Aged, Blind, Disabled (ABD): SSI-Criteria State Policy FAQs

Policy 317:35-5-41 and 317:35-5-42

INCOME:

VERIFYING INCOME

When do we have to request verification of income?

You must request verification of income if the person doesn’t receive SSI. If the person receives SSI the income has already been verified.

If the person receives SSI and the income appears questionable, it must be verified. For example, if OWL shows earnings that the client didn’t report, or if the client is receiving a full SSI benefit but reports he earns $150 a week, this would be questionable. If the income is not questionable, simply record in case notes what income the client reports on the application and no verification is needed.

IRREGULAR/INFREQUENT INCOME

I’m not clear on when we use the new rule regarding irregular or infrequent income.
You must first determine if the income is irregular or infrequent. For the income to be infrequent it must be received in different quarters and cannot be received in subsequent months. For it to be irregular the client must not reasonably expect to receive it. For example, if a client won at bingo in November and again in December, this income was irregular (because it wasn’t anticipated) but was not infrequent (because it was in subsequent months). Or, if a client receives mineral income every three months, it is infrequent but is not irregular.

Once you’ve determined that the income is either irregular or infrequent, you can apply the appropriate disregard ($30 for earned income and $60 for unearned).

Instructions to Staff have been added to the new policy to give examples of how to count infrequent and irregular income.

ADOPTION SUBSIDY PAYMENT

I have an SSI child who receives a full SSI check and $450 in an adoption subsidy payment. Isn’t that too much income?

If the child receives an adoption subsidy payment, you must verify this on SDX (page 1 under “Unearned Income Data”). When a child is receiving an adoption subsidy payment, SSI is reduced dollar for dollar. If the adoption subsidy payment isn’t showing on SDX, immediately refer the client to SSI to report the payment. Keep in mind that as long as the adoption subsidy is less than the SSI standard, the child remains eligible for SSI. Policy still says it is exempt income for the medical benefit (317:35-5-42(b)(16), but is counted for the SSP. [Memo F95 09-10].

EARNED INCOME DISREGARDS

I have a client who works and is making payments on the vehicle modification for his truck to accommodate his wheel chair. Do I deduct the total amount he owes before the $20/$65 and ½ of the remainder
Deduct the payment for that month before the earned income deductions. Keep in mind that you cannot deduct the total amount he owes – only deduct that month’s payment. If the vehicle modification is included in the monthly payment on the truck (because he had it done when he purchased the truck), you must determine how much of the truck payment is for the vehicle modification since you can’t deduct the entire truck payment.

Refer to article ABD: SSI-Criteria State Order of Deductions for Earned Income

RESOURCES:

VERIFYING RESOURCES

When do we have to request verification of resources?

You must request verification of resources if the person doesn’t receive SSI. If the person receives SSI the resources have already been verified.

If the person receives SSI and the resources are questionable, they must be verified. If the resources are not questionable, simply record in case notes what resources the client reports on the application and no verification is needed.

VEHICLES

If a client has more than one vehicle, do we have to verify the value?

Yes – only one vehicle is excluded from counting as a resource, regardless of its value, if it is used for transportation of the individual or a member of the individual’s household. The resource value of all other vehicles, if applicable, must be verified.

My client has a truck and a motorcycle. Do I have to verify the value of the motorcycle?
You must verify the value of whichever vehicle he doesn’t use regularly for transportation. However, if the person receives SSI ask if it’s been reported to SSI. If it has, the value would not have to be verified (unless you question whether or not it’s been reported).

BURIAL FUNDS

If my client doesn’t receive SSI, how do I verify it if she states that her savings account is set aside for burial?

Ask her if there have been any disbursements from the account and request a copy of (at least) the last year’s savings accounts statements. If there are any disbursements that aren’t for burial costs then you know it’s not set aside for burial purposes.

Does this mean that the $1500 can be in the everyday checking account if the client states it’s for burial purposes?

Only if the $1500 remains in the checking account every month and isn’t touched.

IRREVOCABLE PREPAID BURIAL POLICIES AND CONTRACTS

Is the SSI-criteria policy regarding irrevocable prepaid burial policies (IPPB) only for people who receive SSI?

No. As with all the new rules, this applies to all ABD-related people.

If my client has life insurance in addition to an IPPB, do I still apply the $10,000 rule?

No. The new rule disregards IPPB’s, but when the client or spouse has cash value life insurance or a revocable burial policy, the cash value is a countable resource.

So I can’t disregard the life insurance if the face value is less than $1,500 when there’s an IPPB?

Correct. When the person has an IPPB, the $1,500 life insurance exclusion must be reduced dollar for dollar. Therefore, unless the face value of the IPPB is less than $1,500, the cash value of the life insurance is a countable resource. [See 317:35-5-41.2(f)(2)]

If the face value of the IPPB exceeds $10,000, we count the amount over $10,000 as a resource, right?

No. Because SSI excludes IPPB’s regardless of the face value, we must exclude them also.

HOUSEHOLD COMPOSITION

When both spouses are aged, blind or disabled they are an eligible couple. However, when the couple has minor children, it depends on the amount and source of the income as to whether they are an eligible couple or an eligible individual with an ineligible spouse.

INELIGIBLE SPOUSE

We have a case where the wife receives a full SSI check even though the husband receives $842 in Social Security disability benefits. How is she eligible for a full SSI check when their combined income is over the ABD couple standard?

Since SSI treats a spouse who doesn’t receive SSI as an ineligible spouse, the ineligible child allocation can be deducted from the husband’s social security. In this situation the couple has two children, so $784 of the husband’s income is disregarded as the ineligible child allocation. This made the wife eligible for a full SSI check.

Then aren’t both of them eligible for Medicaid since their income is below the couple standard?

No, because he is being treated as in ineligible spouse. For both of them to be eligible for Medicaid we would have to look at them as an eligible couple, which means we’d have to count $1,575 in income, and this is over the eligible couple standard.

What if both spouses receive Social Security disability benefits and no SSI?

If there are ineligible minor children, the spouse applying for Medicaid would be treated as the eligible spouse and the other spouse would be the ineligible spouse. Here’s an example.  Wife receives $800 in Social Security disability benefits, the husband receives $900 and neither of them is eligible for Medicare yet.  They have two minor children, each of whom receives $48 in Social Security benefits from the parents. The husband needs to have surgery. $392-48= $344 that will deducted as the ineligible child allocation for each child for a total of $688. $800 – $688 = $112 of the wife’s income that must be considered in determining the husband’s eligibility.  $900+ $112 = $1012, which is below the QMBP individual and spouse standard. Therefore the husband is eligible for QMBP if the couple meets all the other factors of eligibility. If there are no ineligible minor children, the couple’s income must meet the QMBP couple standard.

Since we’re treating one spouse as an ineligible spouse, can we deduct the ineligible child allocation even if there are no minor children in the home?

No.

OTHER TOPICS

If an on-going client is now ineligible because of these changes, do we have to close the case?

You don’t have to do anything until time of review, unless the case comes to your attention for another reason.

For example, let’s say your client is now ineligible because she has $3,000 in cash value life insurance not being used to fund the $5,000 IPPB. The client would have to option of cashing in the life insurance and spending it down so she can become eligible again

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