Subchapter A. GENERAL PROVISIONS
FOR MA INCOME COMMON TO ALL CATEGORIES OF MA
GENERAL PROVISIONS FOR MA INCOME
Sec.
181.1. General policy on MA income common to all categories of MA.
181.2. Definitions.
181.3. Income reporting and verification provisions for all categories of MA.
CONTINUING AND RETROACTIVE ELIGIBILITY PROVISIONS
FOR ALL CATEGORIES OF MA
181.11. Continuing eligibility.
181.12. Retroactive eligibility.
181.13. Eligibility under NMP-MA spend-down.
181.14. Eligibility under MNO-MA spend-down.
TREATMENT OF INCOME COMMON TO
ALL CATEGORIES OF MA
181.21. Treatment of actual and anticipated income and expenses.
181.22. Averaging income.
181.23. Changes in income, expenses and circumstances.
181.24. [Reserved].
TREATMENT OF LUMP SUM COMMON TO ALL
CATEGORIES OF MA
181.31. Treatment of lump sum.
CATEGORIES OF MA
181.41. Categories of NMP-MA.
181.42. Categories of MNO-MA.
181.43. [Reserved].
181.63. [Reserved].
GENERAL PROVISIONS FOR MA INCOME
§ 181.1. General policy on MA income common to all categories of MA.
(a) In determining income eligibility for categorically needy NMP-MA, the total amount of income available to the applicants/recipients in 1 calendar month is used.
(b) In determining income eligibility for MNO-MA, the total amount of income available to the applicants/recipients in a consecutive 6-calendar month period is used. In determining income eligibility for retroactive eligibility coverage for MNO-MA, the total amount of income available to the applicants/recipients in the combined retroactive and prospective period, a consecutive 6-calendar month period, is used. The combined period can be less than 6 months only if the applicant/recipient is deceased.
(c) A person receiving AFDC, GA, SBP or SSI and who is living in the household of a person applying for, or receiving, MA is not included in the determination of MA eligibility. The income of persons living in the household is not considered available to meet the needs of a person applying for, or receiving, MA except for payments made to the applicant/recipient for goods, services, rent, room and board.
(d) As a condition of eligibility for MA, an applicant/recipient shall take necessary steps to obtain and make available potential sources of income available to him, such as, but not limited to, benefits under retirement, unemployment compensation, workers compensation, State or county retirement and disability benefits, veterans benefits, union pensions and employer’s pensions and annuities.
(1) An applicant, except a PD or TD applicant—see § § 181.41 and 181.42 (relating to categories of NMP-MA; and categories of MNO-MA)—or a recipient who, without good cause, fails to cooperate in an effort to establish eligibility for SSI, Retirement, Survivors and Disability Insurance (RSDI), or another potential benefit is ineligible for MA until the applicant complies with the cooperation requirement.
(2) A PD or TD applicant—see § § 181.41 and 181.42—who, without good cause, fails to cooperate in establishing eligibility for a potential benefit is ineligible for MA for a minimum of 60 calendar days. Ineligibility for MA continues after the minimum of 60 calendar days until the applicant complies with the cooperation requirement.
(e) In determining income eligibility for MA for an applicant/recipient group in an AFDC- or GA-related category which includes a woman whose pregnancy is verified, the unborn child is counted as a member of the applicant/recipient group. If multiple births are expected and verified, each unborn child is counted as a member of the applicant/recipient group.
(f) In determining income eligibility for MA, the amounts in Appendices A—J are used as specified in this chapter. Revisions that are required by Federal law or regulations to the appendices will be published as a notice in the Pennsylvania Bulletin, for codification in the Pennsylvania Code.
(1) Appendix A is the Federal benefit rate plus the State supplement payable under Title XVI of the Social Security Act (42 U.S.C.A. § § 1381—1383c).
(2) Appendix B is 300% of the Federal benefit rate payable under Title XVI of the Social Security Act.
(3) Appendix C is the family size allowance, by county and family size, payable under the State’s AFDC Program under Title IV-A of the Social Security Act (42 U.S.C.A. § § 602—615).
(4) Appendix D is the Federal benefit rate payable under Title XVI of the Social Security Act.
(i) Item 1 is one-half of the Federal benefit rate payable under Title XVI of the Social Security Act for one person.
(ii) Item 2 is one-half of the Federal benefit rate payable under Title XVI of the Social Security Act for two persons.
(5) Appendix E is a chart of calculations of one-third of the family size allowance payable under the State’s AFDC Program under Title IV-A of the Social Security Act.
(6) Appendix F is the State’s medically needy income limit determined under 42 CFR 435.812 (relating to medically needy income standards: reasonableness), subject to the limitations in 42 CFR 435.1007 (relating to medically needy).
(7) Appendix G is the monthly figures for the medically needy income limit.
(8) Appendix H is one-third of the monthly income amount for medically needy only income eligibility.
(9) Appendix I is the standard of need of the State’s AFDC Program under Title IV-A of the Social Security Act.
(10) Appendix J is the gross income limit for AFDC- and GA-related NMP-MA cases, based on the gross income test in the State’s AFDC Program under Title IV-A of the Social Security Act.
Authority The provisions of this § 181.1 amended under sections 201(2) and 403(a) of the Public Welfare Code (62 P. S. § § 201(2) and 403(a)).
Source The provisions of this § 181.1 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended August 28, 1992, effective upon publication and apply retroactively to October 1, 1989, 22 Pa.B. 4432; amended July 28, 2000, the provisions under Act 20 effective July 1, 1995, the provisions under Act 35 effective retroactive June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211622) to (211624).
§ 181.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Applicant/recipient—A person who is applying for, or receiving, MA or a group of related persons who are living together and who choose to apply for, or receive, MA as one group.
Calendar quarter—A period of 3 full calendar months beginning with January, April, July or October.
Community spouse—The spouse living at home who has a spouse who had lived at home but is now an institutionalized spouse.
Countable net income—Income counted in determining income eligibility for MA, which is actual and deemed income less appropriate exemptions, deductions and disregards.
Deemed income—Income which is attributed to the applicant/recipient whether or not the income is actually received.
Earned income—Money or other compensation received in return for services rendered.
Full-time employment—Employment which averages at least 30 hours per week in a calendar month.
IRC—Internal Revenue Code (26 U.S.C.A. § § 1—1043).
Infrequent income—Income that is received not more than once in a calendar quarter.
Institutionalized spouse—The spouse who is receiving skilled care, heavy care/intermediate services or intermediate care in a nursing facility or other medical institution, including services in an ICF/MR facility, for a period likely to last for at least 30 consecutive days.
Irregular income—Income that is not subject to scheduling or is unpredictable.
LRR—Legally Responsible Relative—The spouse of a person, or the natural or adoptive parent of a child under 21 years of age.
Legal guardian—A person who is court appointed as the legal guardian.
MCCA—The Medicare Catastrophic Coverage Act of 1988 (Pub. L. 100-360, 102 Stat. 602) (July 1, 1988).
NFC—Nursing Facility Care—Skilled care, heavy care/intermediate services or intermediate care in a nursing facility or other medical institution.
Nonrecurring income—Income that is received in a single payment and not expected to continue.
Parent—The natural or adoptive father or mother of a child under 21 years of age.
Part-time employment—Employment which averages less than 30 hours per week in a calendar month.
Personal property—Privately-owned possessions. The term includes, but is not limited to, cash, bank accounts, stocks, bonds, mortgages, cash value of life insurance policies, household furnishings, personal effects, motor vehicles, boats and Federal, State and local tax refunds. The term does not include real property.
Real property—Land, buildings, mobile homes and improvements thereto.
Restricted income—Income limited by the payer for the use of a specified person.
SSI—Supplemental Security Income—The benefit amount paid to an eligible person or to an eligible person and his eligible spouse under Title XIV of the Social Security Act (42 U.S.C.A. § § 1381—1383c).
Spouse—A person who is married to another by legal ceremony or by common-law.
Unearned income—Money or other compensation received for which a service is not rendered.
Authority The provisions of this § 181.2 amended under sections 201(2) and 403(a) of the Public Welfare Code (62 P. S. § § 201(2) and 403(a)).
Source The provisions of this § 181.2 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended August 28, 1992, effective upon publication and apply October 1, 1989, 22 Pa.B. 4432; amended July 28, 2000, the provisions under Act 20 effective retroactive to July 1, 1995, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211624) to (211625).
Notes of Decisions Countable Net Income
Under 55 Pa. Code § § 181.101, 181.132 and this section, workers’ compensation benefits and disability insurance were properly calculated as unearned income which must be counted for purposes of Medical Assistance eligibility. Goldstein v. Department of Public Welfare, 654 A.2d 295 (Pa. Cmwlth. 1995).
Cross References This section cited in 55 Pa. Code § 181.110 (relating to income deemed available from the spouse).
§ 181.3. Income reporting and verification provisions for all categories of MA.
(a) The applicant/recipient or a person acting on his behalf is required to report and verify earned and unearned income, allowable deductions, such as work and personal expenses, and medical expenses used in determining eligibility for MA.
(b) Verification for income, expenses and deductions consists of documentation specified by the Department which is appropriate for the item being verified and includes, but is not limited to, paystubs, pay envelopes, a statement by the employer or other documentary proof of the business income and work and personal expenses of the applicant/recipient, award letters or copies of benefit checks.
(c) Verification for medical expenses includes, but is not limited to, invoices, bills, receipts and statements which identify the type, amount and the date of the medical service.
(d) An applicant/recipient may not be denied MA for lack of verification if he has cooperated in the verification attempt.
Authority The provisions of this § 181.3 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
Source The provisions of this § 181.3 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.
CONTINUING AND RETROACTIVE ELIGIBILITY
PROVISIONS FOR ALL CATEGORIES OF MA
§ 181.11. Continuing eligibility.
(a) Eligibility for continuing MA benefits begins with the date eligibility is established or the date of application, if the applicant/recipient is otherwise eligible.
(1) If the applicant is ineligible in the month of application, eligibility begins with the first day of the following month if the applicant is eligible beginning from the first day of that month.
(2) Authorization of MA benefits in the GA-related NMP category begins when all eligibility factors are verified, verification is received from a third party or the client has cooperated in the verification attempt and the applicant/recipient is otherwise eligible.
(b) For NMP-MA categories, income eligibility for continuing MA benefits exists when the applicant’s/recipient’s countable monthly net income is equal to, or less than, the income limits for the applicable category. Those income limits are:
(1) For persons in the aged, blind and disabled categories not receiving skilled nursing care or intermediate care, the NMP-MA income limits in Appendix A.
(2) For persons in the aged, blind and disabled categories receiving skilled nursing care or intermediate care, the NMP-MA income limits in Appendix B.
(3) For persons in the AFDC categories and the GA category, the NMP-MA income limits in Appendix C.
(c) For MNO-MA categories, income eligibility for continuing MA benefits exists when the applicant’s/recipient’s countable net income for a 6 calendar month period is equal to, or less than, the appropriate MNO-MA income limits in Appendix F.
(d) For persons who do not meet the requirements of subsection (b) or (c), eligibility for continuing MA benefits exists if the applicant/recipient meets the eligibility requirements under § 181.13 or § 181.14 (relating to eligibility under NMP-MA spend-down; and eligibility under MNO-MA spend-down).
Authority The provisions of this § 181.11 issued under sections 201(2) and 403(a) of the Public Welfare Code (62 P. S. § § 201(2) and 403(a)).
Source The provisions of this § 181.11 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 28, 2000, the provisions under Act 35 effective retroactive to June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211626) and (267115).
Cross References This section cited in 55 Pa. Code § 181.312 (relating to deductions from earned income for the AFDC categories of MNO-MA); and 55 Pa. Code § 181.314 (relating to deductions from earned income for the GA categories of MNO-MA).
§ 181.12. Retroactive eligibility.
(a) The earliest possible date for retroactive MA benefits to begin is the first day of the third month preceding the month of application.
(1) The period of eligibility for retroactive MA benefits under NMP-MA begins with the first day of the month in the retroactive period in which the first medical service was incurred, if the applicant was otherwise eligible during that month.
(2) The period of eligibility for retroactive MA benefits under MNO-MA begins with the first day of the month in the retroactive period in which the first medical service was incurred, if the applicant was otherwise eligible during that month.
(b) For NMP-MA categories with the exception of the persons covered in § 181.71 (relating to special NMP-MA income limit for institutionalized aged, blind and disabled persons), income eligibility for retroactive MA benefits exists when the applicant’s/recipient’s countable monthly net income for the retroactive period is equal to, or less than:
(1) The appropriate NMP-MA income limits in Appendix A for persons in the aged, blind and disabled categories not receiving skilled nursing care or intermediate care.
(2) The appropriate NMP-MA income limits in Appendix C for persons in the AFDC categories and the GA category.
(c) For MNO-MA categories, income eligibility for retroactive MA benefits exists if one of the following applies:
(1) The applicant’s/recipient’s countable net income in the combined retroactive/prospective period, less medical expenses is equal to, or less than, the appropriate MNO-MA 6-month period income limits in Appendix F.
(2) The applicant’s/recipient’s countable net income in the combined retroactive/prospective period, less medical expenses is equal to, or less than, the appropriate MNO-MA 6-month period income limits in Appendix F. Unpaid medical expenses that are not subject to payment by a third-party, which remain the legal obligation of the applicant/recipient, and are not to be paid for under the MA Program once MA is authorized and paid medical expenses, are deducted from the countable net income in the combined retroactive/prospective period as provided under § 181.14(e)(1)—(6) (relating to eligibility under MNO-MA spend-down). This includes medical expenses incurred before the retroactive period.
Authority The provisions of this § 181.12 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)); amended under sections 201, 403 and 443.1 of the Public Welfare Code (62 P. S. § § 201, 403 and 443.1).
Source The provisions of this § 181.12 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 15, 1991, effective March 1, 1991, 21 Pa.B. 624; amended August 16, 1991, effective August 17, 1991, 21 Pa.B. 3704; amended July 28, 2000, the provisions under Act 35 effective retroactive to June 17, 1996, the expansion of allowable medical expense income deductions effective retroactive to February 1, 1999, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (267115) to (267116).
Notes of Decisions Because they relate to different things, the 60-day time period for submitting an exception under this section does not conflict with the three-month time period established at 55 Pa. Code § 181.12(a) which pertains to determinations of retroactive eligibility. Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. 1999).
§ 181.13. Eligibility under NMP-MA spend-down.
(a) Eligibility under NMP-MA spend-down is available to an applicant/recipient except for an applicant/recipient receiving skilled nursing care or intermediate care.
(b) The applicant/recipient shall meet the NMP-MA eligibility criteria, including the income criteria, to qualify for NMP-MA spend-down.
(c) The period of NMP-MA spend-down eligibility begins the day of the calendar month in which eligibility for NMP-MA spend-down is established and continues through the last day of that calendar month.
(d) Income eligibility for NMP-MA spend-down exists when the applicant’s/recipient’s:
(1) Countable net income less $10 is equal to, or less than, the appropriate NMP-MA income limits in Appendix A for the aged, blind and disabled categories not receiving skilled nursing care or intermediate care.
(2) Countable net income less $10 and medical expenses in subsection (e) is equal to, or less than, the appropriate NMP-MA income limits in Appendix A for the aged, blind and disabled categories not receiving skilled nursing care or intermediate care.
(3) Countable net income less $10 is equal to, or less than, the appropriate NMP-MA income limits in Appendix C for the AFDC categories and the GA categories not receiving skilled nursing care or intermediate care.
(4) Countable net income less $10 and medical expenses in subsection (f) is equal to, or less than, the appropriate NMP-MA income limits in Appendix C for the AFDC categories and the GA categories not receiving skilled nursing care or intermediate care.
(e) Deductible medical expenses include:
(1) Unpaid medical expenses, including those reasonably expected to be incurred, which meet the requirements in this paragraph. The unpaid medical expenses:
(i) Are not subject to payment by a third-party.
(ii) Are not to be paid for under the NMP-MA Program once NMP-MA is authorized.
(iii) Are the legal obligation of the applicant/recipient.
(iv) Have not previously been used as a deduction in the determination of eligibility for a prior authorization of MA.
(2) Paid medical expenses which meet the requirements in this paragraph. The paid medical expenses:
(i) Are paid in the calendar month for which spend-down is requested.
(ii) Have not previously been used as a deduction in the determination of eligibility for a prior authorization of MA.
(f) Medical expenses meeting the requirements in subsection (e) are deducted in the calendar month for which spend-down is requested in the following order:
(1) Medicare and other health insurance premiums including enrollment fees, deductibles or coinsurance charges incurred by the applicant/recipient regardless of whether they are paid or unpaid.
(2) Copayments or deductibles required by the Department. An applicant/recipient participating in the Copayment Program required by the Department is permitted a medical expense deduction for copayment expenses, subject to the copayment limit established by the Department.
(3) Expenses incurred—paid and unpaid—by the applicant/recipient for necessary medical and remedial services recognized under State statutes or regulations but not included in the NMP-MA Program.
(4) Expenses incurred—paid and unpaid—by the applicant/recipient for necessary medical and remedial services that are included in the NMP-MA Program.
(g) A monthly review of eligibility for NMP-MA spend-down is required except when the countable net income less $10 is equal to, or less than, the appropriate income limit. A monthly review does not require a reapplication unless:
(1) The monthly review falls in the month that a complete reapplication of eligibility for NMP-MA is due.
(2) Three consecutive months have elapsed since the applicant/recipient requested a determination of eligibility for NMP-MA spend-down.
Authority The provisions of this § 181.13 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
Source The provisions of this § 181.13 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.
Cross References This section cited in 55 Pa. Code § 181.11 (relating to continuing eligibility).
§ 181.14. Eligibility under MNO-MA spend-down.
(a) Eligibility under MNO-MA spend-down is available to applicants/recipients.
(b) The applicant/recipient shall meet the MNO-MA eligibility criteria, including the income criteria, to qualify for MNO-MA spend-down.
(c) Income eligibility for MNO-MA spend-down exists when the applicant’s/recipient’s countable net income less medical expenses is equal to, or less than, the appropriate MNO-MA income limits in Appendix F (relating to six-month period medically needy income limits (MNIL)) for a 6-month period. Medical expenses deducted include those identified in subsection (d) and deducted in the order provided in subsection (e).
(d) Deductible medical expenses include:
(1) Unpaid medical expenses, including those reasonably expected to be incurred, which meet the requirements in this paragraph. The unpaid medical expenses:
(i) Are not subject to payment by a third-party.
(ii) Are not to be paid for under the MNO-MA Program once MNO-MA is authorized.
(iii) Are the legal obligation of the applicant/recipient.
(iv) Have not previously been used as a deduction in the determination of eligibility for a prior authorization of MA.
(2) Paid medical expenses which meet the conditions listed in this paragraph. The expenses:
(i) Have been paid in the month of application, or any month in the retroactive period or a combination of both, for which the individual is applying.
(ii) Have not been previously used as a deduction in the determination of eligibility for a prior authorization of MA.
(ii) Are the legal obligation of the applicant/recipient and are not subject to payment by a third party.
(3) Medical and remedial expenses paid by a public program if the following apply:
(i) The public program is not financed in whole or in part by Federal funds.
(ii) The expenses are wholly financed by the State or a subdivision of the State, for example, county or municipality.
(iii) The expenses have been paid in the month of application, or any month in the retroactive period, or a combination of both, for which the individual is applying.
(iv) The expenses have not been previously used as a deduction in the determination of eligibility for a prior authorization of MA.
(e) Medical expenses meeting the requirements in subsection (d) are deducted from the countable net income in the following order:
(1) Medicare and other health insurance premiums, including enrollment fees, deductibles or coinsurance charges incurred by the applicant/recipient regardless of whether they are paid or unpaid.
(2) Copayments or deductibles under the following programs:
(i) An applicant/recipient participating in the Copayment Program required by the Department is permitted a medical expense deduction for copayment expenses, subject to the copayment limit established by the Department.
(ii) The allowable medical expense for an applicant/recipient determined eligible for the Pharmaceutical Assistance Contract for the Elderly (PACE) Program is limited to the current PACE payment for each prescription.
(3) For persons not eligible for, or not receiving, the PACE benefits, the allowable medical expense is the full prescription payment if:
(i) The applicant/recipient had been denied PACE benefits and the reasons for denial have not changed.
(ii) The applicant/recipient has not been determined eligible for PACE.
(iii) The applicant/recipient had good cause for not applying for, or participating in, the PACE program. Factors that constitute good cause include the following:
(A) The client’s health or age precludes participation or makes it impractical.
(B) The client had been unaware of the responsibility to apply for PACE participation.
(C) The client had previously been denied PACE benefits and the circumstances that caused denial have not changed.
(4) Paid and unpaid expenses incurred by the applicant/recipient for necessary medical and remedial services recognized under State statutes or regulations but not included in the MNO-MA Program.
(5) Paid and unpaid expenses incurred by the applicant/recipient for necessary medical and remedial services that are included in the MNO-MA Program.
(6) Medical and remedial expenses paid by a public program meeting the requirements in subsection (d)(3).
(7) For an applicant/recipient receiving skilled nursing care or intermediate care, the projected cost of his care, for a period not to exceed 6 months, at the private rate for the appropriate level of care anticipated to be received by the applicant/recipient in the skilled nursing or intermediate care facility.
Authority The provisions of this § 181.14 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)); amended under sections 201, 403 and 443.1 of the Public Welfare Code (62 P. S. § § 201, 403 and 443.1).
Source The provisions of this § 181.14 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended February 15, 1991, effective March 1, 1991, 21 Pa.B. 624; amended August 16, 1991, effective August 17, 1991, 21 Pa.B. 3704; amended January 17, 1992, effective January 18, 1992, 22 Pa.B. 275; amended July 28, 2000, the expansion of allowable medical expense income deductions effective retroactive to February 1, 1999, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211630) to (211632).
Cross References This section cited in 55 Pa. Code § 181.11 (relating to continuing eligibility); 55 Pa. Code § 181.12 (relating to retroactive eligibility); 55 Pa. Code § 181.312 (relating to deductions from earned income for the AFDC categories of MNO-MA); and 55 Pa. Code § 181.314 (relating to deductions from earned income for the GA categories of MNO-MA).
TREATMENT OF INCOME COMMON
TO ALL CATEGORIES OF MA
§ 181.21. Treatment of actual and anticipated income and expenses.
(a) In determining retroactive eligibility for MA, the actual income and expenses verified for the retroactive period are used.
(b) In determining continuing eligibility for MA, except NMP-MA spend-down, either the anticipated or actual income, or both, and work, personal and dependent care expenses to be received beginning with the first day of the calendar month containing the effective date of the application or reapplication are used, or the actual income and work, personal and dependent care expenses received 30 days before the calendar month of application or reapplication for MA may be projected to determine anticipated income and work, personal and dependent care expenses.
(c) A combination of actual and anticipated income and expenses are considered to determine NMP-MA spend-down eligibility for MA. Actual income and expenses are used from the beginning of the calendar month to the day of the calendar month in which eligibility for NMP-MA spend-down is established. Anticipated income and work, personal and dependent care expenses are used for the remainder of the calendar month.
Authority The provisions of this § 181.21 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
Source The provisions of this § 181.21 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.
Notes of Decisions Department properly applied its ‘‘name-on-the instrument’’ rule attributing entire pension to petitioner for purposes of computing his patient pay amount; wife has no present ownership interest in pension although it is marital property subject to equitable distribution upon divorce. Buck v. Department of Public Welfare, 566 A.2d 1269 (Pa. Cmwlth. 1989).
§ 181.22. Averaging income.
Income is averaged for a person who is employed under an annual contract of employment and who works and receives income from the contract in fewer than 12 months but more than 8 months. The income payable under the contract is prorated over the period of the contract.
Authority The provisions of this § 181.22 amended under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
Source The provisions of this § 181.22 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended February 17, 1978, effective February 18, 1978, 8 Pa.B. 404; amended October 27, 1978, effective November 27, 1978, 8 Pa.B. 2909; corrected November 10, 1978, effective November 27, 1978, 8 Pa.B. 3086; explained November 6, 1981, 11 Pa.B. 3954; amended November 6, 1981, effective November 7, 1981, 11 Pa.B. 3969; amended July 9, 1982, effective July 10, 1982, 12 Pa.B. 2177; amended August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108930) to (108931).
§ 181.23. Changes in income, expenses and circumstances.
When an applicant’s/recipient’s income, expenses or circumstances, or both, change, the change is considered to determine continuing eligibility for MA.
Authority The provisions of this § 181.23 amended under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)).
Source The provisions of this § 181.23 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; explained November 6, 1981, 11 Pa.B. 3954; amended November 6, 1981, effective November 7, 1981, 11 Pa.B. 3969; amended July 9, 1982, effective July 10, 1982, 12 Pa.B. 2177; amended August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108931) to (108935).
Cross References This section cited in 55 Pa. Code § 161.73 (relating to requirements); and 55 Pa. Code § 161.83 (relating to requirements).
§ 181.24. [Reserved].
Source The provisions of this § 181.24 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended July 9, 1982, effective July 10, 1982, 12 Pa.B. 2175; reserved August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108935) to (108938).
TREATMENT OF LUMP SUM COMMON
TO ALL CATEGORIES OF MA
§ 181.31. Treatment of lump sum payment.
(a) A lump sum payment is a nonrecurring payment. Types of lump sum payments include delayed wages, bonuses, Earned Income Tax Credit (EITC), cash prizes, cash lottery winnings, life insurance benefits, cash inheritances, personal injury and other damage awards and settlements and retroactive benefits, such as retirement, survivors and disability insurance, delayed unemployment compensation and workers compensation.
(b) A lump sum payment is counted as a resource under § 178.4 (relating to treatment of resources for all categories of MA) unless it would be more helpful to the applicant/recipient group to have the lump sum treated as income.
(c) If the lump sum is treated as income, it is counted as income in the calendar month received.
(1) Earned lump sum payments, such as delayed wages and bonuses, are treated as earned income and are added to other earned income received in the calendar month.
(i) A person in an SSI-related category of MA is entitled to the deductions listed under § 181.132 (relating to deductions from earned income) from the earned lump sum income.
(ii) A person in an TANF-related category of MA, including a person in a GA-related category of MA with a child who is simultaneously a recipient of MA in an TANF-related category, is entitled to the deductions listed under § 181.311 or § 181.312 (relating to deductions from earned income for the TANF categories of NMP-MA; and deductions from earned income for the GA categories of MNO-MA) from the earned lump sum income.
(iii) A person in a GA-related category of MA is entitled to the deductions listed under § 181.313 or § 181.314 (relating to deductions from earned income for the GA categories of NMP-MA; and deductions from earned income for the GA categories of MNO-MA) from the earned lump sum income.
(2) Unearned lump sum payments, such as cash prizes, cash lottery winnings, life insurance benefits, cash inheritances and personal injury, are treated as unearned income and are added to other unearned income received in the calendar month.
(i) A person in an SSI-related category of MA is entitled to the deductions listed under § 181.131 (relating to deductions from unearned income) from the unearned lump sum income.
(ii) A person in an TANF-related category of MA and a person in a GA-related category of MA are entitled to the following deductions from the unearned lump sum income:
(A) Those listed under § 181.315 (relating to unearned income expense deductions).
(B) Expenses the applicant/recipient incurs which are directly related to the particular type of lump sum payment, such as the charge for burial from an insurance benefit or verified medical expenses from a personal injury award.
(d) The balance of the lump sum remaining subsequent to the calendar month the lump sum was received and counted as income as described in subsection (c) is considered a resource to the applicant/recipient.
Authority The provisions of this § 181.31 issued under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)).
Source The provisions of this § 181.31 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended December 28, 1990, effective December 29, 1990, and apply retroactively to October 1, 1989, 20 Pa.B. 6387; amended September 10, 1999, effective September 11, 1999, 29 Pa.B. 4784. Immediately preceding text appears at serial pages (211634) to (211635).
Cross References This section cited in 55 Pa. Code § 178.4 (relating to treatment of resources for all categories of MA).
CATEGORIES OF MA
§ 181.41. Categories of NMP-MA.
An NMP-MA applicant or recipient shall meet the income requirements of the category of NMP-MA for which the applicant or recipient is eligible. The following explains the different NMP-MA categories:
(1) The PA category designates an NMP person who is at least 65 years of age. This category is an SSI-related category.
(2) The PJ category designates an NMP person who meets the eligibility conditions as a disabled person. This category is an SSI-related category.
(3) The PM category designates an NMP person who meets the eligibility conditions as a blind person. This category is an SSI-related category.
(4) The PC category is a TANF-related category and designates an NMP individual who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
(ii) An individual 21 years of age or older and under 65 years of age who meets the requirements of a specified relative under § 151.42 (relating to definitions) and is responsible for the care and control of a dependent child. For purposes of determining if the individual 21 years of age or older and under 65 years of age is a specified relative, a dependent child, including the child who is receiving SSI, is a child under 18 years of age or under 19 years of age if the child is a full-time student in secondary school or the equivalent level of a vocational or technical school and who meets the deprivation of support conditions under § 153.43(a)—(c) (relating to TANF deprivation of support or care requirements).
(iii) A pregnant woman 21 years of age or older who is a member of a two parent household which does not meet the unemployed principal wage earner definition in § 153.44(d) (relating to procedures).
(5) The PU category is a TANF-related category and designates an NMP individual who is one of the following:
(i) The parents in a two parent household that includes a dependent child as defined in paragraph (4) and an unemployed principal wage earner as defined in § 153.44(d).
(ii) A pregnant woman with no other children and the father of her unborn child, who constitute a two parent household with an unemployed principal wage earner, as defined in § 153.44(d).
(6) The PD category is a GA-related category and designates an NMP person who is 21 years of age or older and under 65 years of age, who meets the GA eligibility requirements and who chooses to receive only NMP-MA.
Authority The provisions of this § 181.41 amended under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)); Titles I and III of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L. No. 104-193) (PRWORA), creating the Temporary Assistance for Needy Families (TANF) Program, and amending 42 U.S.C.A. § § 601—619, 651—669(b) and 1396u-1; section 1902(a)(10)(A) of the Social Security Act (42 U.S.C.A. § 1396a(a)(10)(A); and the Federal TANF regulations in 45 CFR 260.10—265.10.
Source The provisions of this § 181.41 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 28, 2000, the provisions under Act 49 effective retroactive to September 1, 1994, the provisions under Act 20 effective retroactive July 1, 1995, 30 Pa.B. 3779; amended September 13, 2002, effective retroactively to March 3, 1997, 32 Pa.B. 4435. Immediately preceding text appears at serial pages (268372) to (268373).
Cross References This section cited in 55 Pa. Code § 181.1 (relating to general policy on MA income common to all categories of MA).
§ 181.42. Categories of MNO-MA.
An MNO-MA applicant or recipient shall meet the income requirements of the category of MNO-MA for which the applicant or recipient is eligible. The following explains the different MNO-MA categories:
(1) The TA category designates an MNO person who is 65 years of age or older. This category is an SSI-related category.
(2) The TJ category designates an MNO person who meets the eligibility conditions as a disabled person. This category is an SSI-related category.
(3) The TM category designates an MNO person who meets the eligibility conditions as a blind person. This category is an SSI-related category.
(4) The TB category designates an MNO person who receives a SBP.
(5) The TC category is a TANF-related category and designates an MNO individual who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
(ii) An individual 21 years of age or older and under 65 years of age who meets the requirements of a specified relative under § 151.42 (relating to definitions) and is responsible for the care and control of a dependent child. For purposes of determining if the individual 21 years of age or older and under 65 years of age is a specified relative, a dependent child, including the child who is receiving SSI, is a child under 18 years of age or under 19 years of age if the child is a full-time student in secondary school or the equivalent age level of a vocational or technical school and who meets the deprivation of support conditions under § 153.43(a)—(c) (relating to TANF deprivation of support or care requirements).
(iii) A pregnant woman 21 years of age or older who is a member of a two parent household which does not meet the unemployed principal wage earner definition in § 153.44(d) (relating to procedures).
(6) The TU category is a TANF-related category and designates an MNO individual who is one of the following:
(i) The parents in a two parent household that includes a dependent child as defined in paragraph (5)(ii) and an unemployed principal wage earner as defined in § 153.44(d).
(ii) A pregnant woman who is 21 years of age or older, with no other children, in a two parent household with an unemployed principal wage earner as defined in § 153.44(d).
(7) The TD category is a GA-related category and designates an MNO person who does not meet the requirements for another category of MA.
Authority The provisions of this § 181.42 amended under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. § § 201(2) and 403(b)); and section 1902(a)(10)(C) of the Social Security Act (42 U.S.C.A. § 1396a(a)(10)(C)).
Source The provisions of this § 181.42 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 28, 2000, the provisions under Act 49 effective retroactive to September 1, 1994, the provisions under Act 20 effective retroactive to July 1, 1995, 30 Pa.B. 3779; amended September 13, 2002, effective retroactively to March 3, 1997, 32 Pa.B. 4435. Immediately preceding text appears at serial pages (268373) to (268375).
Cross References This section cited in 55 Pa. Code § 181.1 (relating to general policy on MA income common to all categories of MA).
§ 181.43. [Reserved].
Source The provisions of this § 181.43 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended October 27, 1978, effective November 27, 1978, 8 Pa.B. 2909; corrected November 10, 1978, effective November 27, 1978, 8 Pa.B. 3086; amended January 4, 1980, effective March 5, 1980, 10 Pa.B. 43; explained November 6, 1981, 11 Pa.B. 3954; amended November 6, 1981, effective November 7, 1981, 11 Pa.B. 3969; amended November 6, 1981, effective November 7, 1981, 11 Pa.B. 3972; amended July 9, 1982, effective July 10, 1982, 12 Pa.B. 2177; reserved August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108938) to (108939).
§ 181.63. [Reserved].
Source The provisions of this § 181.63 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended January 4, 1980, effective March 5, 1980, 10 Pa.B. 43; corrected January 11, 1980, effective March 5, 1980, 10 Pa.B. 130; amended July 9, 1982, effective July 10, 1982, 12 Pa.B. 2177; reserved August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108939) to (108940).
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