Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (210-RICR-40-00-3)


210-RICR-40-00-3 ACTIVE RULE EMERGENCY RULE

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3.1Overview of the SSI Methodology

3.2SSI Methodology: Treatment of Income

3.3Factors Considered in the Treatment of Income

3.4Federally Mandated Income Exclusions

Federally Mandated Income Exclusions

Agent Orange settlement payments

Child care assistance under the Child Care and Development Block Grant Act of 1990, Pub. Law 113-186 (as in effect on September 1, 2018)

The first (1st) two thousand dollars ($2,000.00) per calendar year received as compensation for participation in clinical trials that meet the criteria detailed in § 1612(b) of the Social Security Act (September 1, 2018)

Payments made for supporting services or reimbursement of out-of-pocket expenses to volunteers participating in corporation for national and community service (CNCS, formerly ACTION) programs:

AmeriCorps program

Special and demonstration volunteer program; University year for ACTION (UYA)

Retired senior volunteer program (RSVP)

Foster grandparents program

Senior companion program

Energy employees occupational illness program payments

Federal food and nutrition programs:

Food assistance (formerly known as food stamps)

U.S. department of agriculture food commodities distributed by a program (private or governmental)

School breakfast, lunch, and milk programs; Women, infants, and children program (WIC); Nutrition programs for older Americans

Student financial assistance received under the Higher Education Act of 1965 (U.S.C. Title 20) (as in effect on September 1, 2018) or Bureau of Indian Affairs is excluded from income and resources, regardless of use:

Pell Grants

Student services incentives

Academic achievement incentive scholarships; Byrd scholars;

Federal supplemental education opportunity grants;

Federal educational loans (federal PLUS loans, Perkins loans, Stafford loans, Ford loans, etc.);

Upward bound;

Gear up (gaining early awareness and readiness for undergraduate programs);

State educational assistance programs funded by the leveraging educational assistance program;

Work-study programs.

Home energy assistance provided on the basis of need, in accordance with 20 C.F.R. § 416.1157 (as in effect on September 1, 2018)

Matching funds that are deposited into individual development accounts (IDAs), either demonstration project or TANF-funded, in accordance with 42 U.S.C. § 604 (as in effect on September 1, 2018)

Japanese-American and Aleutian restitution payments

Payments to victims of Nazi persecution

Netherlands WUV payments to victims of persecution from 1940-1945

Department of Defense payments to certain persons captured and interned in North Vietnam, in accordance with the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1998, Pub. Law 105-78 (as in effect on September 1, 2018)

Radiation exposure compensation trust fund payments, in accordance with the Radiation Exposure Compensation Act (“the Act” or “RECA”), 42 U.S.C. § 2210 note (2018) (as in effect on September 1, 2018 )

Veterans Affairs payments made to or on behalf of:

Certain Vietnam veterans’ natural children regardless of age or marital status, for any disability resulting from spina bifida suffered by such children

Certain Korea service veterans’ natural children regardless of their age or marital status, for any disability resulting from spina bifida suffered by such children

Women Vietnam veterans’ natural children regardless of their age or marital status, for certain birth defects

Austrian social insurance payments received under the provisions of the Austrian General Social Insurance Act, 20 U.S.C. § 1613(a), 20 C.F.R. § 416.1236 (as in effect on September 1, 2018). These payments must be documented and identifiable from countable insurance

Payments made to Native Americans as listed in Part IV of 20 C.F.R. § 416(K) Appendix (as in effect on September 1, 2018)

Payments from the Ricky Ray hemophilia relief fund or the class settlement in the case of Susan Walker v. Bayer Corporation et al. under the Ricky Ray Hemophilia Relief Fund Act of 1998, Pub. Law 105-369 (as in effect on September 1, 2018)

3.5SSI Methodology: Treatment of Resources

3.6Factors Considered in the Treatment of Resources

3.7Federally Mandated Exclusions


Title 210 Executive Office of Health and Human Services
Chapter 40 Medicaid for Elders and Adults with Disabilities
Subchapter 00 Integrated Coverage Groups
Part 3 Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (210-RICR-40-00-3)
Type of Filing Amendment
Regulation Status Active
Effective 06/17/2022 to 10/15/2022

Regulation Authority:

42 U.S.C. 1396r-5(d)

Purpose and Reason:

Pursuant to 42 U.S.C. 1396r-5(d), when an institutionalized individual has a spouse living in the community, deductions must be made from the institutionalized individual’s income to provide money for the spouse living in the community.  The FPL is used to calculate this amount and therefore must be updated annually to reflect the adjustments made to the FPL each year.  This adjustment must be reflected in our regulations.

This amendment makes the annual July 1 update to Medicaid regulation to reflect the new Minimum Monthly Maintenance of Need Allowance and Community Spouse Monthly Housing Allowance for 2022.


Brief statement of Reason for Finding Imminent Peril:

The updated dollar amounts in this regulation directly impact Medicaid eligibility and are effective as of 7/1/2022. Due to a delay in the SSA’s official release of the 2022 Spousal Impoverishment Numbers, this regulation is being filed under the Emergency provisions contained in the Administrative Procedures Act to ensure timely federal compliance.?  A direct final version is being promulgated concurrently and will supersede the emergency promulgation when it is finalized.