Section 477-24-001 - RELATIVE RESPONSIBILITYIn determining eligibility, the Department must consider as available to a client the income and resources of
1. A parent (biological, adoptive, or step) for a child if the child is eighteen (18) years old or younger and is still considered part of the household; and2. One spouse for another spouse. 001.01 Parent for Child Relative Responsibility 24-001.01AChild Considered Part of Household: If a child is living in the same household with his/her parent(s), the parent(s)'s income and resources must be considered available to the child. 24-001.01A1Exceptions: A parent(s)'s income and resources are not considered available to i. A pregnant minor who, pursuant to Neb. Rev. Stat. section 71-6903, is denied financial support by her parents, guardians, or custodians due to her refusal to obtain an abortion, and is therefore considered emancipated for purposes of public assistance;ii. A child receiving Home and Community-Based Waiver;iii. A child receiving Developmental Disability Waiver; oriv. A child approved for Katie Beckett Medicaid. See 477 NAC 24-001G2b(1) and 477 NAC 27-009.24-001.01A2Temporary Absence: If a child is temporarily absent from the home (ninety (90) days or fewer) but is still considered part of the household, the parent(s)'s income and resources must be considered available to the child. Temporary absence includes, but is not limited to 1. School attendance where the child returns to the home on a regular basis (weekends, vacations, or summers). 2. Residence in an institution for a developmental disability or mental illness for 90 days or fewer may be considered temporary absence if the child was living in his/her parent(s)'s household before institutionalization and will return to the parent(s)'s household upon discharge.24-001.01BChild No Longer Considered Part of Household: If a child is permanently out of the home and no longer considered part of the household, his/her parent(s)'s income and resources shall not be considered available to the child.24-001.01CDetermination of Paternity: Paternity cannot be established unless an alleged father has signed a birth certificate, written and notarized paternity acknowledgment form or a court has determined him to be the father. Note: Paternity cannot be established for an unborn.
24-001.01C1Unmarried Parents: When unmarried parents are living together, the alleged father is not financially responsible unless he has acknowledged paternity or a court has determined that he is the father of the child after the birth.24-001.01C2Children of a Marriage: Married individuals are considered the parents of any children who are conceived or born during a marriage, even if the couple is separated, has filed for divorce or annulment, or states that one individual is not the parent of the child, unless there is a court order that states otherwise.24-001.01DMilitary Service: If a parent is absent due to active duty in the uniformed services of the United States, that parent is still considered part of the assistance unit and his/her income is considered available to the unit. Uniformed service is defined as the Army, Navy, Air Force, Marine Corps, Coast Guard, Environmental Sciences Services Administration, and Public Health Service of the United States. If the client states that separation is due to reasons other than performance in military service, the client must provide proof of bona fide separation. If the parent in the military is incarcerated, s/he is no longer considered part of the assistance unit.
24-001.01EJoint Physical Custody: In a household where both parents are present, though not necessarily continuously, income and resources of each must be used in a child's eligibility determination and the needs of both parents included in the unit. This includes situations in which the non-custodial parent has sufficiently frequent contact with the child(ren) so that the normal parental roles of providing guidance, physical care, and maintenance have not been interrupted. This policy applies when there is joint physical (shared) custody in which the physical custody of the child(ren) is split between both parents. This can be either on a scheduled basis as included in a divorce decree or on an informal basis as agreed to by both parents. The percentage of time spent with each parent is irrelevant in a joint custody arrangement for Non-MAGI cases.
24-001.01FSpecial Provisions Pertaining to Minor Parents24-001.01F1Minor Parent: If a minor parent has a legal guardian, according to Nebraska law, the guardian has no financial responsibility for the minor.24-001.01F2 Medically Needy Minor's Parent(s): If a minor parent is living with his/her medically needy parent(s) who is receiving Medicaid for another child, the minor parent must be in his/her parent(s)'s unit. If assistance is received for the minor's child, that child must also be in the parent(s)'s unit.
When a minor parent becomes emancipated, graduates from secondary school at age 18, or reaches age 19, s/he and his/her child become a separate unit.
Note: The family is not required to receive Medicaid for the minor's child.
24-001.01F3Minor Living in Parent(s)' Home: If a minor is living in his/her parent(s)' home, s/he is considered emancipated if s/he has married. If the minor has married, s/he may be a separate unit with his/her child. If the marriage is annulled, the minor is not considered emancipated.24-001.01F4Minor Not Living with Parent(s): If the parent(s) has been contributing to the support of the minor, written verification from the parent(s) of his/her plans to continue or not continue to support is required.24-001.01F5Minor Parent Living with Specified Relative, Guardian, or Conservator: A minor parent who is living with a specified relative, guardian, or conservator is considered emancipated unless the minor parent is being supported from his/her parent(s), guardian, or conservator. Note: See 477 NAC 1-001 for a list of specified relatives.
24-001.01GDeeming Provisions for ABD Children24-001.01G1Parent for Child: If an ABD child age 17 or younger is living in the household of his/her parent(s), the income and resources of the parent(s) shall be deemed (i.e., determined available). See 477 NAC 24-002.03 for exceptions to this deeming requirement.
24-001.01G2Disabled Child Not Receiving SSI24-001.01G2aDeeming Income and Resources of Responsible Persons: A parent(s)'s income and resources are considered in determining the eligibility of a child age 17 or younger who is part of the household when the disabled child does not receive SSI. When there is a self-supporting parent(s) for children in two different program cases, the procedures for deeming found below are followed and the resulting deemed income and resources are divided between the program cases containing the children on ABD. A portion of the income and resources of these individuals is deemed to the child using the following procedures.
24-001.01G2bNeither Parent nor Child is Receiving SSI: If neither a disabled child nor his/her disabled parent(s) is receiving SSI, and the child is living in the same household with his/her parent(s), the parent(s)'s income and resources must be deemed, with the following exceptions. 24-001.01G2b(1) Exceptions: x 1.Home and Community-Based Waiver: If a child living in his/her parent(s)'s home is receiving Medicaid services through a Home and Community-Based Service waiver, the parent(s)'s income and resources are not deemed when determining eligibility for Medicaid.2.Katie Beckett: If a child is not receiving waiver services, the income and resources of a parent are not deemed for Medicaid if the child is severely disabled and would require the level of care provided in a medical institution as well as certain medical services for special needs (a Katie Beckett child; see 477 NAC 27-009).24-001.01G3Child Receiving SSI: If a child age 17 or younger leaves a nursing facility or hospital where s/he was receiving an institutional personal needs amount SSI payment and goes home under a waiver, SSI must be notified of the waiver eligibility. Even though income and resources of the parent(s) may make the child ineligible for SSI, if the child is waiver-eligible, SSI continues the institutional personal needs amount payment without deeming income and resources of the parent(s). Note: If the parent(s) is receiving SSI, none of the parent(s)'s income shall be deemed.
24-001.01G4Child in an IMD: If a child under age 19 is placed in an IMD and is a ward of the Department or another public agency, or if the placement is court-ordered, see 477 NAC 25-001. If the child who is placed in an IMD is still considered part of the household, the parent(s)' income is deemed. See Appendix 477-000-009 for calculation procedures.001.02 Special Provisions Pertaining to Spouse-for-Spouse Relative Responsibility for ABD 24-001.02ADivorce and Separation: A divorce dissolves the marriage of a couple and there is no longer spouse-for-spouse responsibility. A legal separation does not dissolve the marriage.24-001.02BDetermining Financial Responsibility for a Married Couple: 24-001.02B1Living Together without Medicaid Waiver or Program of All-Inclusive Care for the Elderly (PACE) Services: The income and resources of spouses living together in the same household shall be considered available to each other. The resource standard for two shall be used to determine eligibility whether one spouse or both are eligible. Exception: If one spouse is receiving VA benefits, and is eligible for ABD Medicaid, then eligibility shall be determined separately. This only applies if the couple would be ineligible for SSI as a couple. If they would both be eligible for SSI, the non-SSI spouse must apply.
24-001.02B2Living Together with Medicaid Waiver or PACE Services: If only one spouse is eligible for ABD Medicaid, then use the spousal impoverishment treatment of resources and income. An assessment and designation of resources must be completed. See 477 NAC 26-003.01B and 477 NAC 26-003.01F. If both spouses are eligible for ABD Medicaid, then eligibility shall be determined separately. The resource standard for one shall be used for each spouse. The combined resources must be $8,000 or less.24-001.02B3Living Apart and Neither in a Specified Living Arrangement: Eligibility shall be determined separately beginning the first full month the couple ceases to live together. Consider only the income and resources in the applicant spouse's name. The spouse shall be allowed a resource standard for one, and eligibility shall be determined separately. Total countable resources for each spouse must not exceed $4,000. This guideline shall be followed whether one spouse or both are eligible.24-001.02B4Living Apart and Both in a Specified Living Arrangement: If both spouses are in a specified living arrangement (see 477 NAC 26-001), eligibility is determined as follows: Consider the income of each spouse separately. Consider the resources that each spouse has in their own name. Combined resources must be below $8,000. Each spouse shall be allowed a resource standard for one. This guideline shall be followed whether one spouse or both are eligible.
24-001.02B5Living Apart with One in a Specified Living Arrangement: If only one spouse is eligible for ABD Medicaid, spousal impoverishment rules apply for treatment of income and resources (see 477 NAC 26-004 and 477 NAC 26-003). An assessment and designation of resources must be completed (see 477 NAC 26-003.01B and 477 NAC 26-003.01F). The spouse shall be allowed the resource standard for one. If both spouses are eligible and one enters a specified living arrangement, income and resources shall be considered separately beginning the first full month the couple ceases to live together. Each spouse shall be allowed a resource standard for one. Combined resources must be $8,000 or less. Note: If one spouse is temporarily absent from the home, the couple's income and resources shall continue to be considered together. An absence of fewer than 90 days is considered temporary. If the spouse will be absent more than 90 days, the spouse's plans or ability to return home shall be evaluated.
24-001.02CSpouse for Spouse Hardship Exemption: A hardship exemption may be granted to enable an eligibility determination using only the applicant's resources in cases where it is not possible to verify the resources of the non-institutionalized spouse due to inability to obtain complete information. This exemption can only be granted by Central Office. Note: If the community spouse is assisting the applicant with the application process or was living with the institutionalized spouse just prior to institutionalization, spouse for spouse financial responsibility applies.
001.03 Blindness or Disability Determination 24-001.03AEligibility Requirements Applicable Only to Blind or Disabled: All applicants for Aid to the Blind or Aid to the Disabled after January 1, 1974, must meet the medical definitions of blindness or disability of the RSDI/SSI Programs as administered by the Social Security Administration (SSA). The determination by SSA that an individual is disabled or blind must be accepted for eligibility for AABD/MA. In some cases, the State Review Team (SRT) may make the determination of blindness or disability.24-001.03BDetermination of Eligibility for the Blind or Disabled24-001.03B1Disability Determination: In the determination of eligibility for aid to the blind or disabled, all eligibility requirements except that of the disability determination are the responsibilities of the SSA.24-001.03B2Direct Referral to the State Review Team: In the following situations a referral may be submitted directly to the SRT for a determination of disability and its probable duration without waiting for an SSI determination if the individual is not eligible for another assistance program, and during the initial intake it is apparent that: 1. The individual has income and/or resources in excess of the limit for the SSI Program. The client's potential eligibility for SSI must be monitored. If income and/or resources fall below the SSI limit, a referral must be made immediately. The client is allowed 60 days to apply for this potential benefit;2. The individual requires immediate long term hospitalization and/or treatment for a severe impairment before SSI can make a determination, or would be required to extend his/her hospital stay solely because of a delay in processing the SSI application, i.e., due to SSI's required waiting periods before a decision on certain types of disability can be made such as cancer or stroke (this does not include diagnostic examinations or tests, routine medications, or drug/alcohol treatment). An immediate referral must be made to SSI; The individual is institutionalized (e.g., nursing home or public institution) and SSI will be unable to make a determination. An individual is eligible for SSI benefits while institutionalized only if Medicaid will pay 50 percent of his/hercare. Therefore, SSI may, in some cases, wait for a determination of eligibility for Medicaid. An immediate referral must be made to SSI;
3. The individual is deceased and SSI will not make a disability determination; or4. The individual is a non-U.S. citizen who SSI will not review. 24-001.03B3Subsequent Referrals to SSA: The agency shall continue to monitor the client's potential eligibility for RSDI and SSI benefits even though the SRT has made the determination of disability.001.04 SSI Program If a client has not applied for SSI, an application must be filed immediately. A client must be referred to SSI if:
1. The client lives alone and has monthly unearned income less than the referral amount for an individual;2. An eligible couple are living together and have monthly unearned income less than the referral amount for a couple (Note: both must apply for SSI); or3. An individual is in a nursing home and has unearned income of less than $50 per month. Exception: If income is less than these amounts but resources are less than levels for MA, an SSI referral is not made but must consider eligibility for Medicaid.
001.05 Institutionalization An individual may qualify for AABD/MA while living in an institution only if the institution is subject to the licensing requirements of the Nebraska Department of Health.
24-001.05APatients in a Medical Institution and Convalescent Leave: Assistance may be provided for a client who is a patient in a medical institution, i.e., hospital, nursing home, etc., if all other eligibility factors are met. Psychiatric wards of medical hospitals are considered part of the medical institution and are not subject to the restriction on psychiatric care identified previously. The Central Office is responsible for determining the public or private nature of an institution, and whether a public institution is one in which otherwise eligible individuals may receive assistance.
24-001.05BCriteria for Determining Public Nature of Institutions: Prisons, jails, etc., are designated in the law as public institutions whose inmates are ineligible to receive assistance. Governmental participation in financial support of an institution, in policy formulation, or in the application of policy to specific situations, is evidence of the public control which makes it a public institution. Payment from public funds to, or in support of, individuals in a private institution is not considered governmental participation in support of the institution.001.06 Factors Relating to Eligibility of Clients in Institutions 24-001.06APrivate Institution and Home: The private institution in which the client chooses to reside may be a fraternal, benevolent, or charitable institution, or the client may make plans for living in a home which is privately owned and operated and which furnishes shelter, board, and care according to the client's needs. In determining the eligibility of a person living in a private institution or home, it is necessary to determine if s/he has entered into any agreement with the institution that s/he is to receive shelter and care in return for a transfer of property, insurance, or other assets. In determining eligibility of an individual in a private institution, it is necessary to determine what the institution is able to furnish its guests from its own resources. The individual may be eligible to receive assistance if residing in one of the facilities previously described if the terms of his/her stay do not in any way restrict the use of his/her personal assets or income and if the individual has a need.
001.07 Working Disabled Part A Medicare Beneficiaries Individuals who were receiving RSDI disability benefits and return to work but remain disabled may continue to be entitled to Part A Medicare at no cost for 48 months. The Omnibus Budget Reconciliation Act of 1989 allowed these individuals, at the end of 48 months, to enroll in Part A Medicare and pay a premium. It also required state Medicaid programs to purchase Medicare Part A premiums for these individuals.
24-001.07AAge: To be eligible for the payment of the Medicare premium, an individual must be age 64 or younger.24-001.07BDisability: To be eligible for the payment of the Medicare premium, an individual must continue to have a disabling impairment as determined by SSA. SSA has the responsibility to periodically verify that the disability continues. If SSA determines through a continuing disability review that the client is no longer disabled, SSA notifies the Department and eligibility for AABD/MA cases. If the client voluntarily withdraws from Medicare Part A premium, eligibility for AABD/MA cases.24-001.07CReceipt of Other Assistance: Through the AABD/MA program an individual may choose to receive either payment of the Medicare Part A premium or full Medicaid benefits but not both at the same time. While receiving either form of assistance, the client may request the other; however, the client is not eligible for full Medicaid benefits for any month for which the Department has paid the Medicare Part A premium. If a client who is on AABD/MA with excess and is paying his/her own Part A Medicare premium fails to meet his/her excess obligation, the Department retroactively pays the Medicare Part A premium for the excess cycle. At the end of this excess cycle, the client must decide whether to continue with the state paying the Part A premium or to begin a new excess cycle and assume payment of the Part A premium him/herself.
477 Neb. Admin. Code, ch. 24, § 001
Amended effective 3/13/2018