Ohio Admin. Code 5160:1-3-03.1 - Medicaid: income
(A) This rule describes how income, as
defined in rule
5160:1-1-01 of the
Administrative Code, is treated for the purpose of determining eligibility for
medical assistance for an aged, blind, or
disabled individuals
individual .
(B) Treatment of income.
(1) Eligibility for medical assistance is
dependent in part upon the amount of monthly income available to or received by
the individual.
(a) Gross income, prior to any
deductions or exclusions, that can be reliably anticipated is considered
available in
when calculating countable income for a month. Thus,
when an individual is receiving a pension or is regularly employed or
self-employed, the expected amount of income is counted.
(i) Wages are counted as earned income in the
calendar month in which they are paid
received, even if
when all of the
work which produced the wages is
was performed in a prior month.
(ii) When the time of receipt of the income
is at the employee's
individual's discretion, the
employee
individual shall avail
himself/herself of
promptly request such
wages.
(iii) When the payment of
wages is deferred at the employee's
individual's request, the administrative agency shall
determine when the wages would normally have been paid and allocate them as
income for the month in which the wages would have normally been paid. The
administrative agency shall assume the wages were payable in equal segments
throughout the applicable period and determine eligibility accordingly. When
the payment of wages is deferred due to circumstances beyond the control of the
employee
individual , the administrative agency shall consider
the wages as income when the income is actually received.
(b) Receipt of cash, income in-kind, or
something of value in a particular month is considered income to the individual
for that month. Any portion of the income which is retained by an individual
into the next month becomes a resource.
(2) All income, except income excluded in
rule 5160:1-3-03.2 of the
Administrative Code, shall be considered in
when determining
the amount of income that is available to an individual.
(3) When an eligible individual resides with
an ineligible spouse or parent(s), a portion of the ineligible spouse's or
parent's income shall be deemed as available income to the eligible individual.
This deeming of income is subject to conditions and limitations as described in
rule 5160:1-3-03.3 of the
Administrative Code.
(4) Net-earnings from self-employment are the gross income
from any trade or business minus allowable deductions for that trade or
business.
(a) When the individual has filed
taxes for the previous year, use all tax forms that were filed with the
internal revenue service (IRS).
(b)
When the individual has not filed taxes for the previous year, the following
may be used:
(i) Business records including
receipts for the costs of doing business, or
(ii) Estimated net income.
(5) The monthly income
allowance (MIA) from an institutionalized individual to a community spouse, as described in rules
5160:1-6-07 and
5160:1-6-07.1 of the
Administrative Code, shall be treated as unearned income to the community
spouse in the determination of the community spouse's eligibility for medical
assistance.
(C) Under
certain circumstances, the amount of income determined available to an
individual may be greater than the amount of income that the individual
actually receives for his or her own
personal use. The following types of income deductions
are not subtracted from the individual's countable income for purposes of
determining eligibility for medical assistance. This list is not all-inclusive.
(1) Court-ordered income deductions.
(a) This includes child and/or spousal
support, even if
when such support is paid directly to the former
spouse or child's guardian by the employer or benefit payer.
(b) A division of marital property in a
divorce settlement, which may include a retirement pension, is not considered a
court ordered
court-ordered income deduction.
(2) Deductions due to a repayment of an
overpayment, loan, or other debt, unless the amount being withheld to reduce a
previous overpayment was included when determining the amount of unearned
income for a previous month in the determination of medical assistance
eligibility.
(3) Garnishments and
liens placed against earned or unearned income of the individual, regardless of
the purpose for the garnishment or lien.
(D)
Potential
income must be explored prior to approving medical assistance. An individual
who does not avail himself/herself of potential income is presumed to fail to
do so in order to make himself/herself eligible for medical
assistance.
An individual must take all
necessary steps to obtain potential income, as required by paragraph (B)(4) of
rule 5160:1-2-10 of the
Administrative Code. An individual who does not take the necessary steps to
pursue potential income is presumed to have done so in order to be eligible for
medical assistance. Such non-utilization of income constitutes
ineligibility unless the individual demonstrates
good cause can be shown.
Such
Types of
potential income includes
include, but is
are not limited to:
(1) Retirement, survivors, disability
insurance (RSDI); or
(2) Prouty benefits; or
(3)
Railroad retirement; or
(4) Veterans benefits;
or
(5) Other public/private retirement
benefits;
.
(E) The following items are not considered
income, in accordance with 20 C.F.R. 416.1103 (as in effect
October 1, 2019
2023 ). This list is not all
inclusive
all-inclusive :
(1) A personal service performed for an
individual is not income to the individual where the service is not convertible
to cash.
(2) Payments made on
behalf of an individual under credit life or credit disability policies
directly to loan companies, mortgage companies, etc.
(3) Money an individual borrows or money
received as the repayment of the principal of a bona fide loan. Any interest
received on the money loaned is unearned income. If
When the proceeds
of the loan are retained in the month following the month of receipt, they are
counted as a resource.
(4) A bill
paid directly to a creditor or vendor by a third party on behalf of the
individual, unless payment is for food or shelter, to include:
(a) A
premium payment for supplementary medical insurance.
(b) Medical insurance premiums.
(5) An arrearage of child support
which is payable to an individual on behalf of an adult child unless the
individual retains the income and does not give it to the adult
child.
(6) Receipts from the sale,
exchange or replacement of a resource are not income but remain
resources.
(7) A rebate, refund, or
other return of money an individual has already paid. The money returned is not
income.
(8) Any amount refunded on
income taxes already paid.
(9) The
replacement of an individual's income that was lost, stolen, or destroyed and
was previously used in
when determining eligibility.
(10) A return of erroneously received
payments.
(11) Cash or in-kind
assistance from a governmental or nongovernmental program for medical or social
services that are not food or shelter.
(F) Verification of income.
(1) The individual's statements of source and
amount of income are subject to verification. At the time of
application/renewal,
application and renewal, the income of the individual
and household member(s) whose income affects the individual, shall be verified electronically or documents
shall be required to be submitted which verifies
verify all
sources of income. When necessary, the administrative agency shall obtain a
signed release of information and contact other sources to verify income.
(a) When the administrative agency is unable
to verify the income through electronic sources, the administrative agency will
contact the individual to collect the information needed.
If
When the
individual declares the verifications cannot be accessed or submitted, the
individual's statement is to
shall be accepted.
(b)
If
When the
administrative agency is unable to make contact with the individual,
a request for information or verification documents
shall be sent electronically, via postal mail, or personally delivered to the
individual
a written (electronic or paper)
request for the necessary information or verification documents is to be
sent as set forth in rule
5160:1-2-01 of the
Administrative Code.
(2)
An individual's report of income is subject to verification when a review is
conducted by the Ohio department of medicaid
ODM
(ODM)
quality assurance review
program integrity compliance section.
(3) The individual has the burden of
verifying the sources and amounts of income, and has the responsibility of
reporting income changes to the administrative agency in accordance with rule
5160:1-2-08 of the
Administrative Code.
(4) When an
individual claims to have no income at the time of application/renewal
application or renewal , the administrative agency
shall review the application/renewal
application or renewal for inconsistencies requiring
resolution. It is the individual's responsibility to
support
The individual is responsible for
supporting the claim of no income.
;
However
however , when verification is not available and the
individual has cooperated with the administrative
agency in trying to obtain it
verification , the administrative agency may process
the case
application
or renewal based on the individual's statement as long as there is no evidence to cast doubt on the income
allegations
unless available information
conflicts with the attestation . Reference rule
5160:1-2-10 of the
Administrative Code for additional information on
regarding
acceptable verification.
(5) When
income in-kind is received, the administrative agency shall determine whether
in-kind support and maintenance is being received in accordance with rule
5160:1-3-03.8 of the
Administrative Code.
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 09/03/1977, 12/31/1977, 03/01/1979, 10/01/1979, 12/07/1979, 01/03/1980, 12/01/1984 (Emer.), 02/10/1985, 08/01/1985, 10/01/1988 (Emer.), 12/20/1988, 09/01/1992, 10/01/2002, 07/01/2005, 10/01/2006, 01/25/2015, 08/01/2016, 01/01/2018, 07/08/2020 (Emer.), 12/14/2020
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.