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

(A) Introduction.

(1) 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), a portion of the income and resources of such spouse or parent are included in determining the individual's eligibility for medicaid for the aged, blind or disabled.

(2) The basis for the deeming of income lies in the concept that a husband and wife, and parents of children under age eighteen, who are 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 provision sets forth a formula for calculating the amount of income that the ineligible spouse or parent is responsible to deem to an otherwise-eligible spouse or child. This formula is utilized instead of determining support and maintenance in accordance with rule 5101:1-39-17 of the Administrative Code.

(B) Definitions:

(1) "Allocation," for the purpose of this rule, means 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.

(2) "Child," for deeming purposes, means 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).

(3) "Deemed income" means income attributed to another person whether or not the income is actually available to the person to whom it is deemed.

(4) "Deemor" means an individual whose income and/or 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 does not exclude him or her from this definition.

(5) "Eligible child" means a child in the household who has applied for medicaid for the aged, blind or disabled, and who meets all of the applicable non-financial and financial medicaid eligibility criteria.

(6) "Eligible parent" means a parent in the household who has applied for medicaid for the aged, blind or disabled, and who meets all of the applicable non-financial and financial medicaid eligibility criteria.

(7) "Eligible spouse" means the member of the married couple who has applied for medicaid for the aged, blind or disabled, and who meets all of the applicable non-financial and financial medicaid eligibility criteria.

(8) "Household" means the eligible individual, the individual's spouse, any of the couple's children or the children of either member of the couple, the eligible child, the eligible child's parent(s), other children of the parent(s), or the eligible individual and the individual's essential person.

(a) A household does not exist if an individual or a group of individuals does not have a residence. In such a case, only the eligible individual's income is used to determine medicaid eligibility.

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

(c) An eligible individual or an ineligible spouse or parent who is temporarily absent, as defined in rule 5101:1-37-01 of the Administrative Code, is still considered to be a member of the household for deeming purposes.

(9) "Individual" has the same meaning as in rule 5101:1-37-01 of the Administrative Code.

(10) "Ineligible child" means a child in the household who does not meet all of the eligibility criteria for medicaid for the aged, blind or disabled.

(11) "Ineligible parent" means an eligible child's parent who does not meet all of the eligibility criteria for medicaid for the aged, blind or disabled.

(12) "Ineligible spouse" means an eligible individual's husband or wife who does not meet all of the eligibility criteria for medicaid for the aged, blind or disabled.

(13) "Parent" means a natural or adoptive father or mother living in the same household as the eligible child. The income of a stepparent who lives with the eligible child is deemed to the child only when the natural or adoptive parent also lives in the household with the stepparent and the child. If the natural or adoptive parent divorces a stepparent and the child is living with the stepparent, the stepparent is not a parent or spouse for deeming purposes.

(14) "Sponsor" means 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.

(15) "Sponsored alien," for purposes of this rule, means an alien whose sponsor as described in paragraph (B)(14) of this rule is the ineligible spouse or parent in the household being considered.

(16) "Spouse" means a person who is legally married to another under Ohio law.

(C) In accordance with 20 C.F.R. 416.1161 (as in effect on March 1, 2013), when determining the income of an ineligible spouse, parent or sponsor of an alien, or of an ineligible child in the household, the following items shall not be considered income:

(1) Income excluded by federal laws other than the Social Security Act;

(2) Any public income-maintenance (PIM) payments, as defined in 20 C.F.R. 416.1142(a) (as in effect on March 1, 2013), received by the ineligible spouse or parent(s), or by an ineligible child in the household, and any income which was counted or excluded in figuring the amount of that payment;

(3) Any of the income of the ineligible spouse or parent that is used to determine the amount of a PIM payment to someone else;

(4) Any portion of a grant, scholarship, fellowship, or gift used or set aside to pay tuition, fees or other necessary educational expenses;

(5) Money received for providing foster care to an ineligible child;

(6) The value of food assistance and the value of foods donated by the department of agriculture;

(7) Food raised and consumed by members of the household;

(8) Tax refunds on income, real property, or food purchased by the family;

(9) Income used to fulfill an approved plan for achieving self-support (PASS), as defined in 20 C.F.R. 416.1181 (as in effect on March 1, 2013);

(10) The amount of court-ordered child support payments paid by a household member for a child outside the home.

(11) The value of in-kind support and maintenance;

(12) Alaska longevity bonus payments made to an individual who is a resident of Alaska and who, prior to October 1, 1985, met the twenty-five-year residency requirement for receipt of such payments in effect prior to January 1, 1983, and was eligible for supplemental security income (SSI);

(13) Disaster assistance as described in 20 C.F.R. 416.1150 and 416.1151 (as in effect on March 1, 2013);

(14) Income received infrequently or irregularly, as defined in 20 C.F.R. 416.1112(c)(2) and 416.1124(c)(6) (as in effect on March 1, 2013);

(15) Blind work expenses of the ineligible spouse or parent;

(16) Income of the ineligible spouse or ineligible parent which was paid under a federal, state, or local government program to provide the eligible individual with chore, attendant or homemaker services;

(17) Certain support and maintenance assistance as described in 20 C.F.R. 416.1157(c) (as in effect on March 1, 2013);

(18) Housing assistance as provided in 20 C.F.R. 416.1124(c)(14) (as in effect on March 1, 2013);

(19) The value of a commercial transportation ticket as described in 20 C.F.R. 416.1124(c)(16) (as in effect on March 1, 2013). However, if such a ticket is converted to cash, the cash is income in the month the spouse or parent receives the cash;

(20) Refunds of federal income taxes and advances made by an employer relating to an earned income tax credit, as provided in 20 C.F.R. 416.1112(c) (as in effect on March 1, 2013);

(21) Payments from a fund established by a state to aid victims of crime, as described in 20 C.F.R. 416.1124(c)(17) (as in effect on March 1, 2013);

(22) Relocation assistance, as described in 20 C.F.R. 416.1124(c)(18) (as in effect on March 1, 2013);

(23) Combat pay received from one of the uniformed services pursuant to 37 U.S.C. 310 (as in effect on March 1, 2013);

(24) Impairment-related work expenses, as described in 20 CFR 404.1576 (as in effect on March 1, 2013), incurred and paid by an ineligible spouse or parent, if the ineligible spouse or parent receives disability benefits under title II of the act;

(25) Interest earned on excluded burial funds and appreciation in the value of excluded burial arrangements which are left to accumulate and become part of separate burial funds, and interest accrued on and left to accumulate as part of the value of agreements representing the purchase of excluded burial spaces, as described in 20 C.F.R. 416.1124(c) (9) and (15) (as in effect on March 1, 2013);

(26) Interest and dividend income from a countable resource or from a resource excluded under a federal statute other than section 1613(a) of the Social Security Act (as in effect on March 1, 2013); and

(27) Earned income of a student as described in 20 C.F.R. 416.1112(c)(3) (as in effect on March 1, 2013).

(D) If the eligible spouse or parent(s) is/are receiving Ohio works first (OWF) or SSI payments, then the payments themselves and any of the OWF- or SSI-eligible individual's own income that was used to compute eligibility for such payments are not considered available for deeming. 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.

(E) When an individual is living in the same household with an ineligible spouse who has income, perform the following steps to calculate the amount of income to deem to the individual:

(1) Determine the ineligible spouse's income, applying any appropriate exclusions listed in paragraph (C) of this rule;

(2) Deduct the appropriate allocation for each ineligible child in the household and for each eligible alien sponsored by the ineligible spouse:

(a) The allocation amount is the current SSI federal benefit rate (FBR) for a couple minus the current FBR for an individual.

(b) The allocation for each ineligible child in the household or sponsored alien is reduced by the amount of that child's or alien's income, minus any appropriate exclusions listed in paragraph (C) of this rule.

(c) The ineligible child or sponsored alien allocation(s) must first be taken from the ineligible spouse's unearned income; any remaining allocation amount will be subtracted from the ineligible spouse's earned income.

(3) If the ineligible spouse's remaining income after subtracting the ineligible child or sponsored alien allocation is less than or equal to the current FBR for a couple minus the current FBR for an individual:

(a) Do not deem any income to the individual;

(b) Compare the individual's own income to the current medicaid need standard for an individual.

(4) If the ineligible spouse's remaining income after subtracting the ineligible child or sponsored alien allocation is greater than the current FBR for a couple minus the current FBR for an individual, treat the spouses as if they were an eligible couple:

(a) Combine both spouses' post-allocation earned and unearned incomes;

(b) Subtract the twenty-dollar general disregard from the unearned income; if there is less than twenty dollars of unearned income, subtract the rest of the disregard from the earned income;

(c) Subtract sixty-five dollars from the earned income, then subtract one-half of the remaining earned income.

(d) If the couple's countable income is less than or equal to the current medicaid need standard for a couple, the individual is financially eligible for medicaid.

(e) If the couple's countable income is greater than the current medicaid need standard for a couple, the individual is subject to spenddown provisions as defined in rule 5101:1-39-10 of the Administrative Code.

(F) When an eligible child or children reside(s) with an ineligible parent or parents, perform the following steps to calculate the amount of income to deem to the child(ren):

(1) Determine the income of the ineligible parent(s), applying any appropriate exclusions listed in paragraph (C) of this rule;

(2) Deduct the appropriate allocation for each ineligible child in the household and for each eligible alien sponsored by the ineligible parent:

(a) There is no allocation for an ineligible child receiving PIM payments as described in paragraph (C)(2) of this rule;

(b) The allocation amount is the current FBR for a couple minus the current FBR for an individual.

(c) The allocation for each ineligible child or sponsored alien in the household is reduced by the amount of that child's or sponsored alien's income minus any appropriate exclusions listed in paragraph (C) of this rule.

(d) The ineligible child or sponsored alien allocation(s) must first be taken from the unearned income of the ineligible parent(s); any remaining allocation amount will be subtracted from the earned income of the ineligible parent(s).

(3) Subtract the twenty-dollar general disregard from the unearned income of the ineligible parent(s); if there is less than twenty dollars of unearned income, subtract the rest of the disregard from the earned income of the ineligible parent(s).

(4) Subtract sixty-five dollars from the earned income of the ineligible parent(s), then subtract one-half of the remaining earned income.

(5) Combine the ineligible parents' remaining earned and unearned income.

(6) Subtract the appropriate parental living allowance:

(a) There is no parental living allowance deducted for any parent who receives PIM payments as described in paragraph (C)(2) of this rule;

(b) If two parents (or one parent and a step-parent) reside in the household with the child(ren), subtract the current FBR for a couple;

(c) If one parent resides in the household with the child(ren), subtract the current FBR for an individual;

(d) If both natural or adoptive parents and a step-parent reside in the household with the child(ren), subtract both the current FBR for a couple and the current FBR for an individual.

(7) Divide the remaining income by the number of eligible children the household, and deem the resulting amount to each child.

(8) Any income deemed to a child from an ineligible parent is added to the child's own unearned income.

(9) Subtract the twenty-dollar general disregard from the child's unearned income; if the child has less than twenty dollars of unearned income, subtract the remainder of the disregard from the child's earned income.

(10) Subtract sixty-five dollars from the child's earned income, then subtract one-half of the remaining earned income.

(11) Combine the child's earned and unearned income.

(12) If the result is less than or equal to the current medicaid need standard for an individual, the child is financially eligible for medicaid.

(13) If the result is more than the current medicaid need standard for an individual, the child is subject to spenddown provisions as defined in rule 5101:1-39-10 of the Administrative Code.

(G) When a household comprises an ineligible spouse/parent, an eligible spouse, and one or more children, the ineligible spouse/parent's income is deemed both to the eligible spouse and to the eligible child(ren).

(1) Determine the income of the ineligible spouse/parent, applying any appropriate exclusions listed in paragraph (C) of this rule;

(2) Deduct the appropriate allocation for each ineligible child in the household and for each eligible alien sponsored by the ineligible spouse/parent;

(3) If the ineligible spouse's remaining income after subtracting the ineligible child or sponsored alien allocation is less than or equal to the current FBR for a couple minus the current FBR for an individual:

(a) Do not deem any income to the eligible spouse or child(ren);

(b) Compare the eligible spouse's and children's own income to the current medicaid need standard for an individual.

(4) If the ineligible spouse/parent's remaining income after subtracting the ineligible child or sponsored alien allocation is greater than the current FBR for a couple minus the current FBR for an individual:

(a) Round down the ineligible spouse/parent's income to the nearest dollar;

(b) Divide the result by the number of eligible individuals (spouse and child(ren)) and round down to the nearest dollar;

(c) Deem the resulting quotient to each eligible individual.

(5) Any income deemed to an eligible individual from an ineligible spouse/parent is added to the eligible individual's own unearned income.

(6) Subtract the twenty-dollar general disregard from each eligible individual's unearned income; if the individual has less than twenty dollars of unearned income, subtract the rest of the disregard from the individual's earned income;

(7) Subtract sixty-five dollars from the eligible individual's earned income, then subtract one-half of the individual's remaining earned income.

(8) Compare the eligible spouse's resulting countable income to the current medicaid need standard for couples:

(a) If the eligible spouse's resulting countable income is less than or equal to the current medicaid need standard for couples, the eligible spouse is financially eligible for medicaid.

(b) If the eligible spouse's resulting countable income is greater than the current medicaid need standard for couples, the eligible spouse is subject to spenddown provisions as defined in rule 5101:1-39-10 of the Administrative Code.

(9) Compare each eligible child's final countable income to the current medicaid need standard for an individual:

(a) If the eligible child's resulting countable income is less than or equal to the current medicaid need standard for an individual, the eligible child is financially eligible for medicaid.

(b) If the eligible child's resulting countable income is greater than the current medicaid need standard for an individual, the eligible child is subject to spenddown provisions as defined in rule 5101:1-39-10 of the Administrative Code.

(H) Refer to rule 5101:1-2-35 of the Administrative Code for sponsor-to-alien deeming requirements.

Replaces: 5101:1-39-19

Effective: 03/01/2013
R.C. 119.032 review dates: 03/01/2018
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011
Prior Effective Dates: 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