State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

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15.1 Income Introduction

15.1.1 Elderly, Blind, or Disabled Fiscal Test Group

An EBDElderly, Blind, or Disabled fiscal test group (FTG) usually includes the individual who is non-financially eligible for Medicaid and anyone who lives with him or her and who is legally responsible for him or her. EBD fiscal test groups are groups of one or two. Spouses who live together are in each other’s FTG. This means that the income and assets of both spouses are counted when determining Medicaid eligibility for either or both spouses. The FTG size for this living arrangement is two.

There are some exceptions to this Policy:

• Blind or disabled minors (or dependent 18-year-olds): A blind or disabled minorA minor is a person less than age 18. (or dependent 18-year-old ) living with his or her parents would be a one-person FTG. Special instructions for deeming parental income to the disabled minor are described in Section 15.1.2 Special Financial Tests for Disabled Minors
• Children and young adults who are applying for HCBW Medicaid for enrollment into the CLTS waiver program are a one-person FTG and have eligibility determined under the policy in Section 37.3 HCBW Medicaid CARES Processing for the CLTS Waiver Program.
• 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 applicant's FTG. For this situation, you would have a one-person FTG when determining the Medicaid eligibility of the non-SSI spouse.
• Medicaid Purchase Plan (MAPP): Children are included in the FTG of a MAPP applicant or member, so the FTG for this program could be greater than two people. See Section 26.2.2 Fiscal Test Group for more information.

An individual applying for Long-Term Care Medicaid, including Institutional Medicaid, HCBWHome and Community-Based Waiver, Family Care, PACEProgram of All-Inclusive Care for the Elderly, Partnership, or IRISInclude, Respect, I Self-Direct. A Medicaid waiver program., 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.

15.1.2 Special Financial Rules for Disabled Children for SSI-Related Medicaid

Some amount of parental income may be deemed to a blind or disabled minor child or dependent 18-year-old when determining the child’s financial eligibility for SSI-Related Medicaid and Medicare Savings Programs.

The blind or disabled child is a separate fiscal test group of one. The deemed parental income is added to the child’s own income for the eligibility determination.

An “eligible child" in this section is defined as a minor child or dependent 18-year-old who is blind or disabled.

An “ineligible child” in this section is defined as a minor child or dependent 18-year-old who lives in the same household as the eligible child and is neither blind nor disabled.

Children who receive SSI are not counted as household members for purposes of this deeming process.

To determine how much parental income must be deemed to each eligible child:

1. Determine how much parental income to allocate to any ineligible children in the household. To do this, for each ineligible child, subtract the child’s unearned and earned income from the SSI-Related Deeming Amount to an Ineligible Minor. This amount is updated annually and can be found in SECTION 39.4.2 DISABLED MINORS DEEMING AND ALLOWANCES.
2. Determine the remaining total parental income as follows:
   1. Subtract the ineligible child allocation amount (Step 1) from the parental unearned income. If there is not enough parental unearned income to subtract the whole amount, subtract the rest from parental earned income.
   2. If there is any remaining parental unearned income from Step 2(a), subtract the $20 general income disregard from the remaining unearned income. If there is not enough unearned income to subtract the full $20, subtract the rest of the $20 general income disregard from the parental earned income.
   3. Starting from what is left of the parental earned income, first subtract $65, and then subtract half of the remaining parental earned income.
   4. To the remaining parental earned income, add any parental unearned income remaining after steps 2(a) and (b).
3. Determine the amount of parental income that must be deemed to the eligible children by subtracting the appropriate Parental Living Allowance from the remaining total parental income determined in Step 2. Use the Parental Living Allowance amount for one parent if only one parent lives in the household. Use the amount for two parents if both parents (or one parent and a spouse) live in the household. The Parental Living Allowance amounts are updated annually and can be found in SECTION 39.4.2 DISABLED MINORS DEEMING AND ALLOWANCES.
4. Divide the parental deemed income equally among the eligible children.

Example 1:

Mr. and Mrs. Darwin live with their two minor children, Matthew and Jenny. Matthew is disabled and applying for Medicaid in 2022. Jenny is neither blind nor disabled. Neither child has income. Mr. and Mrs. Darwin have no unearned income and their gross earned income is $3,800 a month. In 2022, the SSI-Related Deeming Amount to an Ineligible Minor is $420 and the Parental Living Allowance for two parents is $1,261. ------------- Determine amount allocated for ineligible child ($420 - $0) = $420 Determine total parental income: Start with $3,800 gross parental earned income Subtract $420 allocated for Jenny = $3,380 Subtract $20 general income disregard = $3,360 Subtract $65 earned income disregard = $3,295 Subtract half of remaining earned income = $1,647.50 Subtract parental living allowance for two parents ($1,261) from total parental income ($1,647.50) = $386.50 Divide by the number of eligible children (1) = $386.50 deemed to Matthew

 

Example 2:

Lawrence is a single parent with three minor children, Abel, Maris, and Dean. Dean is disabled and applying for Medicaid in 2022. Abel and Maris are neither blind nor disabled. None of the children have any income. Lawrence has $600 monthly unearned income and $2,050 monthly earned income. In 2022, the SSI-Related Deeming Amount to an Ineligible Minor is $420 and the Parental Living Allowance for one parent is $841. ------------- Determine amount allocated for ineligible children ($420 - $0) + ($420 - $0) = $840 Determine total parental income: Start with $600 gross unearned income Subtract $840 allocated for Abel and Maris = -$240 remaining allocation Subtract $240 remaining allocation from gross parental earned income ($2,050) = $1,810 Subtract $20 general income disregard = $1,790 Subtract $65 earned income disregard = $1,725 Subtract half of remaining earned income = $862.50 Subtract parental living allowance for one parent ($841) from total parental income ($862.50) = $21.50 Divide by the number of eligible children (1) = $21.50 deemed to Dean

15.1.3 Income

See Section 39.4 Elderly, Blind, or 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 BadgerCare Plus Eligibility Handbook Section 43.2 Financial Test for TBTuberculosis-Related income limits.

15.1.4 Supplemental Security Income-Related Test

A fiscal group with income that does not exceed the categorically needy income limit passes the Medicaid SSI-related categorically needy income test (see Section 24.1 SSI-Related Medicaid Introduction for more information).

If an SSI-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, or 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 SSI-related 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.

15.1.5 Availability

Available income can include more than a person actually receives if any of the following are true:

• A benefit payment (such as a Social Security benefit) has been reduced to recover a previous overpayment. 
• Amounts are being withheld because of a garnishment or to pay a debt or other legal obligation.
• Amounts are being withheld to make another payment (such as Medicare premiums).

Available income can include less than a person actually receives if part of the payment is for an expense the person had in getting the payment. For example, if someone is paid for damages they received in an accident, the medical, legal, or other expenses connected with the accident are subtracted from countable income.

If the person receives a retroactive check from a benefit program other than SSI, legal fees connected with the claim are subtracted. 

Any part of taxable income used to pay personal income taxes is not subtracted, because the payment of taxes is not an expense the person has in getting the income. 

Note

Applicants and members are not required to apply for cash benefits such as Social Security disability or retirement benefits, Supplemental Security Income (SSI), unemployment benefits, pensions, etc., as a condition of eligibility for Medicaid. Cash benefits that a person might potentially be eligible for that they do not actually receive must not be counted as income.

15.1.6 Countable Income

Countable income is the prospective gross monthly amount used in the eligibility determination and post-eligibility calculations.

15.1.6.1 Migrant Workers

Annualize migrant workers income (see Chapter 31 Migrant Workers).

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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