Any income received in a Lump Sum, covering a period of more than one month, whether received on a recurring or nonrecurring basis, is considered as income in the month it is received. Examples of lump sums may include, but is not limited to, accumulation of wages, gambling winnings, VA benefits, Workers’ Compensation, bonus lease payments and annual rentals from land/ or minerals.
SSI / RSDI
There is however, an exception to the rule when the lump sum payment is a SSI lump sum or RSDI (Retirement, Survivors, and Disability Insurance). These retroactive payments do not count as income in the month of receipt.
Gaming Income
The gaming revenue per capita payments that many tribal members receive is countable unearned income, as these payments do not fall under excluded per capita payments shown in policy 317:35-5-42(b)(6).
Resources
Any amount from any lump sum source retained on the first day of the next month is considered as a resource.
There are a few exceptions to this rule.
- Any unspent portion of retroactive SSI and RSDI benefits is excluded from resources for nine (9) calendar months following the month of receipt. However, unspent money from a retroactive payment must be identifiable (separate) from other resources for this exclusion to apply. The money may be commingled with other funds, but if this is done where it is no longer identifiable, the amount will count toward the resource limit.
- Lump Sum payments used to establish dedicated bank accounts by representative payees in order to receive and maintain retroactive SSI benefits for disabled/ blind children under age 18 are excluded as income. The interest income generated from dedicated bank account is also excluded. The dedicated bank account consisting of the retroactive SSI lump sum payment and accumulated interest is excluded as a resource in both the month received and any subsequent months.
Note: Changing a resource from one form to another, such as converting personal property to cash is not considered a lump sum payment.
MIPT
When it is anticipated that the lump sum payment will cause client to need a Medicaid Income Pension Trust, it can be established prior to income being received. Then the MIPT would be funded in the month of the lump sum preventing overpayments or ineligibility. If the combination of the lump sum and regularly received income exceeds the Maximum monthly countable income for a Medicaid Income Pension Trust as shown on Appendix C-1, Schedule VIII.B.1, client would not be eligible for medical for the month.
Vendor Payment
When the lump sum can be anticipated prior to receipt you would need to adjust the vendor payment for nursing home care or assisted living, and then adjust for the following month.
- If vendor payment needs adjusted, case notes must be documented prior to sending it to Remedy for assistance.
- If it is a negative action, permission is required and documented before sending it to Remedy.
Lump Sum FAQS
- ADvantage waiver client’s gross income is $1,000 per month. There is an anticipated lump sum of $500. What does the worker need to do?
- Update case notes and image the verification.
- Nursing home client’s gross income is $1,850. Client knows they are going to get a lump sum of $3,670. What would the worker need to do?
- If time permits, close the case. If unable to close, write and submit overpayment. Update case notes and image the verification.
- ADvantage waiver client’s gross income is $1,000. Client knows they are going to receive a lump sum of $1500. What does the worker need to do?
- Have client establish an MIPT and fund with the amount over the categorical income standard. Update case notes and image the verification. If client does not get MIPT established an overpayment will need to be written and submitted.
- Nursing home client’s gross income is $1,000. Client knows they are going to receive a lump sum of $500. What does the worker need to do?
- If there is time, adjust the vendor payment. If not enough time, attempt to obtain permission from the client or their representative to adjust the vendor payment. Update case notes and image the verification. If it is one you have to get permission to change you will need to submit a Remedy Ticket to get it corrected. If the client does not give permission you will need an overpayment.
- ADvantage client’s gross income is $1,000. Client presents proof of receipt of $1,500 SSI lump sum of $1,500. What does the worker need to do?
- Update case notes and image the verification. Request verification of total resources effective the first of the following month. Any unspent portion of retroactive SSI and RSDI benefits is excluded from resources for nine (9) calendar months following the month of receipt.
- Nursing home client’s gross income is $1,000. Client knows they are going to receive a lump sum of $2,250 this month. What does the worker need to do?
- Have a client establish a MIPT and fund with the amount over the categorical income standard. Update case notes and image the verification. If client does not get MIPT established, an overpayment will need to be written and submitted.
- ADvantage client’s gross income is $1,850. Client provides verification of receipt of a lump sum of $2,550 this month. What does the worker need to do?
- Update case notes and image the verification. Write and submit an overpayment for this month’s benefits.
- Nursing home client’s gross income is $1,000. Client’s POA presents proof of receipt of $1,500 SSI lump sum on the 25th of the current month. What does the worker need to do?
- Update case notes and image the verification. Request verification of total resources effective the first of the following month. Any unspent portion of retroactive SSI and RSDI benefits is excluded from resources for nine (9) calendar months following the month of receipt.
Comments or Suggestions?
We want Quest to be your source for important information that you need to succeed at in your work but we need your help:
Was this article helpful? Was it missing something you needed to get the job done?
Tell us what you think, what you know about this article. What are we doing well, and what we could do better.
All fields are required.