13-530 Code Vt. R. 13-170-530-X

Current through August, 2024

Section 13 170 530 - VERMONT HEALTH ACCESS PLAN (VHAP) (5300)

Section 5321 Income

(05/01/2010, 10-02)

Countable income is all earned and unearned income, as defined in this section, less all allowed deductions.

Income in the month of application (or review) and future months is estimated based on income in the calendar month prior to the month of application (or review) unless changes have occurred or are expected to occur and this income does not accurately reflect ongoing income. If changes are expected to occur, an estimate of income based on current information should be used.

To determine countable monthly income, average weekly income is multiplied by 4.3 and average bi-weekly income is multiplied by 2.15.

A. Lump Sum Receipts

Lump sum benefits that would have been counted as income if received on time, such as social security benefits and unemployment compensation, shall be added to all other countable income of an applicant for or recipient of VHAP and counted only in the month of receipt.

Windfall lump sums such as insurance payments and money received from the sale of a resource (including the sale of an excluded resource) are not counted.

An insurance payment or similar third party payment that is received for a specific purpose, such as the payment of medical bills or funeral costs, and is used for the stated purpose is excluded. Payments not used for the stated purpose are counted as income in the month received.

B. Unearned Income

Unearned income includes, but is not limited to, the following:

Income from pension and benefit programs, such as social security, railroad retirement, veteran's pension or compensation, unemployment compensation, and employer or individual private pension plans or annuities.

Interest and dividends.

Child support payments (see 4001.82 #23 for the exclusion of the first $ 50) and alimony payments.

Income from capital investments in which the individual is not actively engaged in managerial effort.

Time payments on mortgages or notes resulting from a casual sale (i.e., a sale not related to self-employment) of real (stationary or fixed) property or personal property.

Voluntary contributions from others.

Unearned income does not include the following:

Infrequent or irregular voluntary cash contributions or gifts, such as Christmas, birthday, or graduation presents, received from friends or relatives.

In-kind income.

Five percent of a VA monthly award that is retained by a guardian.

C. Earned Income

Earned income includes all wages, salary, commissions or profit from activities in which the individual is engaged as an employee or a self-employed person, including, but not limited to, active management of capital investments (e.g., rental property).

Earned income is defined as income prior to any deductions for income taxes, FICA, insurance or any other deductions voluntary or involuntary except that, in determining earned income for self-employed individuals, business expenses are deducted first.

Earnings over a period of time, for which settlement is made at one given time, are also included (e.g., sale of farm crops, livestock, poultry). Monthly income is determined by dividing the settlement by the number of months in which it was earned.

Earned income does not include in-kind income.

The following items are deducted from gross earned income in the sequence listed:

- Business expenses (self-employment only)

- Standard employment expense deduction

- Dependent care expenses

D. Business Expenses

Business expenses, which are deducted from gross receipts to determine adjusted gross earned income, are limited to operating costs necessary to produce cash receipts, such as:

1. Office or shop rental; taxes on farm or business property;

2. Hired help;

3. Interest on business loans;

4. Cost of materials, stock, and inventory, livestock for resale required for the production of this income; and

Tax returns and business records are considered appropriate sources of accurate figures for farm and business receipts and expenses.

The income of a VHAP group owning or operating a commercial boarding house shall be treated as any other business income. A commercial boarding house is defined as an establishment licensed as a commercial enterprise that offers meals and lodging for compensation. In areas without licensing requirements, a commercial boarding house shall be defined as a commercial establishment that offers meals and lodging with the intention of making a profit.

No computation is required for foster homes furnishing boarding care to children in custody of, and placed by, the Family Services Division (FSD). Department board rates are established to cover expenses only, with no profit available; therefore, no earned income is considered available from this source.

For a VHAP group that is not a commercial boarding house, the business expense of furnishing room and board, alone or as part of custodial care, shall be allowed, provided that the amount shall not exceed the payment the VHAP group receives from the roomer/boarder for lodging/ meals. (See the Medicaid Procedures Manual at P-2420 D2 for the table of standard business expense deductions for homes providing room or board on a non- commercial basis.)

E. Standard Employment Expense Deduction

The standard employment expense deduction is the first $ 90.00 earned per month after deduction of business expenses, where applicable.

The standard employment expense deduction is applied separately to the gross countable earned income of each individual in the VHAP group who is employed or self-employed.

F. Dependent Care Expenses

Dependent care expenses necessary to enable the individual to retain his or her employment or accept employment will be deducted up to a maximum of $ 175.00 per month for the care of each member of the VHAP group who is an incapacitated adult or a child age two years or older, and up to a maximum of $ 200 per month for the care of each child under two years of age who is a member of the VHAP group.

Dependent care expenses for the care of a child are not deducted unless the child requiring care is a member of the VHAP group or is not a member of the VHAP group solely because he/ she is an SSI/AABD or an ANFC recipient and is:

1. under age 13; or

2. at least age 13 but younger than age 21 and physically or mentally incapable of caring for himself or herself, as verified by the written report of a physician or licensed psychologist; or

3. at least age 13 but younger than age 21 and under court supervision.

Dependent care expenses will be allowed as paid up to the maximum. If a recipient's dependent care expenses are below the maximum, transportation to and from the dependent care facility may be deducted as part of the expense up to the maximum for both dependent care and transportation.

Payments for dependent care provided by a member of the same VHAP group, by the child's parent (biological, adoptive, or stepparent) or legal guardian, or the incapacitated adult's spouse do not qualify as necessary dependent care expenses under this policy.

The provider of care must be at least 16 years of age. A deduction for dependent care expenses for care of a child can be allowed only when neither parent is available and able to provide the necessary care. A deduction for dependent care expenses for care of an incapacitated adult can only be allowed when the incapacitated adult's spouse (where applicable) is either unavailable, or available but unable to provide the necessary care because he/she is incapacitated. Incapacity shall be determined in accordance with the process used to determine whether a parent applying for or receiving ANFC is incapacitated (see WAM 2332.1). This process shall give appropriate consideration to the treating physician's opinion. A spouse is considered unavailable if he/she is employed during the time care is required.

If dependent care is required for reasons other than employment (e.g., protective services child care or care for training purposes), the client shall be referred to SRS.

Section 5322 Excluded Income

1. Any income received by a recipient of SSI/AABD or ANFC living in the VHAP household.

2. All income to an undergraduate student (including parents or children in the VHAP group) from student grants, loans, or work study if:

a. such loans or grants are made under a program administered or insured by the U.S. Secretary of Education; or

b. the sponsor of the grant or loan precludes its use for maintenance purposes; or

c. the work/study program is administered by a college or university recognized by educational authorities and the undergraduate student is enrolled half time or more than half time, as defined in relation to the definition of full time used by the school.

Examples of excludable income sources are: federal Pell Grants, Vermont Student Assistance Corporation grants or loans, federal Supplemental Educational Opportunity Grants (SEOG), and federal College Work-Study Programs (CWSP).

That portion of any Veterans Administration Educational Assistance Program payment that is for the student and is actually used for tuition, books, fees, child care services or other expenses necessary for enrollment is also excluded.

3. Student financial assistance provided under Title IV of the Higher Education Act or Bureau of Indian Affairs Student Assistance programs.

Examples of programs in Title IV of the Higher Education Act include:

a. Federal Pell Grants.

b. Federal Supplemental Educational Opportunity Grants (SEOG).

c. State Student Incentive Grants (SSIG).

d. Federal College Work Study (CWSP).

e. Federal Perkins Loans. These are different from loans under the Carl D. Perkins Vocational and Applied Technology Education Act, which are not totally disregarded (see #4).

f. Educational loans under the federal Family Educational Loan Program or the federal Direct Student Loans Program (Stafford or PLUS loans).

4. Student financial assistance provided under the Carl D. Perkins Vocational and Applied Technology Education Act when the assistance is made available to meet attendance costs. Attendance costs include:

a. tuition and fees normally assessed a student carrying the same academic workload as the applicant/recipient, as determined by the institution, including costs for rental or purchase of any equipment, materials, or supplies required of all students in the same course of study as the applicant/recipient; and

b. an allowance for books, supplies, transportation, dependent care and miscellaneous personal expenses for a student attending the institution on at least a half-time basis, as determined by the institution.

5. Reimbursements for expenses (such as child or dependent care, transportation, purchase or maintenance of clothing, and meals) attributable to participation in unpaid voluntary activities, including the value of meals provided during the course of these activities.

6. Payments made pursuant to a court order for support or alimony, an administrative order for support issued by the Human Services Board, or a contract between the Office of Child Support and noncustodial parent requiring the payment of support. This income exclusion is limited to payments actually made by a member of the VHAP group toward the support of a person outside the group. The payment amount is deducted first from the VHAP group's countable earned income, with any balance deducted from unearned income.

7. The value of food stamp benefits under the Food Stamp Act of 1977.

8. The value of foods donated by the U. S. Department of Agriculture (surplus commodities).

9. Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

10. Earned income of a child under the age of 19 if such child is a full-time student or a part-time student who works less than full time. A child is a student if he or she is enrolled in a school, college, university, or a course of vocational or technical training designed to prepare him or her for gainful employment. Such educational institution shall determine whether the student is enrolled full time or part time. Full-time employment is work that involves 100 or more hours per month; less than full-time employment is work that involves fewer than 100 hours per month.

11. Monthly income of any child (see definition of child at 10, above) from any program carried out under the Job Training Partnership Act (JTPA). This applies to earned or unearned income, except that, in the case of earned income, this disregard may not exceed six months per calendar year.

This income cannot be disregarded for adults.

The $ 10 per day allowance given to individuals in JTPA training is always disregarded as income for both children and adults.

12. Payments for support services and/or reimbursement for out-of-pocket expenses made to individual volunteers serving as foster grandparents, senior health aides, or senior companions and to persons serving in the Service Corps of Retired Executives and Active Corps of Executives or any other program under Titles II and III pursuant to Section 418 of P.L. 93-133.

13. Payments to individual volunteers under Title 1 of P.L. 93-133. Section 404(g); University Year For Action payments under P.L. 93-113, and P.L. 96-143; and Section 9 (VISTA) payments; unless determined by the Director of ACTION to be equivalent to or greater than the federal or state minimum wage.

14. The tax-exempt portions of payments made pursuant to P.L. 92-203 (Alaska Native Claims Settlement Act of 1973).

15. Payments distributed per capita to or held in trust for members of any Indian Tribe under P.L. 92-254 or P.L. 93-134, or P.L. 94-540.

16. Payments received for the care of foster children in the custody of, and placed by, the Department of Social and Rehabilitation Services. The rate of payment is established to cover expenses only, with no profit available; therefore, no income is considered available from this source.

17. Experimental Housing Allowance Program payments made under Annual Contributions Contracts entered into prior to January 1, 1975, under the U.S. Housing Act of 1937, as amended.

18. Reach Up support services, either as reimbursements or advance payments to the individual for child care, transportation, work-related expenses, work-related supportive services, education, or training-related supportive services.

19. Any benefits received under Title VII. Nutrition Program for the Elderly, of the Older American Act of 1965, as amended.

20. The value of supplemental food assistance received under the Child Nutrition Act of 1966, as amended, and the Special Food Service Program for children under the National School Lunch Act, as amended ( P.L. 92-433 and P.L. 93-150).

21. Receipts distributed to members of certain Indian tribes referred to in Section 5 of P.L. 94-114, which became effective October 17, 1975.

22. Any income received from an emergency fuel supplement or energy allowance to assist with the cost of heating.

23. The first $ 50 in child support payments made by a noncustodial parent on behalf of a VHAP group member within each calendar month. When more than one noncustodial parent makes child support payments on behalf of a single VHAP group in the same calendar month, the maximum amount of child support to be disregarded in determining the VHAP group's eligibility is $ 50.

24. Payments to persons of Japanese or Aleut ancestry as restitution for injustices suffered during the Second World War.

25. Federal Earned Income Tax Credit (EITC), whether received with each paycheck or as a refund (lump sum).

26. Payments made from the Agent Orange Settlement Fund or any other fund established because of the Agent Orange product liability litigation.

27. Payments made pursuant to the Radiation Exposure Compensation Act ( P.L. 101-426).

28. Payments made under Indian Trust Funds Acts ( P.L. 97-458 and P.L. 98-64) and initial purchases made with such funds by the original recipient of the funds.

29. Interest held in a trust or in restricted lands pursuant to section 8 of P.L. 93-134 and up to $ 2,000 annual income received from the lease or other uses of the individually owned trust or restricted lands.

30. Distributions made under P.L. 100-241, which amended the Alaska Native Claims Settlement Act:

a. cash, including cash dividends on stock received from a Native Corporation, to the extent that it does not, in the aggregate, exceed $ 2000 per individual per calendar year; or

b. stock, including stock issued or distributed by a Native Corporation as a dividend or distribution of stock; or

c. a partnership interest; or

d. land or an interest in land, including land or an interest in land received from a Native Corporation as a dividend or distribution on stock; or

e. an interest in a settlement trust.

31. Payments made pursuant to the Maine Indian Claims Settlement Act of 1980 to a member of the Passamaquoddy Indian Tribe, the Penobscot Nation, or the Houlton Band of Maliseet Indians.

32. Payments made to a member of the Aroostook Band of Micmacs pursuant to the Aroostook Band of Micmacs Settlement Act.

33. Financial assistance paid through the Disaster Relief Act of 1974 as amended by P.L. 100-707 in 1988 and provided as major disaster and emergency assistance. This disaster coverage is intended to provide relief to people living or working in an area severely struck by natural or man-made disaster. The disaster must have been so severe as to cause the President to designate a Federal Disaster Zone. Additional relief provided under these circumstances by states, local governments and disaster assistance organizations is also excluded.

34. Bona fide loans.

Section 5323 Countable Income

Complete the following steps to determine countable income:

I. Constitute the VHAP group according to the definition included in the Financial Need of a VHAP Group (4001.8) section.

II. Determine the combined countable income for the VHAP group, as constituted in step I above.

III. Compare the result to the applicable income test for the VHAP group size, as constituted at step I above.

All otherwise eligible individuals in a VHAP group who pass the income test are income-eligible for the VHAP program.

Individuals potentially eligible for traditional Medicaid, such as pregnant women and children, have their eligibility determined under those rules but are considered members of the VHAP group for purposes of determining the VHAP group size and countable income.

13-530 Code Vt. R. 13-170-530-X

EFFECTIVE DATE:
October 1, 2008 Secretary of State Rule Log #08-040 [Bulletin #08-20; amended, renumbered and reorganized, see rule 13 170 000 for prior history and section conversion table.]
AMENDED:
December 4, 2008 Secretary of State Rule Log #08-047 [5312]; January 15, 2010 Secretary of State Rule Log #09-043 [5330, 5351]; May 1, 2010 Secretary of State Rule Log #10-012; February 26, 2011 Secretary of State Rule Log #11-007 [5351]; August 1, 2012 Secretary of State Rule Log #12-030; April 1, 2014 Secretary of State Rule Log #13-029 [Repeal sections 5300-5320, and 5324-5360, see rule 13 170 001 l

STATUTORY AUTHORITY:

33 V.S.A. §§ 105, 1901