††††† 907 KAR 20:020. Income standards for Medicaid other than Modified Adjusted Gross Income (MAGI) standards or for former foster care individuals.

 

††††† RELATES TO: KRS 205.520, 38 U.S.C. 5503, 42 U.S.C. 1382a, 1396jj(b), 1397aa, 9902(2)

††††† STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 C.F.R. 435, 42 U.S.C. 1396a, 1396b, 1396d, 1397aa

††††† NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the Medicaid Program in accordance with 42 U.S.C. 1396 through 1396v. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law for the provisions of medical assistance to Kentucky's indigent citizenry. This administrative regulation establishes the income standards by which Medicaid eligibility is determined, except for individuals for whom a modified adjusted gross income is the Medicaid eligibility income standard or former foster care individuals who aged out of foster care while receiving Medicaid coverage.

 

††††† Section 1. Income Limitations. (1)(a) Income shall be determined by comparing adjusted income as required by Section 2 of this administrative regulation, of the applicant, applicant and spouse, or applicant, spouse, and minor dependent children with the following scale of income protected for basic maintenance:

Size of Family

Annual

Monthly

1

$2,600

$217

2

3,200

267

3

3,700

308

4

4,600

383

5

5,400

450

6

6,100

508

7

6,800

567

 

††††† (b) For each additional family member, $720 annually or sixty (60) dollars monthly shall be added to the scale.

††††† (2) For a pregnant woman or child eligible pursuant to 42 U.S.C. 1396a(e) a change of income that occurs after the determination of eligibility of a pregnant woman shall not affect the pregnant woman's eligibility through the remainder of the pregnancy including the postpartum period which ends at the end of the month containing the 60th day of a period beginning on the last day of her pregnancy.

††††† (3) The special income limits and provisions established in this subsection shall apply for a determination of eligibility of a qualified Medicare beneficiary, specified low-income Medicare beneficiary, qualified disabled and working individual, or Medicare qualified individual group 1 (QI-1).

††††† (a) A qualified Medicare beneficiary shall have income not exceeding 100 percent of the official poverty income guidelines.

††††† (b) A specified low-income Medicare beneficiary shall have income greater than 100 percent of the official poverty income guidelines but not to exceed 120 percent of the official poverty income guidelines.

††††† (c) A Medicare qualified individual group 1 (QI-1) shall have income greater than 120 percent of the official poverty income guidelines but less than or equal to 135 percent of the official poverty income guidelines.

††††† (d) A qualified disabled and working individual shall have income not exceeding 200 percent of the official poverty income guidelines.

††††† (4) Income shall be limited to the allowable amounts for the SSI program for:

††††† (a) A child who lost eligibility for SSI benefits due to the change in the definition of childhood disability as established in 42 U.S.C. 1396a(a)(10); or

††††† (b) A person with hemophilia who received a class action settlement as established in 42 C.F.R. Part 130.

††††† (5) Income shall be limited to the allowable amounts for the mandatory or optional state supplement program for an individual described in 42 C.F.R. 435.135.

††††† (6) The following special income factors shall apply for a Medicaid Works individual:

††††† (a) Income for a Medicaid Works individualís spouse shall not exceed $45,000 per year;

††††† (b) A Medicaid Works individualís unearned income shall be less than the SSI standard plus twenty (20) dollars monthly; and

††††† (c) The combination of earned and unearned income for a Medicaid Works individual shall be less than 250 percent of the official poverty income guidelines.

 

††††† Section 2. Income Disregards. In comparing income with the scale established in Section 1 of this administrative regulation, gross income shall be adjusted as established in this section.

††††† (1) In a TANF or family related Medicaid case:

††††† (a) The standard work expense of an adult member or out-of-school child shall be deducted from gross earnings;

††††† (b) For a person with either full-time or part-time employment, the standard work expense deduction shall be ninety (90) dollars per month; and

††††† (c) Earnings of an individual attending school who is a child or parent under age nineteen (19) or a child under age eighteen (18) who is a high school graduate shall be disregarded.

††††† (2) For an ABD Medicaid case or a Medicaid Works individual, the applicable federal SSI disregards pursuant to 42 U.S.C. 1382a(b) shall apply.

††††† (3) For an individual in a Medicaid eligibility group subject to 42 U.S.C. 1396a(a)(10)(E)(i), (ii), or (iv) or 42 U.S.C. 1396d(p), if an annual Social Security cost-of-living adjustment, Railroad Retirement cost-of-living adjustment, or federal poverty level cost-of-living adjustment causes an individual to be ineligible for Medicaid benefits:

††††† (a) The individualís most recent Social Security cost-of-living adjustment, Railroad Retirement cost-of-living adjustment, or federal poverty level cost-of-living adjustment shall be disregarded; and

††††† (b) The disregard referenced in paragraph (a) of this subsection shall continue until the individual loses Medicaid eligibility for any other reason for three (3) consecutive months.

††††† (4)

††††† (a) An ABD Medicaid case shall be the applicable federal SSI disregards pursuant to 42 U.S.C. 1382a(b).

††††† (b) A Medicaid Works individual shall be the applicable federal SSI disregards pursuant to 42 U.S.C. 1382a(b).

 

††††† Section 3. Lump Sum Income. Except as established in Section 8 of this administrative regulation, for a Medicaid case, lump sum income shall be considered as income in the month received.

 

††††† Section 4. Income Exclusions. (1) Income of a person who is blind or disabled necessary to fulfill a plan approved by the United States Social Security Administration to achieve self support, IRWE deduction, or BWE deduction shall be excluded from consideration.

††††† (2) A payment or benefit from a federal statute, other than SSI benefits, shall be excluded from consideration as income if precluded from consideration in SSI determinations of eligibility by the specific terms of the statute.

††††† (3) A cash payment intended specifically to enable an applicant or recipient to pay for medical or social services shall not be considered as available income in the month of receipt.

††††† (4) A Federal Republic of Germany reparation payment shall not be considered available in the eligibility or post eligibility treatment of income of an individual in a nursing facility or hospital or who is receiving home and community based services under a waiver program.

††††† (5) A Social Security cost of living adjustment on January 1 of each year shall not be considered as available income for a qualified Medicare beneficiary, specified low-income Medicare beneficiary, qualified disabled and working individual, or Medicare qualified individual group 1 (QI-1) until after the month following the month in which the official poverty income guidelines promulgated by the United States Department of Health and Human Services are published.

††††† (6) Any amount received from a victimís compensation fund established by a state to aid victims of crime shall be excluded as income.

††††† (7) A veteran or the spouse of a veteran residing in a nursing facility who is receiving a Veterans Administration (VA) pension benefit shall have ninety (90) dollars:

††††† (a) Excluded as income in the Medicaid eligibility determination; and

††††† (b) Excluded as income in the post eligibility determination process.

††††† (8) Veterans Administration payments for unmet medical expenses and aid and attendance shall be excluded in a Medicaid eligibility determination for a veteran or the spouse of a veteran residing in a nursing facility.

††††† (a) Veterans Administration payments for unmet medical expenses and aid and attendance shall be excluded in the post eligibility determination for a veteran or the spouse of a veteran residing in a nonstate-operated nursing facility.

††††† (b) Veterans Administration payments for unmet medical expenses and aid and attendance shall not be excluded in the post eligibility determination process for a veteran or the spouse of a veteran residing in a state-operated nursing facility.

††††† (9) An Austrian Social Insurance payment based, in whole or in part, on a wage credit granted under Sections 500-506 of the Austrian General Social Insurance Act shall be excluded from income consideration.

††††† (10) An individual retirement account, KEOGH plan, or other tax deferred asset shall be excluded as income until withdrawn.

††††† (11) Disaster relief assistance shall be excluded as income.

††††† (12) Income which is exempted from consideration for purposes of computing eligibility for the comparable money payment program (AFDC or SSI) shall be excluded.

††††† (13) In accordance with 42 C.F.R. 435.122 and Section 4735 of Pub.L. 105-33, a payment made from a fund established by a settlement in the case of Susan Walker v. Bayer Corporation or payment made for release of claims in this action shall be excluded as income.

††††† (14) In accordance with 42 C.F.R. Part 130, any payment received by a person with hemophilia from a class action lawsuit entitled "Factor VIII or IX Concentrate Blood Products Litigation" shall be excluded as income.

††††† (15) Family alternatives diversion payments shall be excluded as income.

††††† (16) All monies received by an individual from the Tobacco Master Settlement Agreement shall be excluded.

††††† (17) Income placed in a qualifying income trust established in accordance with 42 U.S.C. 1396p(d)(4) and 907 KAR 20:030, Section 3(5), shall be excluded.

 

††††† Section 5. Consideration of Mandatory or Optional State Supplements. For an individual receiving a mandatory or optional state supplement, that portion of the individual's income which is in excess of the basic maintenance standard, established in Section 1(1) of this administrative regulation, shall be applied to the special need which results in the supplement.

 

††††† Section 6. Pass-through Cases. (1)(a) An increase in a Social Security payment shall be disregarded in determining eligibility for Medicaid benefits if:

††††† 1. The increase is a cost of living increase; and

††††† 2. The individual would otherwise be eligible for an SSI benefit, mandatory state supplement, or optional state supplement.

††††† (b) An individual who would otherwise be eligible for an SSI benefit, mandatory state supplement, or optional state supplement shall remain eligible for the full scope of program benefits with no spend-down requirements, as established in Section 7 of this administrative regulation.

††††† (2) For an individual who applied by July 1, 1988, the additional amount specified in 42 U.S.C. 1383c(b) shall be disregarded, meaning that amount of Social Security benefits to which a specified widow or widower was entitled as a result of the recomputation of benefits effective January 1, 1984, and except for which (and subsequent cost of living increases) an individual would be eligible for federal SSI benefits.

 

††††† Section 7. Spend-down Provisions. (1) A technically eligible individual or family shall not be required to utilize protected income for medical expenses before qualifying for Medicaid.

††††† (2)(a) An individual with income in excess of the basic maintenance scale established in Section 1(1) of this administrative regulation shall qualify for Medicaid in any part of a three (3) month period in which medical expenses incurred have utilized all excess income anticipated to be in hand during that period.

††††† (b) Medical expenses incurred in a period prior to the quarter for which spend-down eligibility is being determined shall be used to offset excess income if the medical expenses remain unpaid at the beginning of the quarter and have not previously been used as spend-down expenses.

 

††††† Section 8. Individual Retirement Account. (1)(a) If an individual reaches the point where the individual is eligible to begin withdrawing from an IRA without suffering a penalty, the individual shall begin withdrawing from the IRA at least the minimum amount determined by the financial institution holding the IRA.

††††† (b) If an individual does not begin withdrawing from an IRA pursuant to paragraph (a) of this subsection, the individual shall be ineligible for Medicaid benefits.

††††† (2) If an individual withdraws funds from an IRA prior to reaching the point where the individual would suffer no penalty for withdrawing funds, the withdrawal shall be considered non-recurring lump sum income.

††††† (3) If an individual withdraws income pursuant to subsection (1)(a) of this section, the income shall be prorated over the period of time the income covers (for example monthly, quarterly, or annually).

 

††††† Section 9. Applicability. The provisions and requirements of this administrative regulation shall:

††††† (1) Apply to:

††††† (a) A child in foster care;

††††† (b) An aged, blind, or disabled individual; and

††††† (c) An individual who receives supplemental security income benefits; and

††††† (2) Not apply to an individual

††††† †whose Medicaid eligibility is determined:

††††† (a) Using the modified adjusted gross income standard pursuant to 907 KAR 20:100; or

††††† (b) Pursuant to 907 KAR 20:075. (21 Ky.R. 2879; Am. 22 Ky.R. 296; eff. 7-261995; 25 Ky.R. 444; 865; eff. 9-16-1998; 26 Ky.R. 1255; 1573; eff. 2-1-2000; 28 Ky.R. 965; eff. 12-19-2001. 30 Ky. R. 1117; 1533; eff. 1-2-2004; 34 Ky.R. 1849; 2122; eff. 4-4-2008; Recodified from 907 KAR 1:640, 9-30-2013; 40 Ky.R. 1164; 1768; 2157; eff. 4-4-2014.)