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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
A lump-sum payment is (1) a nonrecurring payment or accumulation of individual payments, (2) paid in one lump sum to any AFDC-MA AFDC-MA is the category of Medicaid that is based on rules for the Aid to Families with Dependant Children Program (AFDC) that were in effect on July 16, 1996. group member. The payment can be either unearned or earned income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter.. However, do not include payments that are included in farm or self- employment income.
An group member may be a payee for administrative reasons, but not the payment’s owner or beneficiary. If so, do not count the payment as income to the group.
Lump –sum sources include:
Social Security, veterans, unemployment compensation benefits and child support refunds.
Union settlements and compensatory time payments (earned).
Windfall payments like bingo and lottery winnings, personal injury awards, cash inheritance, and nonexempt gifts ( unearned).
These are not windfall payments: (1) assets awarded in a divorce settlement, and (2) a vested interest (the person owns it even before s/he receives it) retirement fund distribution. They are assets not income.
Disregard any amount earmarked and used for the purpose it was paid. This includes back medical bills from an accident or injury, funeral and cemetery costs, and replacement or repairs.
Disregard any amount earmarked for medical services that can be provided only at a future date. First get a signed agreement specifying:
Source and amount of the settlement.
Purpose for which it is earmarked.
That it held in its own account.
Agreement to and understanding that if any amount of the settlement is used for a purpose not earmarked, the total settlement is counted as a lump-sum.
Budget lump-sum payments as follows:
Include with other income the lump-sum payment as unearned or earned income received in the same month. Use the Financial Section to determine Group Budget Income.
Divide Group Budget Income by the Assistance Standard for this size group. The result is the number of months the group is ineligible.
Budget any remainder in step 2 in the 1st month after the period of ineligibility.
Discontinue AFDC-MA in the next possible month immediately after the month in which the person received the lump sum. That date is the beginning of the period of the ineligibility.
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Example 1: For a lump sum received before May cutoff, the next possible payment is June. |
Using the current amount, recalculate (steps 1-3, above) the lump-sum obligation as of the date of change when:
The former group’s grant would have increased due to a statutory increase in the Assistance Standard and Family Allowance.
The lump-sum income or a portion of it becomes unavailable to the former group for a reason beyond the group’s control. Reasons include:
The lump-sum was used because of an immediate threat to the health, safety, or welfare of the former group.
Loss or theft of income.
The person who received it leaves the group.
A former group member incurs and pays all or some medical expenses during the period of ineligibility. The expenses must equal or exceed any balance remaining after calculating the period of ineligibility (step 3, above) or they must be ignored.
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Example 2: Client receives a $2000 lump-sum. You calculate a 3 month period of ineligibility with a $419 left to budget in month 4.
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If the size of the group increases during the period of ineligibility of the person added to the AFDC group separately.
This page last updated in Release Number : 04-03
Release Date : 08/02/04
Effective Date : 08/02/04