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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
15.1.2 Special Financial Tests for Disabled Minors
An EBD fiscal group includes the individual who is non-financially eligible for Medicaid and anyone who lives with them, and who is legally responsible for them. EBD fiscal test groups will always be a group of one (1) or two (2). Spouses who live together are in each other’s fiscal group. This means that the
income
and assets of both spouses are counted when determining Medicaid eligibility for either or both spouses. The fiscal group size for this situation/living arrangement is two.
There are some exceptions to this concept. A blind or disabled minor (or dependent 18-year-old ), living with his or her parents would be a one person fiscal group. Special instructions for deeming parental income to the disabled minor are described in Section 15.1.2 Special Financial Tests for Disabled Minors.
Another exception to the fiscal group policy involves SSI recipients. If one spouse is applying for EBD Medicaid and the other spouse is an SSI recipient, the SSI recipient spouse is not included in the other spouse’s fiscal group. For this situation you would again have a one person fiscal group when determining the Medicaid eligibility of the non-SSI spouse.
An individual applying for Long Term Care Medicaid, including Institutional MA, Home and Community-Based Waivers, Family, PACE , Partnership or IRIS would be a one person fiscal group. If the individual is married, refer to Section 18.1 Spousal Impoverishment Introduction for special instructions regarding spousal impoverishment procedures.
A blind or disabled minor (or dependent 18 year old) would have his or her Medicaid eligibility determined according to the following special procedures when the disabled minor fails Family Medicaid financial tests. This process essentially deems parental income to the disabled minor. The deemed parental income is added to the disabled minor’s income when determining the disabled minor’s financial eligibility for EBD Medicaid.
The disabled minor is a separate fiscal group of one. A child who is an SSI recipient is not considered to be a household member and therefore not included in any of the following procedures.
An ineligible child in this section is a minor child who is neither disabled nor blind.
An eligible child in this section is a minor child who is disabled or blind or both.
Calculate the countable income of everyone in the household using the following six steps. Count all of the person’s income except that which is exempt or unavailable. See Section 15.1 Income Introduction.
For each ineligible child in the household:
Subtract the ineligible child's unearned and earned income from the EBD Deeming Amount to an Ineligible Minor (Section 39.4.2 EBD Deductions and Allowances).
The remainder is the amount to be allocated to the ineligible child from parental gross unearned income.
If there is not enough parental unearned income, allocate the rest from parental gross earned income.
Go to 2.
Subtract $20, the general income exclusion, from any remaining parental unearned income.
If there is not enough unearned income to subtract the full $20, subtract the rest of the $20 from parental earned income.
Go to 3.
Subtract $65 & 1/2 from the remaining parental earned income.
Go to 4.
Add:
Remaining parental unearned income resulting from step 03, and
Remaining parental earned income resulting from step 04
Go to 5.
From the total parent income resulting from 5., subtract:
The Parental Living Allowance (Section 39.4.2 EBD Deductions and Allowances) for a couple if both parents (or one parent and his or her spouse) live in the household; or
The Parental Living Allowance (Section 39.4.2 EBD Deductions and Allowances) for an individual if only one parent lives in the household.
The remainder is the total parental income to be deemed to the eligible child(ren).
Go to 6.
Divide the parental deemed income equally among the eligible children. Use the EBD-Related Determination worksheet (Section 40.1 Worksheet 6) to calculate each child's Medicaid eligibility.
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Example 1: Mr. and Mrs. Darwin have two children. Matthew, eight years old, is disabled, and is the eligible child. Jenny, 10 years old, is the ineligible child. Neither child has income. The Darwins have no unearned income. Parental earned income is $2,775 a month. The parents' earned income of $2,775 minus $367 (deeming amount to an ineligible minor, see 39.4.2) = $2,408. ------------- Remaining earned income $2,408. General income exclusion -20.00 Remainder $2,388. Earned income exclusion -65.00 ------------- Remainder $2,323 1/2 remaining earned income -$1,161.50 Add in the $65 income exclusion Total Disregarded amount $1,226.50 ------------- Remaining earned income $1,161.50 (2,388 - 1,226.50 = 1,161.50) Parental living allowance -$1,100 ------------- Income deemed to eligible child = $61.50 |
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Example 2: Lawrence has three children. One is disabled. None has any income. His monthly income is $2,050 earned, $390 unearned.
Lawrence's unearned income $ 390.00
EBD Deeming Amount for 2 ineligible minors -$734.00 Excess allocation $ -410 Lawrence's earned income $2,050.00 Excess allocation $ -410 -------------- Lawrence's remaining earned income $1,706 General income exclusion -20.00 ------------- Remainder $1,686 Earned income exclusion -65.00 Remainder $1,621 1/2 remaining earned income -$810.50
Remaining earned income $810.50 Parental living allowance $ -$733.00 --------- Income deemed to eligible child $77.50 |
See Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables for EBD income limits. See Section 39.5 Federal Poverty Level Table for all other Medicaid income limits. Chapters for each type of Medicaid explain how to determine the income that you compare to the income limits.
See Section 39.4.2 EBD Deductions and Allowances for TB -Related income limits.
The EBD categorically needy income limit consists of two components; an income amount plus a shelter/ utility amount. The EBD fiscal group’s total actual shelter, fuel, and utility expenses are compared to a maximum allowance that is found in Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables. The actual shelter/utility costs or the shelter/utility maximum, whichever is less, is added to the categorically needy income amount (Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables), and this total becomes the EBD categorically needy income limit. A fiscal group with income that does not exceed the categorically needy income limit passes the Medicaid EBD categorically needy income test.
If an EBD related fiscal group’s income exceeds the categorically needy income limit, their income is then compared to a medically needy limit, which is found in Section 39.4 Elderly, Blind, and Disabled Assets and Income Tables. If the fiscal group’s income is between the categorically needy limit and the medically needy limit, the group passes the Medicaid EBD medically needy income test.
If an EBD fiscal group fails the medically needy income test because their net income exceeds the medically needy income limit, they can still qualify for Medicaid if they can meet a Medicaid deductible. Refer to Section 24.2 Medicaid Deductible Introduction for more information about Medicaid deductibles and to Section 24.5 Calculating the Deductible for instructions on how to calculate a Medicaid Deductible.
General Rules:
Only count income when it is available (see Section 15.1.5 Availability).
Some income is disregarded (see Section 15.3 Exempt/Disregarded Income).
Always use gross income when calculating income.
Some income, even though it is unavailable income, must be counted (e.g., garnishments).
Income is available when:
It is actually available, and
The person has a legal interest in it, and
The person has the legal ability to make it available for support and maintenance.
Note: Available income can include more than a person actually receives if amounts are withheld from earned or unearned income because of a garnishment or to pay a debt or any other legal obligation.
Examples of income sources that someone can make available are social security and unemployment compensation. This includes income increases such as COLA s.
When it is known that a member of the assistance group is eligible for some sort of income or an increased amount of income:
Count the income if the amount is known. Count it as if the person is receiving it.
Ignore the income if the amount is not known.
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Example 3: Ms. M. turned 62 years old and is entitled to Social Security benefits of $900. However, she opted to wait until she turns 65 to start collecting her benefits. Since she is entitled to $900 at age 62, $900 is considered available income. |
Income is unavailable when it will not be available for 31 days or more. The person must document that 1) It will not be available for 31 days or more, and 2) They have started the process to make it available.
Unavailability is usually documented by a letter from an agency stating when the person will receive the benefit. Thus, if he or she has just applied for benefits, do not add it to his or her income yet. The income is not ignored; it is only suspended until it becomes available.
Countable income is the prospective gross monthly amount used in the eligibility determination and post-eligibility calculations.
Annualize migrant workers income. See Section 25.8 Migrant Workers.
This page last updated in Release Number: 15-01
Release Date: 06/10/2015
Effective Date: 06/10/2015
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030