***This version of the Health Care Programs Manual has been replaced and is no longer is effect. Please see the current Health Care Programs Manual for policy in effect as of December 1, 2006.***

The terminology used to describe people with disabilities has changed over time. The Minnesota Department of Human Services ("Department") supports the use of "People First" language. Although outmoded and offensive terms might be found within documents on the Department's website, the Department does not endorse these terms.

MDHS Health Care Programs Manual (Eligibility Policy through 11/30/06)

Chapter 0912 - Income Eligibility

All chapters are numbered beginning with 09. The first chapter is 0901 (Table of Contents).

Chapter 0912

0912

INCOME ELIGIBILITY

PDF(s) Jul 04 | Jul 98

0912.03

MINNESOTACARE INCOME ELIGIBILITY

PDF(s): Jul 04 | Oct 03

0912.03.03

MINNESOTACARE EXCESS INCOME

PDF(s): Jul 04 | Oct 03

0912.03.05

ANNUAL MCHA PREMIUMS

PDF(s): Jul 06 |Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.05

DETERMINING NET INCOME

PDF(s): Oct 03 | Jul 02

0912.05.03

DETERMINING NET INCOME -- ORDER OF DEDUCTIONS

PDF(s): Jul 04 | Oct 03 | Jul 02

0912.05.05

WORK EXPENSE DEDUCTIONS

PDF(s): Jan 06 | Jul 04 | Oct 03 | Jul 02 |

0912.05.07

DEPENDENT CARE DEDUCTION

PDF(s): Oct 03 | Jul 03

0912.05.09

EARNED INCOME DISREGARDS -- METHOD A

PDF(s): Jul 04 | Oct 03 | Dec 02 | Jul 02

0912.05.09.03

EARNED INCOME DISREGARD CYCLE -- METHOD A

PDF(s): Oct 03 | Jul 02

0912.05.09.05

EARNED INCOME DISREGARDS -- METHOD B

PDF(s): May 05 | Jul 98

0912.05.09.07

SPECIAL PERSONAL ALLOWANCE DISREGARD

PDF(s): May 05 | Jul 98

0912.05.09.09

BLIND AND DISABLED STUDENT CHILD DISREGARD

PDF(s): Jan 06 | Jan 05 | Jan 04 | Jan 03 |

0912.05.11

PLAN TO ACHIEVE SELF-SUPPORT

PDF(s): Jul 98

0912.05.13

STANDARD DEDUCTION

PDF(s): Jul 01

0912.05.15

QMB/SLMB/QI COLA DISREGARD

PDF(s): Mar 03 | Apr 02

0912.05.17

WIDOW AND WIDOWER'S DISREGARD

PDF(s): Jul 98

0912.05.19

DISABLED ADULT CHILDREN DISREGARD

PDF(s): Apr 02

0912.05.21

DISABLED WIDOW/ WIDOWER'S DEDUCTION

PDF(s): Jul 98

0912.05.23

PICKLE DISREGARD

PDF(s): Jan 06 | Jan 05 | Jan 04 | Jan 03 |

0912.05.25

ALLOCATIONS

PDF(s): Jul 98

0912.05.25.03

ALLOCATIONS -- COMMUNITY SPOUSE

PDF(s): Jul 06 | Apr 06 | Jan 06 | Jul 05 | Jan 05 | Jul 04 | Jan 04 Jul 03 | Jan 03 | Jul 02 |

0912.05.25.05

ALLOCATIONS -- OTHER RELATIVES

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.05.27

CHILD SUPPORT DEDUCTION

PDF(s): Oct 03

0912.07

INCOME STANDARDS

PDF(s): Jul 04 | Jul 02

0912.07.03

CLOTHING AND PERSONAL NEED ALLOWANCE

PDF(s): Jan 06 | Jan 05 | Jan 04 | Jan 03 |

0912.07.075

75 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Oct 03 | Jul 03 | Jul 02

0912.07.100

100 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.120

120 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.135

135 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.150

150 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05| Jul 04 | Jul 03 | Jul 02

0912.07.175

175 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Oct 03 | Jul 03 | Jul 02

0912.07.185

185 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.200

200 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.275

275 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

0912.07.280

280 PERCENT OF FPG STANDARDS

PDF(s): Jul 06 | Jul 05 | Jul 04 | Jul 03 | Jul 02

INCOME ELIGIBILITY 0912

All of the health care programs consider countable income in establishing eligibility and benefit levels. All of the programs begin the determination with the household's countable income. See §0911 (Income).

MinnesotaCare considers the household's gross income to establish initial and continuing eligibility and to determine the premium amount. See §0912.03 (MinnesotaCare Income Eligibility).

MA and GAMC consider net income for most people. MA and GAMC income deductions and income standards vary among different populations. See §0912.05 (Determining Net Income).

Income standards for health care programs are based on the federal poverty guidelines (FPG). These guidelines are updated annually by the federal government and are effective in July of each year. See §0912.07 (Income Standards). ║

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MINNESOTACARE INCOME ELIGIBILITY 0912.03

MinnesotaCare:

Compare applicants’ countable gross income to the income limit that applies to their eligibility group status and household size. See §0907 (Eligibility Groups and Bases of Eligibility). There are 3 eligibility standards:

• 275% FPG for pregnant women and children under 21. See §0912.07.275 (275 Percent of FPG Standards).

• 275% FPG or $50,000 gross annual income, whichever is less, for parents, caretakers, legal guardians and foster parents, except for pregnant women. • 175% FPG for adults with no children in the household. Adults without children with incomes no greater than 75% FPG qualify for more benefits than those with incomes over 75% FPG. Adults without children with incomes over 75% FPG but no more than 175% FPG qualify for the MinnesotaCare Limited Benefit (MLB) set. See §0912.07.075 (75 Percent of FPG Standards) and §0912.07.175 (175 Percent of FPG Standards).

For households with minor children, also compare gross income to the 150% FPG standard. See §0912.07.150 (150 Percent of FPG Standards). This standard is not used to determine eligibility but affects the following factors:

• Children's group status and insurance barriers. See §0907 (Eligibility Groups and Bases of Eligibility) and §0910 (Other Health Coverage). • Whether a child pays a fixed premium or a sliding scale premium. See §0913 (Premiums and Spenddowns).

Household income must be equal to or less than the income eligibility standard that applies at the time of initial enrollment. See §0912.03.03 (MinnesotaCare Excess Income) for instructions on what action to take if income increases beyond the applicable limit after enrollment.

If household composition changes from families and children to adults without children, or from adults without children to families with children, between the date the household submits an application and the date you process the application, use the household composition at the time of processing.

EXAMPLE:

MinnesotaCare receives an application for Penny and her 20-year-old son Jack on July 17. Jack turns 21 on August 2. The worker processes the application on August 10. Consider both Penny and Jack as Group 3 adults.

EXAMPLE:

Paula applies for MinnesotaCare for herself on July 17. On July 31, the court makes her the legal guardian of her 13-year-old niece. The worker processes the application on August 3. Apply the families and children income standard of 275% FPG or $50,000 since this will be a families with children household on the date eligibility begins.

If people reapply after a break in coverage of one month or more, compare current income to the standard that applies to the household size and type. People are ineligible if current income exceeds the standards.

M. S. 256.9366 subd. 1

M. S. 256.9354 subd. 5

M. S. 256.9366 subd. 4

M. S. 256.9357 subd. 1

MA/GAMC:

No provisions.

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MINNESOTACARE EXCESS INCOME 0912.03.03

MinnesotaCare:

At the time of renewal, when increased income is reported, or when a new household member is added to an existing case, evaluate households with gross annual income above the MinnesotaCare income standard for their household size. Terminate coverage for the end of the month following the month in which excess income is determined for:

• Adults without children whose income exceeds 175% FPG, including adults who lose parental status between renewals.

• Parents and caretakers, other than pregnant women, whose gross annual income exceeds 275% FPG but is less than $50,000.

Terminate coverage for the first available month for:

• Parents and caretakers, other than pregnant women, whose gross annual income exceeds $50,000, regardless of whether income is over 275% FPG.

Pregnant women with incomes over 275% FPG remain eligible through the end of the 60-day post partum period.

Take the following steps for all children under age 21 who report income over 275% FPG:

• Determine if 10% of their gross annual income is less than the premium amount for a policy with a $500 deductible available through Minnesota Comprehensive Health Association (MCHA). See §0912.03.05 (Annual MCHA Premiums). Include all household members in the household size whether or not they are enrolled in MinnesotaCare. • If 10% of the income is equal to or greater than the annual MCHA premium, terminate coverage for the end of the month following the month in which excess income is determined. • If 10% of the gross annual income is less than the household’s MCHA premium, eligibility continues. Do not send 18-month notice of cancellation. This is known as the MCHA exemption. • If income later increases so that 10% of the gross annual income is equal to or greater than the MCHA premium, the children lose the MCHA exemption. Send the MinnesotaCare Over Income Letter (DHS 3407) advising the household that their MinnesotaCare will end in 12 months. Start the 12-month notice period effective the 1st of the next month.

EXAMPLE:

A household consists of John, age 35, Abby, age 31, and their minor child, age 12. When the worker processes their renewal on March 15, the household’s gross annual income is determined to exceed the MinnesotaCare income standard of 275% FPG for a family of 3. Gross income remains under $50,000. Terminate coverage for the parents effective April 30 (the month following the month they are determined to have excess income). To determine continued eligibility for the child, calculate the household’s annual MCHA premium by adding together the following amounts from §0912.03.05 (Annual MCHA Premiums):

For Abby, age 31, add the amount for an adult age 30 to 34.

For John, age 35, add the amount for an adult age 35 to 39.

For the dependent child, add the amount for a child under age 15.

Add these amounts to determine the household’s annual MCHA premium.

Multiply the household’s gross annual income by 10% and compare that figure to the MCHA premium. If 10% of the annual income is greater than the MCHA premium, terminate coverage for the child effective April 30. If 10% of the annual income is less than the MCHA premium, eligibility continues for the child.

When the child’s next renewal is processed on March 15 of the following year, income has increased so that 10% of the annual income now exceeds the household’s MCHA premium. Send the DHS 3407 notifying the household that the child’s coverage will end in 12 months. The 12-month period begins April 1.

EXAMPLE:

Aman, his wife and 3 daughters receive MinnesotaCare. At the time of their annual renewal, processed on March 15, gross income exceeds $50,000. It also exceeds the 275% FGP standard for the household size. Aman and his wife are no longer eligible for MinnesotaCare. Terminate their coverage effective March 31 (the first available month). The children may remain eligible if 10% of their gross income is less than the premium amount for an MCHA policy with a $500 deductible. If 10% of gross income is equal to or greater than the applicable MCHA premium, terminate the children’s coverage effective April 30.

NOTE:

Until February 1, 2004, children whose income increased to over 275% FPG but who did not meet the MCHA exemption were eligible for an 18-month extended eligibility period. Children who were in an 18-month extended eligibility period on February 1, 2004, are entitled to complete the full 18-month period.

Take the following steps when a household that receives the MCHA exemption later reports decreased income OR requests to add a new household member before the next renewal:

• Determine if the new income amount remains equal to or greater than the appropriate standard. If the new income amount is now under the standard, send the MinnesotaCare Income Change Evaluation Letter (DHS 3408) to notify the household that they will not be closed. • If income remains equal to or greater than the standard, determine if 10% of the new income amount continues to be less than the MCHA premium for their household. If it is, send the DHS 3407 to let the household know that they will continue to receive coverage. If it is more than the MCHA premium, send the DHS 3407 to let the household know that they will be closed in 12 months. • If the new income is equal to or greater than the appropriate standard AND 10% of the new income is equal to or greater than the applicable MCHA premium, the household remains in the original 18-month over income period. Review the income again 12 months from the date of the original DHS 3407. Coverage for new members added to the household will end at the same time as the rest of the household.

Take the following steps when a household that receives the 12-month extension later reports decreased income OR requests to add a new household member before the next renewal. Adults can be added to the household when a case is over income, but not to MinnesotaCare coverage, unless the new household member causes income to decrease below the applicable standard.

• If the income is under the standard, end the 12-month over income period. Send the DHS 3408. • If the income is over the standard and 10% of the new income amount is less than the MCHA premium, end the 12-month over income period. Send the DHS 3408. • If the new income is equal to or greater than the appropriate standard AND 10% of the new income is equal to or greater than the applicable MCHA premium, the household remains in the original 12-month over income period. Coverage for new members added to the household will end at the same time as the rest of the household.

Reevaluate the household’s income at the next renewal, when a change in income is reported, or at the end of the 12- month extension period. See §0905.05 (Annual Renewal--Eligibility).

Reevaluate the household’s income at the end of the 12-month extension period.

• If the household reports that employment and income have not changed, document in case notes and cancel MinnesotaCare for the first month for which you can give 10-day notice. • If the household reports a change in employment or income, request verification of the new income for the past 30 days. Document the request in case notes. Allow the household 30 days to return the income verification. • If the household fails to submit verification within 30 days of the request, cancel MinnesotaCare for Over Income for the first month for which you can give 10-day notice.
• If the household submits verification of new income within 30 days, determine if the new income is within the MinnesotaCare limits.
• If the household’s income continues to be equal to or greater than the applicable standard AND 10% of the household’s income continues to be equal to or greater than the household’s annual MCHA premium, give the household 10-day notice and cancel MinnesotaCare at the end of the month. Mail a DHS 3408 with the results of the evaluation and a Certificate of Creditable Coverage (COCC) to the household. See §0916.23 (Certificates of Creditable Coverage). • If the household’s income is less than the applicable standard OR 10% of the income is less than the household’s annual MCHA premium, send the DHS 3408 to notify the household that they will not be canceled.

Do not cancel pregnant women and infants under age 2 who have auto newborn eligibility for being over income. See §0907.09.03 (MinnesotaCare Auto Newborns) and §0907.09 (MinnesotaCare Pregnant Women).

M.S. 256L.07 subd. 1b, c

MA/GAMC:

No provisions.

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ANNUAL MCHA PREMIUMS 0912.03.05

MCHA Annual Premiums effective 7-1-06:

For emancipated minors or children on their own

MinnesotaCare case who are under age 15

$2,817.12

For emancipated minors or children on their own

MinnesotaCare case who are age 15 to age 20

$2,817.12

For each adult age 21 to 29

$2,817.12

For each adult age 30 to 34

$3,128.04

For each adult age 35 to 39

$3,320.04

For each adult age 40 to 44

$3,736.20

For each adult age 45 to 49

$4,625.52

For each adult age 50 to 54

$6,046.56

For each adult age 55 to 59

$7,719.00

For each adult age 60 to 64

$8,451.12

For each adult age 65 and older

$8,451.12

For households with 1 dependent child

$2,374.20

For households with 2 dependent children

$4,748.40

For households with 3 or more dependent children:

Contracts existing before 7/1/2002

$6,350.16

Contracts issued after 7/1/2002

$7,122.60

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DETERMINING NET INCOME 0912.05

MinnesotaCare:

No provisions.

MA:

Determine the household's net income by subtracting deductions and disregards from gross income.

Except for pregnant women and infants under 2 whose gross income is equal to or less than 275% FPG, use net income to determine a client's eligibility and level of benefits.

The following deductions and disregards apply only to earned income:

• Work expense deductions. See §0912.05.05. • Dependent care deduction. See §0912.05.07. • Earned income disregards. See §0912.05.09. • Special personal allowance disregard. See §0912.05.09.07. • Blind and disabled student child disregard. See §0912.05.09.09.

The following deductions may apply to either earned or unearned income:

• Plan to Achieve Self Support (PASS). See §0912.05.11. • Standard deduction. Apply the standard deduction 1st to unearned income. Apply any remainder to earned income. See §0912.05.13. • Allocations to relatives of people who reside in long term care facilities or receive services through the elderly waiver (EW). See §0912.05.25. • Child support deduction. See §0912.05.27.

The following deductions apply only to RSDI income:

• QMB/SLMB/QI COLA disregard. See §0912.05.15. • Widow and widower's disregard. See §0912.05.17. • Disabled adult children disregard. See §0912.05.19. • Disabled widow or widower's disregard. See §0912.05.21. • Pickle disregard. See §0912.05.23.

To determine countable net income, subtract the disregards and deductions that apply to each person's circumstances from countable gross income in the specific order listed below. Compare the result to the applicable income standard. See §0912.07 (Income Standards).

See §0912.05.03 (Determining Net Income--Order of Deductions).

GAMC:

No provisions.

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DETERMINING NET INCOME -- ORDER OF DEDUCTIONS 0912.05.03

MinnesotaCare:

No provisions.

MA:

Also see §0912.05 (Determining Net Income).

METHOD A:

LTCF RESIDENTS:

See §0913.05 (Which Spenddown Type to Use) to determine who must use an LTC spenddown and the type of spenddown. Then allow the income deductions for the appropriate type of LTC spenddown.

See the following for more information about LTC spenddowns:

§0913.13 Long Term Care Spenddown Calculation.

§0913.15 Combination LTC/Medical Spenddown.

§0913.17 Begin/End Use of LTC Spenddown - Part 1.

§0913.17.01 Begin/End Use of LTC Spenddown - Part 2.

§0913.17.03 Begin/End Use of LTC Spenddown - Part 3.

NON-LTCF RESIDENTS:

1. Work expense deductions from earned income for

- Children ages 2-18 using the 150% FPG standard.

- Pregnant women and infants who are not eligible as auto newborns. See §0912.05.05.

2. Earned income disregard for

- Children ages 19 and 20.

- Parents and caretakers.

- Children ages 2-18 with spenddowns.

See §0912.05.09.

3. Dependent care deduction. See §0912.05.07.

4. Child support deduction. See §0912.05.27.

METHOD B:

MA FOR LTCF RESIDENTS AND PEOPLE RECEIVING ELDERLY WAIVER (EW) SERVICES WHO HAVE A COMMUNITY SPOUSE:

See §0913.05 (Which Spenddown Type to Use) to determine who must use an LTC spenddown. Then allow the income deductions for the appropriate type of LTC spenddown.

See the following for more information:

§0913.13 Long Term Care Spenddown Calculation.

§0913.13.03 LTC Spenddown--EW With Community Spouse.

§0913.15 Combination LTC/Medical Spenddown.

§0913.17 Begin/End Use of LTC Spenddown - Part 1.

§0913.17.01 Begin/End Use of LTC Spenddown - Part 2.

§0913.17.03 Begin/End Use of LTC Spenddown - Part 3.

§0912.05.25 Allocations.

QMB OR SLMB FOR LTCF RESIDENTS:

1. Widow and widower's disregard. See §0912.05.17.

2. Pickle disregard. See §0912.05.23.

3. Disabled adult children disregard. See §0912.05.19.

4. QMB/SLMB/QI COLA disregard. See §0912.05.15.

5. Income used to fulfill an approved Plan to Achieve Self Support for disabled or blind people. See §0912.05.11.

6. Earned income disregard for blind or disabled student children. See §0912.05.09.09.

7. Standard disregard. See §0912.05.13.

8. The first $65 of the earned income disregard. See §0912.05.09.05.

9. Work expense deduction for disabled clients. See §0912.05.05.

10. One-half the remaining earned income. See §0912.05.09.05.

11. Work expense deduction for blind clients. See §0912.05.05.

12. Spousal allocation. See §0912.05.25.03.

13. Family member allocation. See §0912.05.25.05.

MA FOR NON-LTCF RESIDENTS:

1. Disabled widow/widower disregard. See §0912.05.21.

2. Widow and widower's disregard. See §0912.05.17.

3. Pickle disregard. See §0912.05.23.

4. Disabled adult children disregard. See §0912.05.19.

5. Income used to fulfill an approved Plan to Achieve Self Support for disabled or blind people. See §0912.05.11.

6. Earned income disregard for blind or disabled student children. See §0912.05.09.09.

7. The first $65 of the earned income disregard. See §0912.05.09.05.

8. Work expense deduction for disabled clients. See §0912.05.05.

9. One-half the remaining earned income. See §0912.05.09.05.

10. Work expense deduction for blind clients. See §0912.05.05.

QMB OR SLMB FOR NON-LTCF RESIDENTS:

1. Widow and widower's disregard. See §0912.05.17.

2. Pickle disregard. See §0912.05.23.

3. Disabled adult children disregard. See §0912.05.19.

4. QMB/SLMB/QI COLA Disregard. See §0912.05.15.

5. Income used to fulfill an approved Plan to Achieve Self Support for disabled or blind people. See §0912.05.11.

6. Earned income disregard for blind or disabled student children. See §0912.05.09.09.

7. Standard disregard. See §0912.05.13.

8. The first $65 of the earned income disregard. See §0912.05.09.05.

9. Work expense deduction for disabled clients. See §0912.05.05.

10. One-half the remaining earned income. See §0912.05.09.05.

11. Work expense deduction for blind clients. See §0912.05.05.

GAMC:

No provisions.

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WORK EXPENSE DEDUCTIONS 0912.05.05

MinnesotaCare:

No provisions.

MA:

METHOD A:

To determine whether children ages 2-18 meet the 150% FPG standard, subtract $90 from the earned income of the child and the earned income of each person whose income is deemed to the child. Subtract the first $90 of each person=s gross earnings. Do not reduce income to less than 0.

EXAMPLE:

Tracy applies for MA for her 4-year-old son, Alex. Tracy earns $1,500 per month. Alex earns $80 per month as a child model. Subtract $90 from Tracy’s income, leaving $1,410. Also deduct any child care or court ordered child support she pays. See §0912.05.07 (Dependent Care Deduction) and §0912.05.27 (Child Support Deduction). Count 0 earned income for Alex.

If a child ages 2-18 does not meet the 150% FPG standard, do not allow the $90 work expense when determining whether the child can spend down to 100% FPG.

For pregnant women and infants through the month of their 2nd birthday who are not eligible as auto newborns:

1. Subtract the amounts below from earned income only. Do not allow any other deductions.

Household Size

Work Expense Deduction for Pregnant Women and Infants

1

$136

2

$140

3

$145

4

$149

5

$156

6

$161

7

$165

8

$170

9

$177

10

$181

Each Additional Person

$ 5

If income after the work expense deduction is equal to or less than 275% FPG for pregnant women or 280% FPG for infants, stop. There is no spenddown.

2. If income exceeds the applicable standard after allowing the work expense deduction, the pregnant woman or infant must spend down to 100% FPG. Do not allow the work expense deduction for this step. Allow the dependent care deduction, the 17% earned income disregard and the deduction for child support paid if applicable. See §0912.05.07 (Dependent Care Deduction), §0912.05.09 (Earned Income Disregards--Method A) and §0912.05.27 (Child Support Deduction).

EXAMPLE:

Jamal and Sheila, a married couple, apply for MA for their 1-year-old son Alex. Both Jamal and Sheila are employed and have day care expenses. Neither pays child support to non-household members. No one in the household has received MA before.

First deduct $145 from the combined gross earnings. If income after the deduction is equal to or less than 280% FPG, Alex is eligible for MA without a spenddown.

If income remains above 280% FPG after the deduction, Alex must spend down to the 100% of FPG standard. See §0912.07.100 (100 Percent of FPG). Re-compute Jamal and Sheila’s income without the $145 work expense deduction. Allow the dependent care deduction and the 17% earned income disregard.

METHOD B:

Clients who use Method B because of age:

• Do not allow a deduction for work expenses.

Clients who use Method B because of disability:

• Allow IMPAIRMENT RELATED work expenses as a deduction. The client must reasonably show the expenses relate directly to the disability and are necessary to produce the earned income. (For instance, do not allow expenses for a transportation method also used by non-disabled people such as a bus or unmodified vehicle.) If transportation expenses are allowed, use the same rate allowed as a flat rate deduction for self-employed people. See §0911.09.03.09 (Self-Employment Transportation).

Clients who use Method B because of blindness:

• Allow any work expense as a deduction when a client can reasonably show it relates directly to producing earned income. If transportation expenses are allowed, use the same rate allowed as a flat rate deduction for self-employed people. See §0911.09.03.09 (Self-Employment Transportation). • Allow a deduction for income or FICA taxes withheld from earnings.

See §0912.05.03 (Determining Net Income--Order of Deductions) for the order in which to apply the disregards and deductions.

Do not allow work expense deductions for items reimbursable or paid for by another source. When an expense qualifies both as a work expense and a PASS deduction, the client must choose whether to allow the expense as a PASS deduction or a work expense deduction. See §0912.05.11 (Plan to Achieve Self-Support).

GAMC:

No provisions.

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DEPENDENT CARE DEDUCTION 0912.05.07

MinnesotaCare:

No provisions.

MA:

METHOD A:

Deduct costs of care for a dependent child or incapacitated adult from the earned income of anyone whose income is used to determine eligibility when that person is:

• At work or in transit to or from work. • Not at work, but needs dependent care to maintain employment. For example, allow the expense for a client who works nights and pays for dependent care while sleeping during the day.

Deduct the costs of dependent care up to:

• $200 per month for each dependent under age 2. • $175 per month for each dependent age 2 and older.

Do not allow a deduction for care provided by a parent, stepparent, or sibling under age 19 of the dependent child.

If both parents are in the household, allow the dependent care deduction only if the non-working parent in the household is incapacitated or otherwise unable to provide care.

When both parents are working during the same hours, allow half the day care costs as a deduction for each parent.

Allow dependent care costs as a deduction in the month incurred or paid.

Do not require verification of dependent care costs.

Allow the dependent care deduction from the earned income of the parent or other caretaker to determine the parent or caretaker's eligibility and to determine the amount of parental earned income to deem to each child applying for or receiving MA.

EXAMPLE:

Thelma applies for MA for herself and her two children, Brett, age 13, and Mandy, age 9. Thelma is employed and pays $250 per month for dependent care for Mandy. She has no dependent care costs for Brett. Allow a dependent care deduction of $175 (maximum allowable for a child over age 2) when determining Thelma's earned income. Use the same net earned income figure for Thelma's, Brett's, and Mandy's eligibility.

Count child support payments that are specifically ordered for dependent care costs as child support income to the child. Do not deduct amounts ordered for dependent care from the parent or other caretaker's dependent care deduction. Allow the full deduction to which the parent or other caretaker is entitled.

EXAMPLE:

Alice applies for MA for herself and her daughter Linda, age 9. Alice receives court ordered child support payments for Linda of $450 per month. The court order specifies that $300 is for child support and $150 is for dependent care. Alice is employed and pays $200 per month for dependent care for Linda. Allow $175 as a deduction from Alice's earned income to determine her own eligibility and the amount to deem to Linda. Count $450 as child support income to Linda. Allow the $50 child support deduction. See §0911.09.11 (Child Support Income).

See §0911.09.11 (Child Support Income)

Do not allow child care costs paid by the child care fund or other 3rd parties (other than child support as described above) as a deduction.

NOTE:

Do not consider payments made by an employer to the day care provider but paid in full by the employee’s own funds (such as Dependent Care Expense Accounts) to be 3rd party payments.

EXAMPLE:

Melinda has child care costs of $375 for her 3-year-old son. The Sliding Fee Child Care Program pays $275 to the provider. Melinda is responsible for the remaining $100. Allow $100 as a deduction from Melinda's earned income when determining her eligibility and the amount to deem to her son.

METHOD B:

Do not allow a dependent care deduction for people who use Method B due to age or disability.

Allow the actual cost of dependent care as a deduction from earned income for people who use Method B due to blindness if the dependent care expense is essential to earning the income. Do not allow a deduction for amounts paid by 3rd parties (other than child support or payments funded by the employee as described under Method A).

GAMC:

No provisions.

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EARNED INCOME DISREGARDS -- METHOD A 0912.05.09

MinnesotaCare:

No provisions.

MA:

METHOD A:

Subtract 17% of the gross earned income for up to 4 months of the following people if their income is considered in determining eligibility. See §0908.07 (Household Composition: Deeming).

• Children ages 19 and 20 • Parents and caretakers • Children under age 19 who have spenddowns.

There is no earned income disregard for children ages 2-18 using the 150% FPG standard.

Do not reduce earned income to less than $0 or use earned income disregards to reduce unearned income.

EXAMPLE:

Jeanna applies for MA for herself and her son. She is employed part-time earning $200 per month. She receives RSDI of $400 per month for her son. Deducting the 17% earned income disregard reduces her net earned income to $166. Jeanna pays dependent care expenses of $175 per month while she is at work. Her countable earned income is zero. Do not deduct an additional $9 from the RSDI income.

Pregnant women and infants through the month of their 2nd birthday and children ages 2 through 18 whose income is equal to or below the applicable standard (275% FPG for pregnant women; 280% FPG for children through the month of their 2nd birthday; 150% FPG for children ages 2 through 18) do not receive an earned income disregard because the disregard is included in the standard. See §0912.05.05 (Work Expense Deductions).

If a pregnant woman has earned income while receiving MA using the 275% FPG standard, the disregard cycle continues to run. This also applies to a spouse or parent whose income is deemed to a pregnant woman, infant under age 2 or child ages 2 through 18. This does NOT apply to infants who are eligible as auto newborns, because no income is deemed to these infants. See §0907.19.05.03 (MA Basis: Auto Newborn).

If a pregnant woman’s gross income exceeds 275% FGP, or an infant’s income exceeds 280% FPG after applying the work expense deduction in §0912.05.05 (Work Expense Deduction), the 17% disregard may be used to spend down to 100% of the FPG standard. See §0912.07.100 (100 Percent of FPG Standard).

EXAMPLE:

Stella, a single woman with no other children, applies for MA/PW in April. Her child is due July 15. She is employed and is not requesting retroactive MA because the health insurance she has through her employer has covered all her bills to date. Her income is under 275% FPG. Stella begins a maternity leave on June 30 and receives her last pay check on July 7. She returns to work on September 15 and receives her 1st pay check on September 22.

Although Stella does not receive an earned income disregard while eligible for MA/PW because her income is less than 275% FPG, count April, May, June, and July as the 4 months of the 17% disregard because Stella received earned income in each of those months.

EXAMPLE:

Paula, a single woman with no other children, applies for MA/PW in June. Her child is due in August. She began a maternity leave in May because of pregnancy complications. She received her last pay check in May and began receiving payments from a disability insurance policy in June. She is not requesting retroactive coverage. Do not count the months in which she receives MA/PW and has no earned income as months of the disregard cycle. Begin the cycle when Paula returns to work if she is still receiving or requesting MA.

If a child ages 2 through 18 has income that exceeds 150% FPG, the 17% disregard may be used to spend down to 100% FPG. See §0912.07.100 (100 Percent of FPG Standard).

For all others, each person whose earned income is considered in determining eligibility is eligible for earned income disregards. Employed people in the same household can be eligible for the earned income disregards concurrently or at different times.

Also see §0912.05.09.03 (Earned Income Disregard Cycle--Method A).

GAMC:

No provisions.

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EARNED INCOME DISREGARD CYCLE -- METHOD A 0912.05.09.03

MinnesotaCare:

No provisions.

MA:

The maximum length of the earned income disregard cycle is 4 consecutive months. Once the disregard runs out, it is not available again until the wage earner, spouse, or child under 21 files a new MA application after being off MA for 12 consecutive months. Also, for 12 consecutive months, the wage earner's income must not have been used to determine MA eligibility for the wage earner's spouse or child under 21 before the wage earner, wage earner's spouse, or child are eligible for the disregards. Do not count disregards used to determine eligibility for a cash program with automatic MA toward the client’s MA-only disregard cycle.

Begin counting the 12 continuous months off assistance with the month after the last month for which the client's income was used to determine MA eligibility.

EXAMPLE:

Sandra applies for MA for herself and her son Derek beginning in July. Her husband Keith, Derek’s stepfather, is not requesting MA or GAMC for himself. His earned income is used to determine Sandra’s eligibility and the 17% disregard is applied for July, August, September, and October.

Keith’s 18-year-old son moves in with the household and Keith requests coverage for him beginning in December. Do not apply an earned income disregard when deeming Keith’s income to his son because the disregard has been used to determine Sandra’s eligibility within the previous 12 months.

EXAMPLE:

Sherry received TYMA from March through the following February. She used 4 months of the earned income disregards while receiving MFIP and MA. She requests continued MA when her extended MA ends. She is not entitled to a new 4-month disregard cycle because she has not been off MA for 12 consecutive months.

Begin the earned income disregard cycle when there is at least $1 of earned income. Apply the disregard even if the client would be income eligible without it.

Start the 4-month cycle over if there is no earned income to apply to the disregard or the person does not receive MA in the 2nd, 3rd or 4th months. This includes clients on manual monthly spenddowns who are ineligible for 1 month.

EXAMPLE:

Annette applies for MA for herself and her daughter in March and requests coverage beginning that month. She is employed but will not receive any earnings in April, because her employer has no work for her. She will begin receiving earnings again in May. She is entitled to the earned income disregard in March. Start the cycle over in May since she had no earnings in April.

Clients may not request termination of MA to avoid using the earnings disregard. The disregard cycle does not stop in this case. People lose their earned income disregards the month following the month they voluntarily request termination of assistance to avoid using the earned income disregard.

EXAMPLE:

Joe applies for MA for himself and his children beginning in June. He is employed. His earnings are under the applicable standard when the earnings disregard is applied but will exceed the standard when the cycle ends. He requests to be terminated in September and asks to reapply for October to start a new 4-month cycle. Continue to count September as the 4th month of the cycle in this case.

Ignore earned income disregards received in another state. Also ignore receipt of MA in another state in determining whether people have been off MA or have not had their income counted toward another person’s eligibility in the past 12 months.

GAMC:

No provisions.

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EARNED INCOME DISREGARDS -- METHOD B 0912.05.09.05

MinnesotaCare:

No provisions.

MA:

For Method A, see §0912.05.09 (Earned Income Disregards--Method A) and §0912.05.09.03 (Earned Income Disregard Cycle--Method A).

Disregard the first $65 plus half the remaining earned income. If more than one person's income is used to determine eligibility (for example, income of the client's spouse), apply the disregard to the total combined earned income.

EXAMPLE:

Norm and his wife Marge apply for MA using Method B. Both are disabled and employed part time. Norm earns $200 per month. Marge earns $500 per month. To determine each person's eligibility, subtract $65 plus one-half of the remaining income from the combined total gross income of $700.

If a person who uses Method B due to disability has impairment-related work expenses, deduct the impairment-related expenses after the $65 work incentive disregard but before deducting one-half of the remaining earned income. See §0912.05 (Determining Net Income) and §0912.05.05 (Work Expense Deductions).

GAMC:

No provisions.

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SPECIAL PERSONAL ALLOWANCE DISREGARD 0912.05.09.07

MinnesotaCare:

No provisions.

MA:

The special personal monthly allowance is an $80 earned income disregard for clients:

• With mental retardation or other certified disabilities.

AND

• Who are employed under a plan of rehabilitation.

AND

• Who live in a skilled nursing facility, intermediate care facility, intermediate care facility for the mentally retarded, or a regional treatment center.

Deduct the first $80 of monthly earned income.

Do not reduce earned income to less than $0 or use the disregard to reduce unearned income. Allow actual work expense deductions in place of Method A or B work deductions.

GAMC:

No provisions.

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BLIND AND DISABLED STUDENT CHILD DISREGARD 0912.05.09.09

MinnesotaCare:

No provisions.

MA:

Method A:

No provisions.

Method B:

Allow this disregard from earned income when a client meets all 3 of these conditions:

• Is under age 22. • Is certified as blind or disabled by the Social Security Administration or the State Medical Review Team. • Is expecting to attend school at least one month in the next calendar quarter, or did attend school at least one month of the current calendar quarter.

Limit the disregard to a maximum of $1,460 per month up to a maximum of $5,670 in calendar year 2006 ($1,410 per month up to a maximum of $5,670 in calendar year 2005). Apply the disregard only to the blind or disabled student’s earned income. Do not apply it to the income of other people whose income is deemed to the student.

Do not reduce earned income to less than $0 or use earned income disregards to reduce unearned income.

GAMC:

No provisions.

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PLAN TO ACHIEVE SELF-SUPPORT 0912.05.11

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Allow an income deduction for earned or unearned income set aside under a Plan to Achieve Self-Support (PASS) for up to 48 months. This deduction is not available to clients using Method B because of age.

A PASS is initially set for 18 months with an 18-month extension usually available. A 48-month PASS would be used only because of special educational or training requirements. A PASS must:

• Be in writing. • Be individually designed for the client. • Have a feasible occupational goal. • Explain what income will be used to meet the PASS objectives. • Explain how the client will keep income set aside to meet PASS objectives separate from other funds. • Set beginning and end dates for the plan.

End the PASS deduction the month after the month one of these occurs:

• The client does not comply with the plan. • The client voluntarily stops participating in the plan. • The client reaches the occupational goal of the plan. • The plan's time limit expires and no extension is available.

Review the PASS at least semi-annually, or more often if circumstances make it necessary.

When an expense qualifies both as a work expense and a PASS deduction, the client must choose between them. Do not allow a deduction for the same expense twice. See §0912.05.05 (Work Expense Deductions).

GAMC:

No provisions.

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STANDARD DEDUCTION 0912.05.13

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Apply a standard disregard of $20 to the earned or unearned income of people applying for or enrolled in QMB, SLMB, QWD, QI or PDP. If a client has both earned and unearned income, apply the disregard to unearned income first and any remainder to earned income. If the income of a spouse or parent of a client is used to determine eligibility, apply the disregard to the combined total income.

Do not allow the standard disregard to determine eligibility for MA.

GAMC:

No provisions.

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QMB/SLMB/QI COLA DISREGARD 0912.05.15

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Do not count the annual RSDI cost of living adjustment (COLA) when determining eligibility for MA, QMB, SLMB, QWD, QI, PDP, TEFRA, and the home and community-based waivers in January through June of each calendar year.

Apply the COLA disregard to both applicants and enrollees who received RSDI in the previous calendar year.

Count the gross RSDI benefits including the COLA beginning July 1st of each year.

EXCEPTION:

Do not apply the COLA disregard to determine eligibility for people who reside in long term care facilities or receive services through the elderly waiver (EW) and use long term care budgeting. Do not apply the COLA disregard when determining whether there is a premium and the amount of the premium for MA-EPD.

The RSDI COLA disregard applies ONLY to RSDI benefits. Do not disregard cost of living adjustments for any other type of benefit or payment.

GAMC:

No provisions.

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WIDOW AND WIDOWER'S DISREGARD 0912.05.17

MinnesotaCare:

No provisions.

MA:

Some disabled widows and widowers who receive MA may disregard cost of living increases in their RSDI benefits. They must meet all of these conditions:

• Currently receive RSDI. • Filed an MA application before 7-1-88. • Have been entitled to receive RSDI continuously since December 1983. • Were a disabled widow or widower in January 1984. • Established a right to receive RSDI benefits before age 60. • Were eligible for SSI or MA benefits before application of the revised actuarial reduction formula. • Lost eligibility for SSI or MA benefits as a result of the change in the actuarial reduction formula.

If a client meets these conditions, disregard all RSDI cost of living increases effective on and after 1-1-84 when determining eligibility.

Determine a client's eligibility retroactive to 7-1-86. Verify the client's status with the Social Security Administration if necessary.

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DISABLED ADULT CHILDREN DISREGARD 0912.05.19

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Disregard Disabled Adult Child (DAC) RSDI benefits of a client who meets all of these conditions:

• Currently age 18 or older. • Became blind or disabled before reaching the age of 22. • Received SSI benefits on the basis of blindness or a disability. • Lost SSI eligibility on or after 7-1-87 due to entitlement to or increased RSDI Disabled Adult Child (DAC) benefits based on disability, retirement or death of a parent.

Count all other income after applying Method B disregards and deductions, including any RSDI benefits the client receives on his/her own account. DAC benefits will usually have the suffix C with a numeral. Check with SSA if you are unsure if a person receives DAC benefits.

GAMC:

No provisions.

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DISABLED WIDOW/WIDOWER'S DEDUCTION 0912.05.21

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Disregard the RSDI benefits of disabled widows and widowers who meet ALL of the following conditions:

• They are currently receiving RSDI Disabled Widow/Widower or Disabled Surviving Divorced Spouse benefits. • They received SSI and/or MSA benefits the month before the month they began receiving RSDI Disabled Widow/Widower or Disabled Surviving Divorced Spouse benefits. • They lost SSI/MSA eligibility on or after 1-1-91 due to receipt of RSDI Disabled Widow/Widower or Disabled Surviving Divorced Spouse benefits. • If their RSDI income were disregarded, their remaining income would be at or below the current SSI or MSA benefit rate. • They are NOT ENTITLED to Medicare Part A.

This disregard ends the first full month the client is eligible for Medicare Part A. Inform the client to notify the worker when a notice of Medicare Part A eligibility is received. The months the client collected SSI or MSA are credited toward the 24-month Medicare waiting period.

Count all other income after applying Method B disregards and deductions.

GAMC:

No provisions.

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PICKLE DISREGARD 0912.05.23

MinnesotaCare:

No provisions.

MA:

METHOD A:

No provisions.

METHOD B:

Clients who meet certain conditions are deemed to be receiving SSI benefits for purposes of determining MA eligibility. These clients may apply the Pickle disregard to their income.

To be eligible for the Pickle disregard, clients must meet ALL of the following conditions:

• Currently receive or be entitled to receive RSDI benefits. • Were eligible for 1619(b) or were eligible for and received SSI, MSA, or 1619(a) benefits while concurrently entitled to or receiving RSDI in any month since April 1977. • Lost eligibility for SSI, MSA, 1619(a) or 1619(b) for any reason.

Clients may be entitled to but not actually receive RSDI benefits for the month for which RSDI eligibility is approved. RSDI benefits are paid in the month following the month they cover. Entitlement to RSDI in a month in which the enrollee received SSI, MSA or 1619(a) or was eligible for 1619(b) qualifies the individual for the Pickle disregard.

EXAMPLE:

John is open on MA and received SSI in June. Effective June 1, John became entitled to RSDI benefits. He received his first RSDI check in July for June. Because John was entitled to RSDI on June 1, SSA determines that John’s income is over the SSI income standard and he loses SSI benefits beginning July 1. John is eligible for the Pickle disregard because he was entitled to RSDI benefits in June while receiving SSI.

When clients eligible for the Pickle disregard have a spouse or parent receiving RSDI, consider the parent or spouse's RSDI income available to the client. Allow the Pickle disregard from the spouse’s or parent’s RSDI when determining the client’s eligibility. Do not allow the Pickle disregard when determining the parent’s or spouse’s eligibility unless they also meet the Pickle eligibility conditions.

Subtract previous cost of living adjustments (COLAs) to determine the RSDI benefit of the client and responsible relative on the more recent of the following dates:

• The last month the applicant or enrollee was eligible for 1619(b) or was eligible for and received MSA, 1619(a) or SSI benefits concurrently with RSDI.

OR

• 7-1-82.

This is known as the Pickle threshold date.

Use the COLA chart below. Divide the client's current gross RSDI benefit by the percentage of the previous year's COLA. (This yields the RSDI level before the last COLA.) Repeat the computation for each RSDI COLA received since the client became ineligible for SSI or MSA.

Current Gross RSDI Amount 1.041 (1-06 RSDI increase)

=

Benefit Before 1-06 COLA

Current Gross RSDI Amount 1.027 (1-05 RSDI increase)

=

Benefit Before 1-05 COLA

Current Gross RSDI Amount 1.021 (1-04 RSDI increase)

=

Benefit Before 1-04 COLA

Current Gross RSDI Amount 1.014 (1-03 RSDI increase)

=

Benefit Before 1-03 COLA

Current Gross RSDI Amount 1.026 (1-02 RSDI increase)

=

Benefit Before 1-02 COLA

Current Gross RSDI Amount
1.035 (1-01 RSDI increase) 

=

Benefit Before 1-01 COLA

Current Gross RSDI Amount
1.024 (1-00 RSDI increase)

=

Benefit Before 1-00 COLA

Benefit before 1-00 COLA 
1.013 (1-99 RSDI increase)

=

Benefit Before 1-99 COLA

Benefit before 1-98 COLA
1.021 (1-98 RSDI increase)

=

Benefit Before 1-98 COLA

Benefit before 1-98 COLA
1.029 (1-97 RSDI increase)

=

Benefit Before 1-97 COLA

Benefit before 1-97 COLA
1.026 (1-96 RSDI increase)

=

Benefit before 1-96 COLA

Benefit before 1-96 COLA
1.028 (1-95 RSDI increase)

=

Benefit before 1-95 COLA

Benefit before 1-95 COLA
1.026 (1-94 RSDI increase)

=

Benefit before 1-94 COLA

Benefit before 1-94 COLA
1.030 (1-93 RSDI increase)

=

Benefit before 1-93 COLA

Benefit before 1-93 COLA
1.037 (1-92 RSDI increase)

=

Benefit before 1-92 COLA

Benefit before 1-92 COLA
1.054 (1-91 RSDI increase)

=

Benefit before 1-91 COLA

Benefit before 1-91 COLA
1.047 (1-90 RSDI increase)

=

Benefit before 1-90 COLA

Benefit before 1-90 COLA
1.04  (1-89 RSDI increase)

=

Benefit before 1-89 COLA

Benefit before 1-89 COLA
1.042 (1-88 RSDI increase)

=

Benefit before 1-88 COLA

Benefit before 1-88 COLA
1.013 (1-87 RSDI increase)

=

Benefit before 1-87 COLA

Benefit before 1-87 COLA
1.031 (1-86 RSDI increase)

=

Benefit before 1-86 COLA

Benefit before 1-86 COLA
1.035 (1-85 RSDI increase)

=

Benefit before 1-85 COLA

Benefit before 1-85 COLA
1.035 (1-84 RSDI increase)

=

Benefit before 1-84 COLA

Benefit before 1-84 COLA
1.074 (7-82 RSDI increase)

=

Benefit before 7-82 COLA

The difference between the current RSDI benefit and the RSDI computed from the COLA chart is the Pickle disregard.

Compare the client’s net countable income after subtracting all earned and unearned disregards, including the Pickle disregard, to the current year’s SSI federal benefit rate (FBR). If income is below the SSI FBR, the client meets the income requirement to be deemed an SSI recipient and is eligible for MA with no spenddown.

If net income is over the SSI FBR, determine the current MSA rate that would apply if the client applied for MSA. See the DHS Combined Manual for MSA standards. If the income after subtracting all earned and unearned income disregards including the Pickle disregard is less than the MSA rate, the client meets the income requirement to be deemed an SSI recipient and is eligible for MA with no spenddown.

Use the SSI or MSA standard for a couple when married clients live together, and one or both of them meet the disability and resource criteria for SSI eligibility. The MSA standard for a client in group residential housing is the group residential housing rate plus the personal needs allowance. Use the MSA standard for a person living with others for an unmarried client who has minor children.

In addition to meeting the income requirement, the client must meet an MA basis of eligibility and must be within MA asset limits.

If a client is determined eligible for the Pickle disregard in the threshold month, disregard all RSDI COLAs beginning with the 1st COLA received after the threshold month.

EXAMPLE:

Bart received RSDI and SSI concurrently through July 1997. He lost SSI beginning in August 1997. July 1997 is the Pickle threshold month. The worker disregards RSDI COLA increases for January 1998 and each year thereafter to determine the amount of the Pickle disregard. After applying the Pickle disregard and all other earned and unearned income disregards, Bart’s income is greater than the SSI FBR but less than the MSA benefit rate. Bart is eligible for the Pickle disregard if he continues to meet an MA basis of eligibility and has assets within MA limits.

If the client's countable income after applying all earned and unearned income disregards including the Pickle disregard is greater than both SSI or MSA standards, do not apply the Pickle disregard to income when determining eligibility.

Determine whether clients potentially eligible for the Pickle disregard become eligible when MSA, SSI, or RSDI standards increase, or when their circumstances change.

For MAXIS system instructions, see TEMP manual TE02.07.067 (Entering Pickle Cases).

GAMC:

No provisions.

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ALLOCATIONS 0912.05.25

MinnesotaCare:

No provisions.

MA:

Clients using an LTC or combination LTC/medical spenddown may deduct a portion of their monthly income and allocate it for the needs of the relatives listed below. See §0913.05 (Which Spenddown Type to Use). Also deduct allocations for the needs of relatives of an LTC client from income when determining QMB, SLMB, or QI eligibility.

Allow an allocation for the needs of the following relatives of LTCF residents:

• The community spouse. • Children under 18, regardless of whether they live with the community spouse. • Any of the following people who live with the community spouse:
• Children under 21. • Children over 21 claimed as a dependent for tax purposes. • Parents claimed as dependents for tax purposes. • Siblings of the client or the community spouse claimed as dependents for tax purposes.

Allow an allocation for the needs of the following relatives of people receiving home care services through elderly waiver (EW):

• The community spouse. • Any of the following people who live with the community spouse: • Children under 21. • Children over 21 claimed as a dependent for tax purposes. • Parents claimed as dependents for tax purposes. • Siblings of the client or the community spouse who are claimed as dependents for tax purposes.

Begin allowing the allocation deduction the first month the LTC spouse resides in a facility or receives home care services through the elderly waiver. End the allocation deduction the 1st full calendar month following a change in circumstances which results in the termination of LTC budgeting. See §0913.17 (Begin/End Use of LTC Spenddown).

If a family member becomes ineligible for an allocation because of a change in circumstances, end the allocation beginning the first month in which the family member is no longer eligible for an allocation. Situations in which eligibility for an allocation ends include:

• A family member enters an LTCF or begins receiving EW services.

EXAMPLE:

Brian resides in an LTCF. His wife Dorothy resides in the community and receives an allocation from Brian's income. Dorothy enters an LTCF. End the allocation beginning the 1st full month of LTC residence or receipt of EW services.

• A family member dies. End the allocation the month after the month of death. • The LTC spouse and the community spouse are divorced. End the allocation the month after the divorce becomes final. • A child or sibling is no longer eligible for an allocation due to age or loss tax dependency status. End the allocation the month after the change occurs.

EXAMPLE:

Gerard is divorced and resides in an LTCF. His 17-year-old daughter Tracy resides with Gerard's former wife and receives an allocation from Gerard's income. Tracy turns 18 and is no longer eligible for an allocation because she does not reside with a community spouse (there is no community spouse in this case). End the allocation the month after Tracy's 18th birthday.

GAMC:

No provisions.

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ALLOCATIONS -- COMMUNITY SPOUSE 0912.05.25.03

MinnesotaCare:

No provisions.

MA:

Also see §0912.05.25 (Allocations) and §0912.05.25.05 (Allocations--Other Relatives).

To calculate the amount of a client's allocation deduction for a spouse:

1. Determine the community spouse's total gross earned and unearned income. (Include income from income-producing assets.) Do not allow MA disregards and exclusions. Add all income received less often than monthly during a calendar year and divide by 12 to determine a monthly figure. Consider interest earned to be income.

VA Aid and Attendance benefits are not available for the needs of relatives unless the VA office grants an apportionment. Consider only the apportioned amount as income to the relative.

2. Determine the monthly total of these shelter expenses for the community spouse:

• Rent or mortgage payments. • Real estate taxes. • Homeowner's or renter's insurance. • Required maintenance charges for a cooperative or condominium. • A utility allowance. Use $305 effective 03/01/2006 (previously $262) for residences billed for heating and/or cooling. For residences not billed for heating or cooling, allow $75 for electricity and $25 for phone service. Reduce the utility allowance by the amount of any utility expenses included in a required cooperative or condominium maintenance charge.

3. Subtract $495 beginning 7-1-06 ($482 from 7-1-05 through 6-30-06) from the total of expenses in step 3. The result is the excess shelter allowance.

4. Add $1,650 beginning 7-1-06 ($1,604 from 7-1-05 through 6-30-06) to the excess shelter allowance. The result, up to a limit of $2,489 ($2,378 from 1-1-05 through 12-31-05), is the maximum monthly income allowance to the community spouse.

If there is a court order for support in excess of $2,489 ($2,378 from 1-1-05 through 12-31-05), use the court-ordered figure as the maximum amount.

5. Subtract the net available income of the community spouse (determined in step 1) from the monthly amount in step 4. The result is the actual allocation deduction amount.

EXAMPLE:

Norma resides in an LTCF. Her husband Leo resides in the community. Leo receives RSDI of $700 per month and a private pension of $300 per month. He has a savings account which earned interest of $600 for the most recent calendar year. He pays rent of $400 per month plus electricity, which includes air conditioning, and phone. He pays $300 per year for renter's insurance. Norma receives RSDI of $800 per month.

Determine Leo's maximum allocation as follows:

1. Determine Leo's total gross monthly income by adding the RSDI amount of $700, the pension amount of $300, and $50 per month interest ($600 divided by 12). Total monthly income is $1,050.

2. Determine Leo’s monthly shelter expenses by adding rent of $400, utility allowance of $305, and $25 per month ($300 divided by 12) for renter’s insurance. Total shelter expenses are $730.

3. Subtract $495 from $730. The result, $235, is the excess shelter amount.

4. Add $235 to $1,650. The result, $1,885, is the maximum monthly allocation amount.

5. Subtract Leo’s monthly income of $1,050 from $1,885. The result, $835, is the actual allocation amount. Allow this amount in Norma’s LTC budget. See §0913.13 (Long Term Care Spenddown Calculation).

If the allocation amount causes significant financial hardship for the community spouse due to exceptional circumstances, you may increase the amount on a temporary basis. Verify the spouse is making reasonable efforts to resolve the situation (for example, seeking more affordable housing). Also see §0909.25.05 (Transfer of Income Producing Asset to Spouse) for the possibility of transferring income producing assets to the community spouse.

If the community spouse wants to apply for MA, an allocation may cause income to exceed the MA standard. The spouse may either:

• Meet a spenddown using the allocated income.

OR

• Request a decrease or end to the allocation. This will increase the LTCF spouse's monthly LTC spenddown.

GAMC:

No provisions.

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ALLOCATIONS -- OTHER RELATIVES 0912.05.25.05

MinnesotaCare:

No provisions.

MA:

Also see §0912.05.25 (Allocations) and §0912.05.25.03 (Allocations--Community Spouse).

To calculate the amount of a client's allocation deduction for a child under 18 not living with the community spouse (which includes a child under 18 living with the LTC client's former spouse), follow the steps below.

1. Determine the child's gross earned and unearned income. If 2 or more children live together, but apart from the community spouse, determine their incomes separately. Add all income received less often than monthly during a calendar year and divide by 12 to determine a monthly income figure. Consider interest earned to be income.

Allow deductions from income if the child has no access to the income or control over the deduction. Do not allow MA disregards and exclusions.

2. If calculations were done for 2 or more children, combine the individual net incomes.

3. Subtract the total countable income from the appropriate standard in the 100% of FPG table in §0912.07.100 (100 Percent of FPG) based on the household size. The household size is the number of children living together. This is the amount of the client's allocation deduction.

EXAMPLE:

Ronald resides in an LTCF. He has 2 children, Jeremy, age 17, and Anne, age 15, who live with his former wife. Jeremy is employed part-time earning $400 per month. FICA taxes of $31 are deducted. Anne has no income. Determine an allocation from Ronald's income as follows:

1. Determine Jeremy's countable income by deducting the $31 FICA tax. He has no control over this deduction.

2. Determine combined income for Jeremy ($369) and Anne ($0) for a total of $369.

3. Subtract $369 from the standard for a household size of 2 in §0912.07.100 (100 Percent of FPG), or $1,121. The result, $752, is the maximum allocation amount. Allow this amount in Ronald’s LTC budget.

NOTE:

If Ronald has court-ordered child support in excess of $752 garnished from his income, allow the excess up to a maximum of $250. See §0913.13 (Long Term Care Spenddown Calculation).

Use the steps below to calculate the amount of a client's allocation deduction for any of the following people who live with the community spouse:

• Children under 21. • Children over 21 claimed as a dependent for tax purposes. • Parents claimed as dependents. • Siblings of the client or the community spouse claimed as dependents.

1. Determine the total of each family member's gross earned and unearned income separately. Do not deem the income of 1 family member to another. Add all income received less often than monthly during a calendar year and divide by 12 to determine a monthly income figure. Consider interest earned to be income. Do not allow MA disregards and exclusions.

2. Subtract the amount of gross income from $1,650 beginning 7-1-06 ($1,604 from 7-1-05 through 6-30-06).

3. Divide the result by 3 and round up to the nearest dollar. This is the amount of the client's allocation deduction.

EXAMPLE:

Sandra resides in an LTCF. Her 18-year-old daughter Marcy lives with Sandra's husband Steve. Marcy receives RSDI of $250 monthly because of Sandra's disability. She is employed part time, earning $300 per month.

Calculate an allocation for Steve as the community spouse following the steps in §0912.05.25.03 (Allocations--Community Spouse). Calculate an allocation for Marcy as follows:

1. Determine Marcy's gross monthly income by adding the $250 RSDI payment to her gross earnings of $300 for a total of $550.

2. Subtract $550 from $1,650 for a result of $1,100.

3. Divide $1,100 by 3. The result, $367, is the maximum allocation amount. Allow this amount as a deduction in Sandra’s LTC budget. See §0913.13 (Long Term Care Spenddown Calculation).

Verify family members' income and expenses needed to determine allocations at the time of the initial eligibility determination. After the initial eligibility determination, only verify changes, including changes reported on 6-month or annual review forms. Inform clients and family members to report changes.

GAMC:

No provisions.

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CHILD SUPPORT DEDUCTION 0912.05.27

MinnesotaCare:

No provisions.

MA:

METHOD A:

Deduct court-ordered child support that a person in the MA household pays to another household. Apply this deduction to current cash payments for child support, medical support, child care, and payments on arrears. Apply the deduction only to the income of the person with the legal obligation to pay support. Do not allow this deduction from the income of other household members.

A person with a legal obligation to pay support whose financial circumstances change after the support order goes into effect must petition the court to modify the support order. Adding a member to the household is not considered a change in circumstances. Allow the deduction for support paid until the next 12-month renewal is due even if you determine a petition must be filed. A person who does not petition to modify a support order by renewal when financial circumstances have changed loses the child support deduction until the month in which verification of filing a petition is received. If the support ordered has decreased by the time of the renewal, the client does not have to petition for a reduction in the order.

Base the deduction on the amount of current support and payments on arrears actually paid. If the order is too new to establish a payment history, allow the ordered amount in the budget. Determine the actual amount paid at the time of the next renewal or 6-month income/asset review. Request verification of the amount actually paid if the reported amount is questionable (for example, the support is paid through IV-D, or the person receiving the support also receives assistance through your agency, and the reported amounts differ).

If the client is using a 6-month spenddown, a monthly automated spenddown, or has no spenddown for a 6-month certification period, do not allow a deduction for child support unless the client has established a pattern of paying the ordered support. To determine whether there is a pattern, allow an average of the past 3 months as a deduction for future months of the income certification period. Allow the actual amounts paid for the retroactive and application months. Document how you arrived at the amount to allow in MAXIS case notes.

Require clients who make sporadic payments to use a manual monthly spenddown. For clients using a manual monthly spenddown, use the amount of support paid each month as a deduction.

METHOD B:

No provisions for clients residing in the community. For clients using an LTCF spenddown, allow a deduction for court-ordered support garnished from income up to a maximum of $250. See §0913.13 (Long Term Care Spenddown Calculation) and §0912.05.25 (Allocations).

GAMC:

No provisions.

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INCOME STANDARDS 0912.07

MinnesotaCare:

Compare the total countable gross income of applicant households to the applicable standard.

For families with children, see §0912.07.275 (275 Percent of FPG Standards).

For adults without children, see §0912.07.175 (175 Percent of FPG Standards).

To determine children's group status and eligibility for the fixed premium, see §0912.07.150 (150 Percent of FPG Standards).

M.S. 256L.04 subd. 1, 7

MA:

Compare the total countable net income to the applicable standard for each person.

For pregnant women, see §0912.07.275 (275 Percent of FPG Standards). For information on eligibility requirements, see §0907.19.05 (MA Basis: Pregnant Women).

For infants through the month of their 2nd birthdays who are not eligible as auto newborns, see §0912.07.280 (280 Percent of FPG Standards).

For QWD, see §0912.07.200 (200 Percent of FPG Standards). For information on QWD eligibility, see §0907.21.09.07 (Medicare Supplement Programs: QWD).

For eligibility during the 2nd 6 months of TYMA, see §0912.07.185 (185 Percent of FPG Standards). For information on eligibility for TYMA, see §0907.19.11 (TMA/TYMA: 1st 6 Months).

For QI-2, see §0912.07.175 (175 Percent of FPG Standards) and §0912.07.135 (135 Percent of FPG Standards). To be eligible for QI-2 benefits, income must fall between these levels. See §0907.21.09.09 (Medicare Supplement Programs: QI).

For children age 2 through age 18, see §0912.07.170 (150 Percent of FPG Standards) and §0907.19.03 (Families and Children Basis: Child under 21). Children with incomes in excess of this standard may be eligible by spending down to 100% of FPG. See 0912.07.100 (100 Percent of FPG standard).

For SLMB, see §0912.07.120 (120 Percent of FPG Standards). For QI1, see §0912.07.120 (120 Percent of FPG Standards) and §0912.07.135 (135 Percent of FPG Standards). Income must fall between these levels for QI-1 eligibility. For information on eligibility for SLMB and QI1, see §0907.21.09.05 (Medicare Supplement Programs: SLMB) and §0907.21.09.09 (Medicare Supplement Programs: QI).

For children ages 19-20, parents/caretakers of dependent children, QMB and MA for people with blindness or disabilities or who are age 65 and over, see §0912.07.100 (100 Percent of FPG Standards). For information on eligibility for these groups, see §0907.19.03 (MA Basis: Child Under 21), §0907.19.07 (MA Basis: Parent/Caretaker), §0907.21 (MA Basis: Age 65 and Over/Blind/Disabled) and §0907.21.09.03 (Medicare Supplement Programs: QMB).

For MA for people who are age 65 and over or who have blindness or disabilities AND have incomes over 100% of FPG, see §0912.07.75 (75 percent of FPG). People in these groups may be eligible for MA by spending down to 75% of FPG. Also apply this standard to all GAMC applicants and enrollees.

GAMC:

Use 75% FPG for all GAMC applicants and enrollees. See 0912.07.75 (75 Percent of FPG).

For GAMC Hospital Only (GHO), income must be between 75% of FPG and 175% of FPG. See §0912.07.175 (175 Percent of FPG).

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CLOTHING AND PERSONAL NEED ALLOWANCE 0912.07.03

MinnesotaCare:

No provisions.

MA:

An LTC spenddown or an LTC/Medical spenddown may include a clothing and personal need allowance. For 2003, the allowance is $72 for all clients except certain veterans and surviving spouses of veterans. For 2005, the allowance is $76 for all clients except certain veterans and surviving spouses of veterans. For 2006, the allowance is $79 for all clients except veterans and surviving spouses of veterans. Veterans who have no spouse or dependent children and surviving spouses of veterans with no dependent children, and who receive a monthly veteran’s pension of $90, have a personal need allowance of $90. See §0913.13 (Long Term Care Spenddown Calculation) and §0913.15 (Combination LTC/Medical Spenddown).

GAMC:

No provisions.

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75 PERCENT OF FPG STANDARDS 0912.07.075

GAMC Standard for Full Benefits

MinnesotaCare Adults Without Children Standard for Basic Plus One Benefits

MA Method B Spenddown Standard (MAXIS Standard H)

75% of Federal Poverty Guidelines (FPG) effective 7-1-06.

Household Size

Monthly Standard

6-Month Standard

Annual Standard

1

$    613

$ 3,678

$ 7,356

2

$    826

$ 4,956

$ 9,912

3

$ 1,039

$ 6,234

$ 12,468

4

$ 1,252

$ 7,512

$ 15,024

5

$ 1,465

$ 8,790

$ 17,580

6

$ 1,678

$ 10,068

$ 20,136

7

$ 1,891

$ 11,346

$ 22,692

8

$ 2,104

$ 12,624

$ 25,248

9

$ 2,317

$ 13,902

$ 27,804

10

$ 2,530

$ 15,180

$ 30,360

Additional People

$    213

$ 1,278

$  2,556

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100 PERCENT OF FPG STANDARDS 0912.07.100

MA Income Standard for Method A children ages 19-20 and parents/caretakers.

MA Income Standard for eligibility without spenddown for elderly/blind/disabled.

(MAXIS Standard E)

Income Standard for QMB is the amounts below plus $20.

(MAXIS Standard Q)

100 % of Federal Poverty Guidelines (FPG) effective 7-1-06:

Household Size

Monthly Standard

6-Month Standard

1

$    817

$   4,902

2

$ 1,101

$  6,606

3

$ 1,385

$  8,310

4

$ 1,669

$ 10,014

5

$ 1,953

$ 11,718

6

$ 2,237

$ 13,422

7

$ 2,521

$ 15,126

8

$ 2,805

$ 16,830

9

$ 3,089

$ 18,534

10

$ 3,373

$ 20,238

Additional People

$    284

$  1,704

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120 PERCENT OF FPG STANDARDS 0912.07.120

MA Income Standard for SLMB and Prescription Drug

(MAXIS Standard S)

120 % of Federal Poverty Guidelines (FPG) plus $20 effective 7-1-06:

Household Size

Monthly Standard

1

$ 1,000

2

$ 1,340

3

$ 1,680

4

$ 2,020

5

$ 2,360

6

$ 2,700

7

$ 3,040

8

$ 3,380

9

$ 3,720

10

$ 4,060

Additional People

$   340

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135 PERCENT OF FPG STANDARDS 0912.07.135

Upper Income Standard for QI-1 . (MAXIS Standard U)

135 % of Federal Poverty Guidelines (FPG) plus $20 effective 7-1-06.

Household Size

Monthly Standard

1

$ 1,123

2

$ 1,506

3

$ 1,889

4

$ 2,272

5

$ 2,655

6

$ 3,038

7

$ 3,421

8

$ 3,804

9

$ 4,187

10

$ 4,570

Additional People

$    383

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150 PERCENT OF FPG STANDARDS 0912.07.150

MinnesotaCare $48 Annual Premium

MA Method A Standard for Children Ages 2-19 (MAXIS Standard G)

150% of Federal Poverty Guidelines (FPG) effective 7-1-06:

Household Size

Monthly Standard

Annual Standard

1

$ 1,225

$14,700

2

$ 1,650

$19,800

3

$ 2,075

$24,900

4

$ 2,500

$30,000

5

$ 2,925

$35,100

6

$ 3,350

$40,200

7

$ 3,775

$45,300

8

$ 4,200

$50,400

9

$ 4,625

$55,500

10

$ 5,050

$60,600

Additional People

$    425

$ 5,100

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175 PERCENT OF FPG STANDARDS 0912.07.175

Income Limits for MinnesotaCare Adults Without Children Over 75% FPG–Limited Benefit

Income Limits for GAMC over 75% FPG–Hospital Only

175% of Federal Poverty Guidelines effective 7-1-06.

Household Size

Monthly Standard

6-Month Standard

Annual Standard

1

$ 1,430

$ 8,580

$17,160

2

$ 1,926

$11,556

$23,112

3

$ 2,422

$14,532

$29,064

4

$ 2,918

$17,508

$35,016

5

$ 3,414

$20,484

$40,968

6

$ 3,910

$23,460

$46,920

7

$ 4,406

$26,436

$52,872

8

$ 4,902

$29,412

$58,824

9

$ 5,398

$32,388

$64,776

10

$ 5,894

$35,364

$70,728

Additional People

$   496

$ 2,976

$ 5,952

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185 PERCENT OF FPG STANDARDS 0912.07.185

MA Income Standards for eligibility during the 2nd 6 months of TYMA (MAXIS Standard F)

185% of Federal Poverty Guidelines (FPG) effective 7-1-06:

Household Size

Monthly Standard

6-Month Standard

 

1

$ 1,511

$   9,066

 

2

$ 2,036

$ 12,216

 

3

$ 2,561

$ 15,366

 

4

$ 3,086

$ 18,516

 

5

$ 3,611

$ 21,666

 

6

$ 4,136

$ 24,816

7

$ 4,661

$ 27,966

8

$ 5,186

$ 31,116

9

$ 5,711

$ 34,266

10

$ 6,236

$ 37,416

Additional People

$   525

$   3,150

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200 PERCENT OF FPG STANDARDS 0912.07.200

MA Income Standards for QWD (MAXIS Standard W).

200% of Federal Poverty Guidelines (FPG) plus $20 effective 7-1-06:

Household Size

Monthly Standard

1

$ 1,654

2

$ 2,221

3

$ 2,788

4

$ 3,355

5

$ 3,922

6

$ 4,489

7

$ 5,056

8

$ 5,623

9

$ 6,190

10

$ 6,757

Additional People

$    567

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275 PERCENT OF FPG STANDARDS 0912.07.275

MinnesotaCare Maximum Income Standards for Applicant Families and Children.

MA Maximum Income Standards for Pregnant Women. (MAXIS Standard C)

275% of Federal Poverty Guidelines (FPG) effective 7-1-06:

Household Size

Monthly Standard

6-Month Standard

Annual Standard

1

$2,246

$13,476

$ 26,952

2

$3,026

$18,156

$ 36,312

3

$3,806

$22,836

$ 45,672

4

$4,586

$27,516

$ 55,032

5

$5,366

$32,196

$ 64,392

6

$6,146

$36,876

$ 73,752

7

$6,926

$41,556

$ 83,112

8

$7,706

$46,236

$ 92,472

9

$8,486

$50,916

$101,832

10

$9,266

$55,596

$111,192

Additional People

$   780

$ 4,680

$ 9,360

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280 PERCENT OF FPG STANDARDS 0912.07.280

MA Income Standard for infants through their 2nd birthday who are not eligible as auto newborns. (MAXIS Standard K)

280% of Federal Poverty Guidelines (FPG) effective 7-1-06:

Household Size

Monthly Standard

6-Month Standard

Annual Standard

1

$2,287

$13,722

$ 27,444

2

$3,081

$18,486

$ 36,972

3

$3,875

$23,250

$ 46,500

4

$4,669

$28,014

$ 56,028

5

$5,463

$32,778

$ 65,556

6

$6,257

$37,542

$ 75,084

7

$7,051

$42,306

$ 84,612

8

$7,845

$47,070

$ 94,140

9

$8,639

$51,834

$103,668

10

$9,433

$56,598

$113,196

Additional People

$   794

$  4,764

$  9,Ԩ

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