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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
1.1.3.1.2 Special Financial Tests for Disabled Minors
See 8.1.5 for EBD asset limits. There is no asset test for
any Family MA subprogram. See 5.11.7.2 for TB-Related asset limits. See 1.1.3.1.2 to determine Medicaid eligibility for disabled minors that fail Family Medicaid financial tests.
Use the EBD Related Determination worksheet when doing manual eligibility determinations for non institutionalized EBD Medicaid applicants and recipients. The EBD fiscal group’s assets must be within the appropriate categorically needy or medically needy asset limit before any member of that group can qualify for Medicaid. EBD fiscal groups who have assets in excess of the appropriate EBD medically needy asset limit are ineligible for Medicaid.
An EBD fiscal
group includes the individual who is non financially eligible for Medicaid
and anyone who lives with them, who is legally responsible for them. Spouses
who live together are in each other’s fiscal group. This
means that the income Income is anything you receive in cash or in kind that you can use to
meet your needs for food, clothing, and shelter.
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 their
parents would be a one person fiscal group. Special
instructions for deeming parental income and assets to the disabled minor
are described in (1.1.3.1.2).
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 living in a medical institution for 30 or more consecutive days would be a one person fiscal group. If the institutionalized person is married, refer to chapter 5.10 for special instructions regarding spousal impoverishment procedures.
A blind or disabled minor (or dependent 18 year old) would have their Medicaid eligibility determined according to the following special procedures when the disabled minor fails Family Medicaid financial tests. This process essentially deems parental income and assets to the disabled minor. The deemed parental income and assets are added to the disabled minor’s income and assets 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 assets of all eligible children and their parents in the household. Count all of the person’s assets except those that are exempt or unavailable. See Chapter 4.5. Before deeming the countable assets of the parent/parents to the eligible children in the household disregard $2000 of these countable assets if there is one parent in the household and $3000 if there are two parents in the household.
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Example1 : A single parent with a disabled minor owns $4500 in nonexempt assets. $2500 of that asset would be deemed to the disabled minor when determining the minor's Medicaid eligibility. |
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Example 2: A parent and his/her spouse own $4500 in non-exempt assets. The parent has a disabled minor. $1500 of the parent's and the spouse's assets would be deemed to the disabled minor when determining the minor's Medicaid eligibility. |
Calculate the countable income of everyone in the Household using the following 7 steps. Count all of the person’s income except that which is exempt or unavailable. See Chapter 4.1.
Divide parental countable assets equally among the eligible children in the household. Add each child's assets to his or her share of parental assets.
Enter the total on line 4 of the EBD-Related Determination worksheet (WKST 06).
If the child's asset amount is greater than the medically needy asset limit, he or she does not pass the asset test and cannot receive Medicaid.
Go to #2, if any child has passed the asset test.
For each ineligible child in the household:
Subtract the ineligible child's unearned
& earned income from the EBD Deeming Amount to an Ineligible Minor
(8.1.5.1).
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 #3.
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 #4.
Subtract $65 & 1/2 from the remaining parental earned income.
Go to # 5.
Add:
Remaining parental unearned income resulting from step 03, and
Remaining parental earned income resulting from step 04
Go to #6.
From the total parent income resulting from
#5, subtract:
The Parental Living Allowance (8.1.5.1) for a couple if both parents (or one parent and his/her spouse) live in the household; or
The Parental Living Allowance (8.1.5.1) 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 #7
Divide the parental deemed income equally among the eligible children. Use the EBD-Related Determination worksheet (WKST 06) 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 assets and no unearned income. Parental earned income is $2,100 a month. Parents' earned income $2,100.00 EBD deeming amount to an ineligible minor -289.50 ------------- Remaining earned income $1,810.50 General income exclusion -20.00 Remainder $1,790.50 Earned income exclusion -65.00 ------------- Remainder $1,725.50 1/2 remaining earned income -869.00 ------------- Remaining earned income $ 856.50 Parental living allowance -869.00 ------------- Income deemed to eligible child $ 40.00 |
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Example 2: Lawrence has three children. One is disabled. None has any income. Lawrence has no assets. His monthly income is $1750 earned, $290 unearned.
Lawrence's unearned income $ 290.00
EBD Deeming Amount for 2 ineligible minors -579.00 Excess allocation $ -289.00 Lawrence's earned income $1,750.00 Excess allocation $-289.00 -------------- Lawrence's remaining earned income $1,461.00 General income exclusion -20.00 ------------- Remainder $1,441.00 Earned income exclusion -65.00 Remainder $1,376.00 1/2 remaining earned income -$688
Remaining earned income $ -688 Parental living allowance $ -579.00 --------- Income deemed to eligible child $ 109 |
See 8.1.5 for EBD income limits. See 8.1.6 for all other MA income limits. Chapters for each type of MA explain how to determine the income that you compare to the income limits.
See (8.1.5.1) for TB-Related income limits.
Use the AFDC Related Determination Worksheet (WKT 14) for Manual Family Medicaid Financial Determinations.
When doing manual EBD income eligibility determinations, use the EBD Related Determination worksheet. Apply the income disregards in the order in which they appear on the worksheet. The 65 & ½ earned income disregard and $20.00 SSI general income disregard are applied to the fiscal group’s income. They are not applied separately to each individual fiscal group member’s income. Special Exempt Income is also an allowable income deduction and a list of Special Exempt Income types can be found in chapter 4.1.3.2.
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 chapter 8.1.5. The actual shelter/utility costs or the shelter/utility maximum, whichever is less, is added to the categorically needy income amount (chapter 8.1.5), 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 chapter 8.1.5. 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 chapter 4.9. for more information about Medicaid Deductibles and to chapter 4.9.5 for instructions on how to calculate a Medicaid Deductible.
This page last updated in Release Number: 05-01
Release Date: 01/11/05
Effective Date: 01/01/05
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