612.01 How to Calculate Income Eligibility for SSI Non-cash

 

A. Introduction

 

The net income test is used to determine income eligibility under SSI Non-cash and only counted income of the customer and responsible relatives is used to determine net income. Income is counted in the month it is received, even if earned in the previous month.

 

The counted income available to a customer minus deductions cannot exceed the appropriate income standard.

 


 

B. Income Standard

 

The income standard for SSI Non-cash is either 100% of the Federal Benefit Rate (FBR) or 100% of the Federal Poverty Level (FPL), whichever is to the customer’s advantage.

 


 

C. Net Test Using FBR and FPL Standard for SSI-Non Cash

 

Always complete the net test using the 100% FBR standard first. If not eligible using the 100% FBR standard, then complete the net test using the 100% FPL standard. The only differences for the net test using the 100% FBR standard for SSI Non-cash and using the 100% FPL standard for SSI Non-cash are:

 


 

D. Deductions from Net Income

 

The table below shows the allowable income deductions used in net income budgeting.

 

Allowable Deduction Amount
Child Support

Varies

Student Child Earned Income Deduction

Varies

General Income Deduction

$20.00

Standard Work Expense Deduction

$65.00

Impairment Related Work Expense Deduction (IRWE)

Varies

½ Subtotal of Earned Income (SSI Non-cash FBR only)

Varies

Blind Work Expenses

Varies

Child Allocations

Varies

 


 

E. Calculation for the Customer Only

 

Take the following actions to determine income eligibility for

 

First, complete net test using FBR standards. If not eligible using FBR standards, complete net test using FPL standards.

 

Net Income Test Using 100% FBR Standard

Step

Action

1

To calculate the net unearned income:

  • Total the counted unearned income (excluding any needs based assistance income) of the customer;

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

2

To calculate the net earned income:

  • Total the counted earned income of the customer;

  • Subtract the Student Earned Income Exclusion (only if under age 22);

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract ½ subtotal of earned income

  • Subtract Blind Work Expenses

 

Note: If any of the subtractions in this step result in a $0.00 subtotal or negative subtotal, the net earned income amount is $0.00.

3

To calculate total net income:

  • Add subtotal obtained from Step 1 to subtotal obtained in Step 2

  • Subtract Child Allocations

4

Compare the result to 100% of the FBR for an individual (MS 621.00.C):

 

IF result is... THEN...
Equal or less than 100% of the FBR for an individual The customer is income eligible under the SSI Non-cash program using 100% FBR standard. Stop
Greater than 100% of the FBR for an individual

Complete net test using 100% FPL standard.

 

Continue to Step 5 (Net Test Using 100% FPL Standard)

 

5

To calculate the net unearned income:

  • Total the counted unearned income (excluding any needs based assistance income) of the customer;

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

6

To calculate the net earned income:

  • Total the counted earned income of the customer;

  • Subtract student earned Income Exclusion (only if under age 22);

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract Blind Work Expenses

 

Note: If any of the subtractions in this step result in a $0.00 subtotal or negative subtotal the net earned income amount is $0.00.

7

To calculate total net income:

  • Add subtotal obtained from Step 5 to subtotal obtained in Step 6

  • Subtract Child Allocations

8

Compare the result to 100% of the FPL for an individual (MS 621.00.C):

 

IF result is... THEN the customer is...
Equal or less than 100% of the FPL for an individual Income eligible under the SSI Non-cash program using 100% FPL standard
Greater than 100% of the FPL for an individual

Income ineligible under the SSI Non-cash program using 100% FPL standard.

 

Note: The customer may be eligible for a Medicare Cost Sharing Program. The net test for QMB, SLMB and QI-1 allows the deduction of ½ of earned income.

 

 

Example 1 (Customer Only-Eligible Using FBR Standard)

Ms. Fry, a 65-year-old single individual, resides with her 10-year-old adopted daughter, Fran and 12-year-old adopted son, Frank. Ms. Fry applies for AHCCCS Health Insurance for herself in 4/13.

 

Ms. Fry receives monthly income of $900.00 Social Security retirement. She also sells Tupperware to make extra money and received $70.00 in 4/13 from this part time job. Fran and Frank receive no monthly income.

 

Step

Action

1

Calculate net unearned income:

$ 900.00 (customer’s total countable unearned income  that is not needs based)

-$ 0.00 (1/3 child support deduction is not applicable)

=$ 900.00 (subtotal)

-$ 20.00 (general income deduction)

=$ 880.00 (subtotal)

+$ 0.00 (has no income based on need)

=$880.00 (net unearned income)

2

Calculate net earned income:

$ 70.00 (customer’s total countable earned income.

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 5.00 (subtotal of earned income)

-$ 2.50 (½ subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=$ 2.50 (net earned income)

3

Calculate total net income:

$880.00 (net unearned income from Step 1 above)

+$ 2.50 (net earned income from Step 2 above)

=$882.50 (subtotal or net income)

-$712.00 ($356.00 allocation for Fran and $356.00 allocation for Frank)

=$170.50 (total net income)

4

Compare the result in Step 3 above to $710.00 (100% of the FBR for an individual):

 

Because $170.50 is less than $710.00, Ms. Fry is income eligible for AHCCCS Health Insurance under SSI Non-Cash using 100% FBR standard.

 

Example 2 (Customer Only-Eligible Using FPL Standard)

 

Mr. Gray is a 70-year-old single individual. Mr. Gray applies for AHCCCS Health Insurance in 4/13.

 

Mr. Gray receives monthly income of $800.00 Social Security retirement. He also works part time in the Ocotillo School cafeteria and received $80.00 in 4/13 from this part time job.

 

Calculate the customer’s eligibility using the net income test as follows:

 

Step

Action

1

Calculate net unearned income:

$ 800.00 (customer’s total countable unearned income  that is not needs based)

-$ 0.00 (1/3 child support deduction is not applicable)

=$ 800.00 (subtotal)

-$ 20.00 (general income deduction)

=$ 780.00 (subtotal)

+$ 0.00 (has no income based on need)

=$780.00 (net unearned income)

2

Calculate net earned income:

$ 80.00 (customer’s total countable earned income)

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 15.00 (subtotal of earned income)

-$ 7.50 (½ subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=$ 7.50 (net earned income)

3

Calculate total net income:

$780.00 (net unearned income from Step 1 above)

+$ 7.50 (net earned income from Step 2 above)

=$787.50 (subtotal or net income)

-$ 0.00 (child allocation not applicable because Mr. Gray has no children)

=$787.50 (total net income)

4

Compare the result in Step 3 above to $710.00 (100% of the FBR for an individual):

 

Because $787.50 is greater than $710.00, Mr. Gray is income ineligible for AHCCCS Health Insurance under SSI Non-Cash using FBR standard. Continue to Step 5 to determine SSI Non-Cash eligibility using 100% FPL standard.

5

Calculate net unearned income:

$ 800.00 (customer’s total countable unearned income that is not needs based)

-$ 0.00 (1/3 child support deduction is not applicable)

=$ 800.00 (subtotal)

-$ 20.00 (general income deduction)

=$ 780.00 (subtotal)

+$ 0.00 (has no income based on need)

=$780.00 (net unearned income)

6

Calculate net earned income:

$ 80.00 (customer’s total countable earned income)

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 15.00 (subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=$ 15.00 (net earned income)

7

Calculate total net income:

$780.00 (net unearned income from Step 5 above)

+$ 15.00 (net earned income from Step 6 above)

=$795.00 (subtotal of net income)

-$ 0.00 (child allocation not applicable because Mr. Gray has no children)

=$795.00.(total net income)

8

Compare the result in Step 7 above to $958.00 (2013 100% of the FPL for an individual):

 

Because $795.00 is less than $958.00, Mr. Gray is income eligible for AHCCCS Health Insurance under SSI Non-Cash using FPL standard.

 


 

F. Calculation for Customer and Spouse

 

Take the following actions to determine income eligibility for a married customer who resides with his or her spouse.

 

First, complete net test using FBR standards. If not eligible using FBR standards, complete net test using FPL standards.

 

Net Income Test Using 100% FBR Standard

Step

Action

1

To calculate net unearned income:

  • Total the counted unearned income of the customer and spouse;

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

2

To calculate net earned income:

  • Subtract the Student Earned Income Exclusion from customer’s counted earned income (only if under age 22);

  • Subtract Student Earned Income Exclusion from spouse’s counted earned income (only if under age 22);

  • After the Student Earned Income Exclusion has been subtracted, subtotal the counted earned income of the customer and spouse.

  • Note: If any of the remaining subtractions listed in this step result in a $0.00 subtotal or negative subtotal, the net earned income amount is $0.00.

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract ½ subtotal of earned income

  • Subtract Blind Work Expenses

3

To calculate total net income:

  • Add subtotal obtained from Step 1 to subtotal obtained in Step 2

  • Subtract Child Allocations

4

Compare the result to 100% of the FBR for couple (MS 621.00.C):

 

IF the result is... THEN...
Equal or less than 100% of the FBR for a couple

The customer is income eligible under the SSI Non-cash program using 100% FBR standard for a couple.

 

Stop

Greater than 100% of the FBR for a couple

Complete net test using 100% FPL standard for a couple.

 

Continue to Step 5 (Net Test Using 100% FPL Standard for a couple).

 

5

To calculate net unearned income:

  • Total the counted unearned income of the customer and spouse;

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

6

To calculate net earned income:

  • Subtract the Student Earned Income Exclusion from customer’s counted earned income (only if under age 22);

  • Subtract Student Earned Income Exclusion from spouse’s counted earned income (only if under age 22);

  • After the Student Earned Income Exclusion has been subtracted, subtotal the counted earned income of the customer and spouse.

  • Note: If any of the remaining subtractions listed in this step result in a $0.00 subtotal or negative subtotal, the net earned income amount is $0.00.

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract ½ subtotal of earned income

  • Subtract Blind Work Expenses

7

To calculate total net income:

  • Add subtotal obtained from Step 5 to subtotal obtained in Step 6

  • Subtract Child Allocations

8

Compare the result to 100% of the FBR for couple (MS 621.00.C):

 

IF the result is... THEN the customer is...
Equal or less than 100% of the FPL for a couple Income eligible under the SSI Non-cash program using 100% FPL standard for a couple.
Greater than 100% of the FPL for a couple

Income ineligible under the SSI Non-cash program using 100% FPL standard for a couple.

 

Note: The customer may be eligible for a Medicare Cost Sharing Program. The net test for QMB, SLMB and QI-1 allows the deduction of ½ of earned income.

 

 

Example 1 (Customer and Spouse - Eligible Using FBR Standard)

Mr. May is 70 years old. He resides with his wife, Mrs. May, who is 45 years old. Their 10-year-old daughter, Sara, resides with them. Mr. May applies for AHCCCS Health Insurance for himself in 4/13.

 

Mr. May receives monthly income of $900.00 Social Security retirement. Mrs. May works part time at Maples Pancake House and received $100.00 in 4/13.  Sara receives no monthly income.

 

Calculate the customer’s eligibility using the net income test as follows:

 

Step

Action

1

Calculate net unearned income:

$ 900.00 (total of the customer’s counted unearned income [$900.00] and the spouse’s counted unearned income [$0.00])

-$ 0.00 (1/3 child support deduction not applicable)

=$ 900.00 (subtotal)

-$ 20.00 (general income deduction)

=$ 880.00 (subtotal)

+$ 0.00 (there is no income based on need)

=$880.00 (net unearned income)

2

Calculate net earned income:

$ 100.00 (total of the customer’s counted earned income [$0.00] and the spouse’s counted earned income [$100.00])

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 35.00 (subtotal of earned income)

-$ 17.50 (½ subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=$ 17.50 (net earned income)

3

Calculate total net income:

$880.00 (net unearned income from Step 1 above)

+$ 17.50 (net earned income from Step 2 above)

=$897.50 (subtotal of net income)

- $356.00 (child allocation amount [$356.00 2013 child allocation amount - $0.00 Sara’s income = $356.00])

=$541.50 (total net income)

4

Compare the result in Step 3 above to $1,066.00 (100% of the FBR for a couple):

 

Because $541.50 is less than $1,066.00, Mr. May is income eligible for AHCCCS Health Insurance under SSI Non-Cash using 100% FBR standard for a couple.

 

Example 2 (Customer and Spouse- Eligible Using FPL Standard)

Mr. June, a 70 year old man, resides with his 50 year old wife. Their 14-year-old son, John, resides with them. Mr. June applies for AHCCCS Health Insurance for himself in 4/13.

 

Mr. June receives monthly income of $1,500.00 Social Security retirement. Mrs. June and John receive no income.

 

Calculate the customer’s eligibility using the net income test as follows:

 

Step

Action

1

Calculate net unearned income:

$ 1,500.00 (total of the customer’s counted unearned income [$1,500.00] and the spouse’s counted unearned income [$0.00])

-$ 0.00 (1/3 child support deduction not applicable)

=$1,500.00 (subtotal)

-$ 20.00 (general income deduction)

=$1,480.00 (subtotal)

+$ 0.00 (there is no income based on need)

=$1,480.00 (net unearned income)

2

Calculate net earned income:

$ 0.00 (total of the customer’s counted earned income [$0.00] and the spouse’s counted earned income [$0.00])

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 0.00 (subtotal of earned income)

-$ 0.00 (½ subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=-$ 0.00 (net earned income)

3

Calculate total net income:

$1,480.00 (net unearned income from Step 1 above)

+$ 0.00 (net earned income from Step 2 above)

=$1,480.00 (subtotal of net income)

- $ 356.00 (child allocation amount [$356.00 2013 child allocation amount - $0.00 John’s income = $356.00])

=$1,124.00 (total net income)

4

Compare the result in Step 3 above to $1,066.00 (100% of the FBR for a couple):

 

Because $1,124.00 is greater than $1,066.00, Mr. June is ineligible under SSI Non-Cash using 100% FBR standard for a couple. Continue to Step 5 to determine SSI Non-Cash eligibility using 100% FPL standard for a couple.

5

Calculate net unearned income:

$ 1,500.00 (total of the customer’s counted unearned income [$1,500.00] and the spouse’s counted unearned income [$0.00])

-$ 0.00 (1/3 child support deduction not applicable)

=$1,500.00 (subtotal)

-$ 20.00 (general income deduction)

=$1,480.00 (subtotal)

+$ 0.00 (there is no income based on need)

=$1,480.00 (net unearned income)

6

Calculate net earned income:

$ 0.00 (total of the customer’s counted earned income [$0.00] and the spouse’s counted earned income [$0.00])

-$ 0.00 (unused portion of the $20.00 general income deduction)

-$ 65.00 ($65.00 work expense deduction)

-$ 0.00 (IRWE deduction)

=$ 0.00 (subtotal of earned income)

-$ 0.00 (blind work expense deduction)

=-$ 0.00 (net earned income)

7

Calculate total net income:

$1,480.00 (net unearned income from Step 5 above)

+$ 0.00 (net earned income from Step 6 above)

=$1,480.00 (subtotal of net income)

- $ 356.00 (child allocation amount [$356.00 2013 child allocation amount - $0.00 John’s income = $356.00])

=$1,124.00 (total net income)

8

Compare the result in Step 7 above to $1,293.00 (2013 100% of the FPL for a couple):

 

Because $1,124.00 is less than $1,293.00, Mr. June is eligible under SSI Non-Cash using FPL standard for a couple.

 


 

G. Calculation for Customer Child and Ineligible Parent

 

The eligibility determination for the customer child with ineligible parent(s) is a three-part process.

 

Take the following actions to determine income eligibility when an unmarried customer child under age 18 resides with at least one ineligible parent(s) (see MS 602.01.C for definition of ineligible parent).

 

First, complete net test using FBR standards. If not eligible using FBR standards, complete net test using FPL standards.

 

Net Income Test Using 100% FBR Standard

1st Process: Determine Child Allocations

 

To determine the total amount of the child allocations for the siblings in the household, follow the steps below for this process.

Step

Action

1

Calculate a child allocation separately for each child of the customer’s parents in the household (excluding the customer child) (MS 610.08)

2

Combine the individual allocations.

2nd Process: Deeming Calculation

 

To calculate the amount deemed from the ineligible parent(s) to the customer child, follow the steps below for this process.

Step

Action

3

To calculate remaining unearned income:

  • Subtract allocation (amount from Step 2) for children (other than the customer) from the ineligible parent(s) counted unearned income

4

To calculate remaining earned income:

  • Subtract any unused allocation from children (other than the customer) from the ineligible parent(s) earned income. (If an ineligible parent is under age 22 and meets the definition of a student, subtract the Student Earned Income Exclusion from the ineligible parent’s earned income before subtracting the unused child allocation).

5

Determine if there is any remaining unearned income in Step 3 above or remaining earned income in Step 4 above:

 

IF... THEN...
No remaining income in Step 3 or Step 4 The amount of income deemed from the ineligible parent(s) is $0.00 and Stop. You do not need to continue with the deeming process.
Any remaining income in Step 3 or Step 4 Continue to Step 6 with the deeming process

 

6

To calculate the net unearned income of the ineligible parent(s), subtract the $20.00 general income deduction from remaining unearned income.

7

To calculate net earned income of ineligible parent(s), subtract the following deductions from the remaining earned income in the order listed:

  • The unused portion of the $20.00 deduction;

  • The$65.00 work expense deduction;

  • Impairment Related Work Expenses;

  • ½ subtotal of earned income

  • Blind Work Expenses

8

To calculate total net income of ineligible parent(s)

  • Add subtotal obtained from Step 6 to subtotal obtained in Step 7.

9

To determine deemed income from ineligible parents(s)

  • Subtract FBR (1 parent) or couple FBR (2 parent) from the subtotal obtained in Step 8.

(See MS 621.00.C for FBR amounts)

3rd Process: Net Income Test Calculation

 

Determine the net income of the customer child using the child’s considered countable income and the amount deemed from the ineligible parent(s).

 

If no income is deemed to be available from the ineligible parent(s), calculate the net income test using only the considered countable income of the customer child.

 

Follow the steps below to calculate the net income used for eligibility.

Step

Action

10

To calculate the net unearned income:

  • Total the counted unearned income of the customer child and the deemed income of the ineligible parent(s)

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

11

To calculate the net earned income:

  • Total the counted earned income of the customer child

  • Subtract student earned income exclusion (if applicable)

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract ½ subtotal of earned income

  • Subtract Blind Work Expenses

12

To calculate total net income:

  • Add subtotal obtained from Step 10 to subtotal obtained in Step 11.

  • Subtract Child Allocations (for the customer child’s dependent children)

13

Compare the result to 100% of the FBR for an individual (MS 621.00.C):

 

IF result is...

THEN...
Equal or less than 100% of the FBR for an individual

The customer is income eligible for AHCCCS Health Insurance under SSI Non-cash program using 100% FBR standard.

Stop

Greater than $100% of the FBR for an individual

Complete net test using 100% FPL standard for an individual.

 

Continue to Step 14 (Net Test Using 100% FPL Standard for an individual).

 

Net Income Test Using 100% FPL Standard

1st Process: Determine Child Allocations

 

To determine the total amount of the child allocations for the siblings in the household child, follow the steps below for this process.

Step

Action

14

Calculate a child allocation separately for each child of the customer’s parents in the household (excluding the customer child) (MS 610.08)

15

Combine the individual allocations.

2nd Process: Deeming Calculation

 

To calculate the amount deemed from the ineligible parent(s) to the customer child, follow the steps below for this process.

Step

Action

16

To calculate remaining unearned income:

  • Subtract allocation (amount from Step 15) for children (other than the customer) from the ineligible parent(s) counted unearned income

17

To calculate remaining earned income:

  • Subtract any unused allocation from children (other than the customer) from the ineligible parent(s) earned income. (If an ineligible parent is under age 22 and meets the definition of a student, subtract the Student Earned Income Exclusion from the ineligible parent’s earned income before subtracting the unused child allocation).

18

Determine if there is any remaining unearned income in Step 16 above or remaining earned income in Step 17 above:

 

IF... THEN...
No remaining income in Step 16 or Step 17 The amount of income deemed from the ineligible parent(s) is $0.00 and Stop. You do not need to continue with the deeming process.
Any remaining income in Step 16 or Step 17 Continue to Step 19 with the deeming process

 

19

To calculate net unearned income of ineligible parent(s)

  • Subtract the $20.00 general income deduction from remaining unearned income

20

To calculate net earned income of ineligible parent(s):

  • From the remaining earned income

    • Subtract the unused portion of the $20.00 deduction;

    • Subtract $65.00 work expense deduction;

    • Subtract Impairment Related Work Expenses;

    • Subtract Blind Work Expenses

21

To calculate total net income of ineligible parent(s)

Add subtotal obtained from Step 19 to subtotal obtained in Step 20.

22

To determine deemed income from ineligible parents(s)

Subtract FPL (1 parent) or couple FPL (2 parent) from the subtotal obtained in Step 21. (See MS 621.00.C for FPL amounts)

3rd Process: Net Income Test Calculation

Determine the net income of the customer child using the child’s considered countable income and the amount deemed from the ineligible parent(s).

 

If no income is deemed to be available from the ineligible parent(s), calculate the net income test using only the considered countable income of the customer child.

 

Follow the steps below to calculate the net income used for eligibility.

Step

Action

23

To calculate the net unearned income:

  • Total the counted unearned income of the customer child and the deemed income of the ineligible parent(s)

  • If a customer child receives child support payments, subtract 1/3 of the child support payment

  • Subtract the $20.00 general income deduction; and

  • Add needs based assistance payments.

24

To calculate the net earned income:

  • Total the counted earned income of the customer child

  • Subtract student earned income exclusion (if applicable)

  • Subtract the unused portion of the $20.00 deduction;

  • Subtract $65.00 work expense deduction;

  • Subtract Impairment Related Work Expenses;

  • Subtract Blind Work Expenses

25

To calculate total net income:

  • Add subtotal obtained from Step 23 to subtotal obtained in Step 24.

  • Subtract Child Allocations (for the customer child’s dependent children)

26

Compare the result to 100% of the FPL for an individual (MS 621.00.C):

 

IF result is... THEN the customer is...
Equal or less than 100% of the FPL for an individual Income eligible for AHCCCS Health Insurance under SSI Non-cash program using 100% FPL standard.
Greater than 100% of the FPL for an individual

Income ineligible for AHCCCS Health Insurance under the SSI Non-cash program using 100% FPL standard.

 

Note: The customer may be eligible for a Medicare Cost Sharing Program. The net test for QMB, SLMB and QI-1 allows the deduction of ½ of earned income.

 

 

Example (Customer Child and Ineligible Parent(s)

 

Mary Kay, a 10-year-old child, resides with her parents and 1-year-old sister, Joy Kay, and 5-year-old brother, John Kay. She has been determined disabled by DDSA. She is not eligible for SSI because her resources exceed $2,000.00. Mary Kay’s parents apply for AHCCCS Health Insurance for Mary in 4/13.

 

Mr. Kay, who is 30 years old, works full time at Good Hair Cuts and received $4,000.00 in 4/13.

 

Mrs. Kay receives monthly income of $400.00 Arizona State Retirement. Mary, Joy and John receive no income. Mr. and Mrs. Kay do not receive and are not applying for any Medicaid benefits for themselves.

 

First, complete net test using FBR standards. If not eligible using FBR standards, complete net test using FPL standards.

 

Net Income Test Using 100% FBR Standard

1st Process: Determine Child Allocations

 

To determine the total amount of the child allocations for the siblings in the household child, follow the steps below for this process.

Step

Action

1

Calculate a child allocation separately for each child of the customer’s parents in the household (excluding the customer child):

 

Joy Kay allocation

 $356.00 (2013 allocation amount)

- $00.00 (Joy Kay’s income)

 $356.00 (allocation amount for Joy Kay)

 

John Kay allocation

 $356.00 (2013 allocation amount)

- $00.00 (John Kay’s income)

 $356.00 (allocation amount for John Kay)

2

Combine the individual allocations:

 

 $356.00 (Joy’s allocation)

+ $356.00 (John’s allocation)

= $712.00 (total allocation)

2nd Process: Deeming Calculation

 

Calculate the amount deemed from the ineligible parent(s) to the customer child, follow the steps below for this process.

Step

Action

3

Calculate remaining unearned income

 

 $400.00 (Mr. and Mrs. Kay’s unearned income)

- $712.00 (child allocation amount from Step 2)

= $ 0.00 (remaining unearned income)

 

Note: If actual subtotal in this Step is a negative amount (as in this case, –$312.00), use $0.00 as the amount of remaining unearned income and use the amount of the negative figure ($312.00 in this case) as the amount of unused allocation for Step 4 below. If actual subtotal is $0.00 or a positive figure, there is no unused child allocation for Step 4 below.

4

Calculated remaining earned income:

 

 $4,000.00 (Mr. and Mrs. Kay’s earned income)

- $ 312.00 (Unused child allocation)

= $3,688.00 (remaining earned income)

5

Determine if there is any remaining unearned income in Step 3 above or remaining earned income in Step 4 above:

 

IF... THEN...
No remaining income in Step 3 or Step 4 The amount of income deemed from the ineligible parent(s) is $0.00 and Stop. You do not need to continue with the deeming process.

Any remaining income in Step 3 or Step 4

 

Note: For this case, there is $3,688.00 remaining earned income.

Continue to Step 6 with the deeming process.

 

Note: For this case, continue to Step 6 because there is remaining earned income of $3,688.00.

 

6

Calculate net unearned income of ineligible parent(s)

 

 $00.00 (remaining unearned income from Step 3 above)

- $20.00 (general income deduction)

 $00.00 (net unearned income)

 

Note: If actual subtotal in this Step is a negative amount (as in this case,–$20.00), use $0.00 as the amount of the net unearned income. The unused portion of the general income deduction for Step 7 below is $20.00 (calculation is $20.00 – $0.00 [remaining unearned income] = $20.00 [unused portion of general income deduction]). If actual subtotal is $0.00 or a positive figure, there is no unused general deduction for Step 7 below.

7

Calculate net earned income of ineligible parent(s):

 

 $3,688.00 (remaining earned income from Step 4 above)

- $20.00 (unused portion of the $20.00 deduction)

- $65.00 ($65.00 work expense deduction)

- $0.00 (Impairment Related Work Expense deduction)

= $3,603.00 (subtotal earned income)

- $1,801.50 (½ subtotal of earned income)

- $0.00 (Blind Work Expense deduction)

= $1,801.50 (net earned income of ineligible parent(s)

8

Calculate total net income of ineligible parent(s)

 

$ 0.00 (net unearned income of ineligible parent(s) from Step 6 above)

+ $ 1,801.50 (net earned income of ineligible parent(s) from Step 7 above)

=$1,801.50 (total net income)

9

Determine deemed income from ineligible parents(s)

 

$1,801.50 (total net income from Step 8 above)

-$1,066.00 (2013 couple FBR/two parent allocation)

$ 735.50 (amount of deemed income)

3rd Process: Net Income Test Calculation

 

Follow the steps below to calculate the net income used for eligibility.

Step

Action

10

Calculate the net unearned income:

$0.00  (customer child’s income)

+$735.50 (deemed income of ineligible parents(s) from Step 9)

-$ 0.00 (1/3 child support deduction does not apply because customer child does not receive child support)

= $735.50 (subtotal unearned income of the customer child)

-$ 20.00 ($20.00 general income deduction)

+$ 0.00 (no needs based assistance payments)

=$715.50 (net unearned income)

11

Calculate net earned income:

$ 0.00 (total of the customer child’s counted earned income [$0.00]

- $ 0.00 (Student earned income deduction - not applicable)

- $ 0.00 (unused portion of the $20.00 general income deduction)

- $ 65.00 ($65.00 work expense deduction)

- $ 0.00 (IRWE deduction)

= $ 0.00 (subtotal of earned income)

- $ 0.00 (½ subtotal of earned income)

- $ 0.00 (blind work expense deduction)

= $ 0.00 (net earned income)

12

Calculate total net income:

$715.50 (net unearned income from Step 10 above)

+$ 0.00 (net earned income from Step 11 above)

=$715.50 (subtotal of net income)

-$0.00  (child allocation amount –customer child does not have dependent children)

=$715.50 (total net income)

13

Compare the result in Step 12 above to $710.00 (100% of the FBR for an individual). Because $715.50 is greater than $710.00, Mary Kay is income ineligible for AHCCCS Health Insurance using FBR 100% income standard. Continue to Step 14 to determine if Mary Kay is eligible using 100 % FPL standard.

Net Income Test Using 100% FPL Standard

1st Process: Determine Child Allocations

 

To determine the total amount of the child allocations for the siblings in the household child, follow the steps below for this process.

Step

Action

14

Calculate a child allocation separately for each child of the customer’s parents in the household (excluding the customer child):

 

Joy Kay allocation

 $ 356.00 (2013 allocation amount)

- $ 0.00 (Joy Kay’s income)

 $356.00 (allocation amount for Joy Kay)

 

John Kay allocation

 $ 356.00 (2013 allocation amount)

- $ 0.00 (John Kay’s income)

 $356.00 (allocation amount for John Kay)

15

Combine the individual allocations:

 

 $ 356.00 (Joy’s allocation)

+ $ 356.00 (John’s allocation)

= $ 712.00 (total allocation)

2nd Process: Deeming Calculation

 

Calculate the amount deemed from the ineligible parent(s) to the customer child, follow the steps below for this process.

Step

Action

16

Calculate remaining unearned income

 

 $ 400.00 (Mr. and Mrs. Kay’s unearned income)

- $ 712.00 (child allocation amount from Step 15)

= - $ 0.00 (remaining unearned income)

 

Note: If actual subtotal in this Step is a negative amount (as in this case, –$312.00), use $0.00 as the amount of remaining unearned income and use the amount of the negative figure ($312.00 in this case) as the amount of unused allocation for Step 17 below. If actual subtotal is $0.00 or a positive figure, there is no unused child allocation for Step 17 below.

17

Calculated remaining earned income:

 

 $ 4,000.00 (Mr. and Mrs. Kay’s earned income)

- $ 312.00 (Unused child allocation)

= $3,688.00 (remaining earned income)

18

Determine if there is any remaining unearned income in Step 16 above or remaining earned income in Step 17 above:

 

IF... THEN...
No remaining income in Step 16 or Step 17 The amount of income deemed from the ineligible parent(s) is $0.00 and Stop. You do not need to continue with the deeming process.

Any remaining income in Step 16 or Step 17

 

Note: For this case, there is $3,688.00 remaining earned income.

Continue to Step 19 with the deeming process.

 

Note: For this case, continue to Step 19 because there is remaining earned income of $3,688.00.

 

2nd Process: Deeming Calculation

 

Calculate the amount deemed from the ineligible parent(s) to the customer child, follow the steps below for this process.

Step

Action

19

Calculate net unearned income of ineligible parent(s)

 

 $ 0.00 (remaining unearned income from Step 16 above)

- $ 20.00 (general income deduction)

 $ 0.00 (net unearned income)

 

Note: If actual subtotal in this Step is a negative amount (as in this case,–$20.00), use $0.00 as the amount of the net unearned income. The unused portion of the general income deduction for Step 20 below is $20.00 (calculation is $20.00 – $0.00 [remaining unearned income] = $20.00 [unused portion of general income deduction]). If actual subtotal is $0.00 or a positive figure, there is no unused general deduction for Step 20 below.

20

Calculate net earned income of ineligible parent(s):

 

 $3,688.00 (remaining earned income from Step 17 above)

- $ 20.00 (unused portion of the $20.00 deduction)

- $ 65.00 ($65.00 work expense deduction)

- $ 0.00 (Impairment Related Work Expense deduction)

= $ 3,603.00 (subtotal earned income)

- $ 0.00 (Blind Work Expense deduction)

= $3,603.00 (net earned income of ineligible parent(s)

21

Calculate total net income of ineligible parent(s)

 

 $ 0.00 (net unearned income of ineligible parent(s) from Step 19 above)

+ $ 3,603.00 (net earned income of ineligible parent(s) from Step 20 above)

= $ 3,603.00 (total net income)

22

Determine deemed income from ineligible parent(s)

 

 $3,603.00 (total net income from Step 21 above)

- $ 1,293.00 (2013 couple FPL/two parent allocation)

 $2,310.00 (amount of deemed income)

3rd Process: Net Income Test Calculation

 

Follow the steps below to calculate the net income used for eligibility.

Step

Action

23

Calculate the net unearned income:

 $ 0.00 (customer child’s income)

+ $ 2,310.00 (deemed income of ineligible parents(s) from Step 22)

- $ 0.00 (1/3 child support deduction does not apply because customer child does not receive child support)

= $2,310.00 (subtotal unearned income of the customer child)

- $ 20.00 ($20.00 general income deduction)

+ $ 0.00 (no needs based assistance payments)

= $ 2,290.00 (net unearned income)

24

Calculate net earned income:

 $ 0.00 (total of the customer child’s counted earned income [$0.00] )

- $ 0.00 (student child earned income deduction-not applicable)

- $ 0.00 (unused portion of the $20.00 general income deduction)

- $ 65.00 ($65.00 work expense deduction)

- $ 0.00 (IRWE deduction)

= $ 0.00 (subtotal of earned income)

- $ 0.00 (blind work expense deduction)

= $ 0.00 (net earned income)

25

Calculate total net income:

$ 2,290.00 (net unearned income from Step 23 above)

+$ 0.00 (net earned income from Step 24 above)

= $2,290.00 (subtotal of net income)

-$ 0.00 (child allocation amount –customer child does not have dependent children)

=$ 2,290.00 (total net income)

26

Compare the result in Step 25 above to $958.00 (100% of the FPL for an individual):

 

Because $2,290.00 is greater than $958.00, Mary Kay is income ineligible for AHCCCS Health Insurance using both the FBR 100% standard and FPL 100% standard.