7123 Other
Budgeting Provisions (Medical Assistance) - The
following additional budgeting provisions apply to the medical assistance
programs.
- Income
Averaging - For independent living applications involving
a 6 month base period, if an average cannot initially be established,
an estimate shall be used to compute countable income or determine
the amount of spenddown. Once the average has been determined, the
budget for the eligibility base period shall be recomputed using actual
amounts received for the months prior to the month the average is
implemented. The average shall then be budgeted for the remainder
of the base. For independent living and long term care applications
where a 1-month base period is used, an estimate shall also be used
until an average has been determined, but the re-budgeting process
is not applicable.
Income may be estimated when there
is a change in circumstance. For re-computing eligibility based on
a change in income, use the average in place prior to the month of
change. In addition, project anticipated income beginning with the
month of change.
A new computation is required whenever income terminates and there
continues to be a spenddown or patient liability in place. When re-computing
income for an independent living base period, the average in place
prior to the income termination shall be used. If there will be only
one month of irregular earnings within the eligibility base period,
the actual amount for that month will be considered if it is known
in time to adjust the budget within the eligibility base period. For
persons in long term care, the average in place prior to the income
termination shall be used. 2.
- Reasonable
Compatibility - This provision is only applicable to the
Medically Needy (MN), MediKan and Medicare Savings Programs (MSP –
QMB, LMB and ELMB). It does not apply to long term care (LTC) or Working
Healthy (WH).
Reasonable compatibility is the earned income verification standard
used to determine if the information reported by the consumer is consistent
with data received through the tiered verification provisions contained
in 1322.4
If the source information is reasonably compatible with the consumer
statement, additional information may not be requested from the consumer.
The reported information is considered verified.
To make the comparison, the income amounts from both the consumer and
the source are converted to a monthly amount. There is reasonable
compatibility when the amount reported by the consumer is either:
- greater than the source
amount, or
- not less than 80% of the
source amount.
The reasonable compatibility test is
performed separately for each individual with reported earnings. All
earnings from all sources (including multiple jobs) for each individual
are combined into one income amount when preforming the test. Once
the reported income amount has been verified as reasonably compatible,
that amount shall be budgeted. Any earned income not verified in this
manner must be verified in accordance with 1322.4(1)(d) . See Appendix
Item W-17 (Reasonable Compatibility Tool).
- Budgeting
Method - This provision is only applicable to the Medically
Needy (MN), MediKan and Medicare Savings Programs (MSP – QMB, LMB
and ELMB). If reported income is verified through either the Tier
3 or Tier 4 process described in 1322.4, the amount of income budgeted
on the medical assistance program will depend on the level of verification
received.
- Full Month -
If a full month (at least 30 days) of income verification is received,
a prospective amount based on the verification received shall
be determined and budgeted in place of the reported amount.
- Partial Month -
If less than a full month (less than 30 days) of income verification
is received, or it cannot be determined if the verification represents
a full month, a prospective amount shall be determined based on
the partial verification received. The greater of either the reported
amount or the prospective amount based on the partial verification
received shall be budgeted.
Note: Verification received from either a KDOL
– BARI/BASI or DCF income record (cash or food assistance program)
under the Tier 3 process shall always be considered a partial
month for purposes of this provision.
- Additional
Budgeting Provisions - The following budgeting provisions
apply where multiple programs are involved for the same individual(s).
- Application -
Where eligibility for multiple program types is being determined
for the same individual at the time of application, if the use
of reasonable compatibility is not required for all the programs,
eligibility shall be determined for all programs without using
reasonable compatibility.
An example would be where a nursing home resident applies for long
term care (LTC) and MSP coverage. The MSP application requires
the use of reasonable compatibility. The LTC application does
not. Eligibility for both LTC and MSP shall be determined by verifying
actual income.
- Program Added -
Where a program using reasonable compatibility is being added
to a program not using reasonable compatibility or vice versa,
eligibility shall be determined for all programs without using
reasonable compatibility beginning with the first month of eligibility
for the added program.
- Transition to New
Program - Where eligibility transitions from a program
using reasonable compatibility to a program not using reasonable
compatibility, eligibility shall be determined for the new program
without using reasonable compatibility. Where eligibility transitions
from a program not using reasonable compatibility to one that
does, the current budgeting in place shall continue to be applied
to the new program through the end of the existing review period.