South carolina department of health and human services medicaid policy and procedures manual



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SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

MEDICAID POLICY AND PROCEDURES MANUAL
CHAPTER 301 – Supplemental Security Income (SSI) Related Income Policy -- Liberalized
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301.01 Introduction


(Eff. 10/01/05)

Eligibility for Medicaid programs is based on the rules used by the Social Security Administration (SSA) to decide eligibility for Supplemental Security Income (SSI). These rules are explained in the Program Operations Manual System (POMS). Links to sections in POMS are included in this manual for detailed explanations of policy and procedures. However, for individuals who are considered institutionalized (Nursing Home, Home and Community Based Services, General Hospital), the manner in which income is treated may differ. These differences are discussed in MPPM Chapter 304, Nursing Home, Waivered Services, and General Hospital.


The following sections explain how to treat income for SSI-related Medicaid programs.
An individual is eligible for Medicaid benefits if he or she:



Income is counted on a monthly basis. An individual who has too much income in a particular month is not eligible in that month. Not all income counts in determining eligibility.

301.02 Income Limits


(Rev. 10/01/07)

Federal law establishes a limit on the amount of monthly countable income an individual may have and still be eligible for Medicaid. The limits vary according to the category of assistance. Refer to MPPM Chapter 103, Program Financial Limits.


Note: Income limits for poverty level groups change annually, usually in March. All other limits are changed effective January of each year.



301.03 Liberalized SSI Income Policy vs. Strict


(Eff. 10/01/05)

The Social Security Act allows states the option of using more liberal income criteria than SSI in certain instances. South Carolina has received approval to exclude the value of In-kind Support and Maintenance (ISM) in determining eligibility for all categories except Optional State Supplementation, Pass-Along, and Retroactive SSI determinations.

Table of Contents

301.04 What Is Income?


(Eff. 10/01/05)

POMS SI 00810.005



Income is anything an individual receives in cash that can be used to meet his needs for food or shelter. Income includes receipt of anything that can be applied, either directly or by sale or conversion, to meet the basic needs of food or shelter.
In-kind income is not cash, but is actually food or shelter, or something that can be used to get one of these basic needs. This type of income is not counted under liberalized eligibility rules.

301.04.01 Relationship of Income to Resources


(Eff. 10/01/05)

POMS SI 00810.010

Income received during a month is evaluated under income rules. If an individual keeps part or all of the income into future months, it is counted as a resource. All other items are evaluated under resource rules. (Refer to MPPM Chapter 302)



Example: Mr. Jones receives his Social Security check in March. It is directly deposited into his checking account. Count the Social Security check as income in March, and subtract the deposit from the checking account to determine how much he has in resources. If he carries all or part of the check into April, you would not subtract the deposit from the checking account, but count the remaining amount as a resource.


Table of Contents

301.04.02 Types of Income


(Eff. 10/01/05)

POMS SI 00810.015

Income is either earned or unearned. Different rules apply to each.


Earned Income (POMS SI 00810.015)

Earned income consists of the following types of payments:



  • Wages

  • Net earnings from self-employment

  • Payments for services performed in a sheltered workshop or work activities center;

  • Royalties earned by an individual in connection with any publication of his work and any honoraria received for services rendered.




Unearned Income (POMS SI 00810.015)


Unearned income is all income that is not earned income. Some types of unearned income are:

  • Annuities, pensions, and other periodic payments

  • Alimony and support payments

  • Dividends, interest, and royalties

  • Rents

  • Benefits received as the result of another's death to the extent that the total amount exceeds the expenses of the deceased person's last illness and burial paid by the beneficiary

  • Prizes and awards

  • In-kind Support and Maintenance - ISM (Not counted in Liberalized policy categories.)









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