caretaker is countable.

(d) Title II benefits retained by a representative payee who does not reside in the same household as the beneficiary are not considered potential income. The requirement to explore potential income in accordance with paragraph (B) of this rule does not apply.

(7) If income is received jointly by a member of the assistance group and one or more persons not in the assistance group, the assistance group member’s portion to be considered available is the prorated share, unless evidence is produced to the contrary.

(8) The income and resources of a supplemental security income (SSI) recipient who is excluded from a CFC assistance group due to receipt of SSI are not countable to the remaining members of that CFC assistance group as set forth in rule 5101:1-40-01 of the Administrative Code.

(9) The income and resources (when appropriate) of a parent specifically excluded from the CFC assistance group due to non-qualified alien status or third tier work activity failure are counted in determining the assistance group’s eligibility. If the individual who is excluded due to failure to meet the citizenship requirement is a parent, individual’s income, less the disregarded amounts set forth in rule 5101:1-40-20.5 of the Administrative Code, is counted in determining the assistance group’s eligibility.

(10) The income and resources of parents or children for whom federal, state, or local foster care maintenance or adoption assistance payments are made are excluded.

(11) A nonrecurring lump-sum payment of unearned income is a money payment accrued over two or more months or a money payment not related to any time period, such as a death benefit or an inheritance. Such a nonrecurring lump-sum payment is considered unearned income unless otherwise exempted or excluded. It is unearned income only in the month received and as such, does not affect income eligibility as set forth in paragraph (A)(2) of this rule. Any portion of a nonrecurring lump-sum payment remaining in the month(s) following the month of receipt is a resource, countable when appropriate, pursuant to rule 5101:1-40-14 of the Administrative Code.

(B) Exploration of potential income.

(1) The CDJFS must explore with each assistance group the potential development of monthly income.

(a) The assistance group must apply for any monthly benefits to which it is entitled.

(b) It is not appropriate to require the assistance group to apply for lump-sum withdrawals of retirement or pension funds which would negate the drawing of monthly benefits in the near future.

(c) If otherwise eligible for healthy families/LIF, an SSI recipient shall have the choice of continuing to receive SSI or receiving healthy families/LIF, but may not receive SSI and healthy families/LIF at the same time. If an SSI recipient chooses to receive healthy families/LIF, the CDJFS must document that the SSI has been terminated prior to the approval of the individual for healthy families/LIF.

(2) Potential sources of income include, but are not limited to:

(a) Social security insurance, RSDI, railroad retirement, unemployment insurance, disability insurance, workers’ compensation.

(b) Benefits available to veterans, servicemen, and their dependents.

(d) Rights and interests in real and personal property.

(e) Responsible relatives, especially an absent parent, who may be contributing or have a legal liability to contribute.

(f) Other persons who may be contributing, i.e., a cash payment made voluntarily by an individual who is not an assistance group member to the assistance group for its unrestricted use (whether or not the individual who is not a member of the assistance group lives with the covered families and children medicaid assistance group). This does not include situations in which an individual shares a residence with an assistance group and shares responsibility for household expenses through an informal arrangement.

(g) The assistance group’s own capacity for self-help and employment.

(h) Private pension plans, union welfare funds, life insurance disability benefits, other forms of assistance, etc.

(3) The assistance group, including the person responsible for a child, is responsible for giving information necessary to income determinations, and for taking all actions necessary to obtain unconditionally available income.

(a) Income shall be unconditionally available if the assistance group has only to claim or accept the income, or to establish eligibility for the income; e.g., relative’s offer of a contribution, RSDI.

(b) Except for the provision in paragraph (B)(1)(c) of this rule, ineligibility for aid results if the assistance group refuses to accept unconditionally available income.

(1) All income of a member of the assistance group, and the parent living in the home, must be verified. Statements as to the amount and source of income must be verified and documentation contained in the case record. The applicant/recipient and any person whose income affects him are required to submit evidence as requested. The CDJFS shall assist in obtaining the verification if the applicant/recipient requests such assistance or is unable to provide it without the agency’s help.

(2) When there is a response at application or reapplication that no income is received, the CDJFS should review the application forms for inconsistencies which require resolution. There may be reason to question the applicant/recipient’s statement of no income based upon living expenses or retention of resources expensive to maintain. It is the individual’s responsibility to provide evidence to substantiate their claim. However, if it appears verification is not available and the applicant/recipient has cooperated in trying to obtain the verification, the case may be processed based on the individual’s statements as long as there is no evidence or facts to cast doubt on the income allegations.

(D) Countable income

(1) Countable income is the amount of income which is compared to the appropriate covered families and children medicaid need standard to determine if an individual or family is eligible for covered families and children medicaid.

(2) The amount of countable income is determined by calculating the nonexempt gross unearned income and the gross earned income minus the appropriate income disregards and then totaling the results. The countable income is compared to the appropriate covered families and children medicaid need standard.

(E) Effective date for income changes

(1) Income changes are evaluated to affect eligibility the first day of the month following the month in which the new or increased income is received.

(2) Income changes do not affect eligibility of individuals who are currently receiving medicaid under provisions for pregnant women, deemed eligible newborns, uninsured children, as defined in rule 5101:1-40-08 of the Administrative Code, whose family income is from one hundred fifty one per cent through two hundred per cent of the federal poverty level (FPL), and families in receipt of the initial six months of transitional medicaid.

(3) All other changes in income must be evaluated in compliance with the pre-termination review provisions in rule 5101:1-38-01.1 of the Administrative Code.

HISTORY: Eff 8-1-75; 4-1-86; 8-1-86 (Emer.); 10-3-86; 7-1-89 (Emer.); 9-23-89; 1-1-90 (Emer.); 3-22-90; 10-1-90; 5-1-91; 7-12-91 (Emer.); 9-22-91; 9-1-94; 10-31-97 (Emer.); 1-26-98; 7-1-00; 1-1-03

Rule promulgated under: RC 111.15

Rule authorized by: RC 5111.011, 5111.01

Rule amplifies: RC 5111.01, 5111.011

R.C. 119.032 review dates: 04/05/2002 and 01/01/2008