§ 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.

   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)).

 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.

   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)).

   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).

   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).

 (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.

   The provisions of this §  181.3 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   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).

   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)).

   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).

 (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.

   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).

   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).

 (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.

   The provisions of this §  181.13 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.13 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 (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.

   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).

   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).

   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.

   The provisions of this §  181.21 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.21 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 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.

   The provisions of this §  181.22 amended under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

 When an applicant’s/recipient’s income, expenses or circumstances, or both, change, the change is considered to determine continuing eligibility for MA.

   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)).

   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).

   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.

   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)).

   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).

   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.

   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.

   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).

 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.

   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)).

   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).

   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).

Subchapter B. AGED, BLIND AND
DISABLED CATEGORIES

SPECIAL NMP—MA INCOME LIMIT FOR INSTITUTIONALIZED
AGED, BLIND AND DISABLED PERSONS

Sec.

§ 181.71. Special NMP-MA income limit for institutionalized aged, blind and disabled persons.

 An aged, blind or disabled applicant/recipient who is receiving skilled nursing care or intermediate care is income eligible for NMP-MA under this special NMP-MA income limit if his total gross monthly income is equal to, or less than, the amount in Appendix B. Total gross monthly income includes:

   (1)  The total earned income as specified in § §  181.91, 181.92, 181.95 and 181.96.

   (2)  The total unearned income as specified in § §  181.101—181.104, 181.107, 181.109 and 181.110.

   (3)  Some income that is identified as excluded in this subchapter is not excluded for purposes of this section and is counted when determining the MA eligible person’s total gross monthly income. This includes:

     (i)   The income exclusion as specified in §  181.122 (relating to earned income exclusion).

     (ii)   The income exclusions as specified in §  181.123 (relating to unearned income exclusions).

   The provisions of this §  181.71 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.71 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   The provisions of this §  181.73 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; reserved August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial page (108941).

ITEMS THAT ARE NOT INCOME FOR THE AGED,
BLIND AND DISABLED CATEGORIES

§ 181.81. Items that are not income.

 The following items are not income and do not count as income when determining income eligibility for MA or in the posteligibility determination of income available from an MA eligible person toward his cost of care in an institution under §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care):

   (1)  Receipts from conversion of a resource. Receipts from the conversion of a resource, such as the sale, exchange or replacement of a resource. This includes cash or an in-kind item that is provided to replace or repair a resource that has been lost, damaged or stolen.

   (2)  Income tax refunds. An amount refunded on income taxes.

   (3)  Payments by credit life or credit disability insurance policies. Payments made under a credit life or credit disability insurance policy issued to, or on behalf of, borrowers to cover payments on loans or installment purchases in the event of the death or disability of the applicant/recipient which are made directly to loan companies or mortgage companies and are not available to the applicant/recipient either directly or by sale or conversion for the purposes of meeting his basic needs.

   (4)  Repayment of loan. Money received from another party in repayment of a loan. Interest received on the money lent is counted as income.

   (5)  Bill paid for applicant/recipient or his spouse. A bill paid by a third-party for the applicant/recipient or his spouse.

   (6)  Replacement income. Income received as a replacement of income lost, destroyed or stolen.

   (7)  Weatherization assistance.

   (8)  MA copayment rebates. A refund to the applicant/recipient authorized as a rebate for payment in excess of the amount required as copayment for MA services.

   (9)  Veterans aid and attendance and housebound allowance. The aid and attendance and housebound allowance portion of a veterans benefit.

   (10)  Borrowed money. Money obtained by borrowing.

   (11)  Medical care and services. Medical care and services if they are:

     (i)   Given free of charge or paid for directly to the provider by another person.

     (ii)   Room and board received during a medical confinement.

     (iii)   Assistance provided in cash or in-kind, including food, clothing or shelter under a Federal, State or local government program, whose purpose is to provide medical care or services including vocational rehabilitation.

     (iv)   In-kind assistance provided under a nongovernmental program whose purpose is to provide medical care or medical services.

     (v)   Cash provided by a nongovernmental medical care or medical services program or under a health insurance policy, except cash if the cash is either repayment for program approved services already paid for by the applicant/recipient or a payment restricted to the future purchase of a program approved service.

     (vi)   Direct payment of the applicant’s/recipient’s medical insurance premiums by anyone on behalf of the applicant/recipient.

   (12)  Social services. Social services if they are one of the following:

     (i)   Assistance provided in cash or in-kind but not received in return for a service performed by the applicant/recipient under a Federal, State or local government program whose purpose is to provide social services including vocational rehabilitation.

     (ii)   In-kind assistance provided under a nongovernmental program whose purpose is to provide social services.

     (iii)   Cash provided by a nongovernmental social services program if the cash is either repayment for program approved services already paid by the applicant/recipient or a payment restricted to the future purchase of a program approved service, such as, but not limited to, cash provided by a private social services agency to an applicant/ recipient for homemaker, attendant care and chore services.

   (13)  Receipt of certain noncash items. Noncash items which are excluded as a resource under Chapter 178 (relating to resource provisions for categorically NMP-MA and MNO-MA). If the item is retained it is not counted as income.

   (14)  Assistance for the homeless.

   The provisions of this §  181.81 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.81 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   The provisions of this §  181.84 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; reserved August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949. Immediately preceding text appears at serial pages (108941) to (108942).

TYPES OF EARNED INCOME COUNTED FOR THE
AGED, BLIND AND DISABLED CATEGORIES

§ 181.91. Gross earned income.

 Gross earned income, including, but not limited to, wages, tips, salaries, commissions, severance pay and bonuses from employment is counted as earned income.

   The provisions of this §  181.91 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.91 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 Income from self-employment is counted as earned income. Self-employment includes, but is not limited to, operating a business, trade or farm, practicing a profession or renting personal or real property as a trade or business.

   The provisions of this §  181.92 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.92 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 A payment received for services performed in a sheltered workshop or work activities center is counted when received or when the payment is set aside for the applicant’s/recipient’s use.

   The provisions of this §  181.95 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.95 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 (a)  The advance monthly EITC payment which an applicant/recipient actually receives is counted as monthly earned income.

 (b)  An applicant/recipient with earned income who is not receiving a monthly advance EITC does not have EITC counted as monthly earned income. The EITC counts as a lump sum payment when the EITC is refunded.

 (c)  A reconciliation of the EITC is required for a current recipient of MA following the end of the tax year if the recipient verifies that the total amount of the advance EITC which was counted as earned income received during the tax year by the Department differs from the year-end EITC. The recipient is responsible for providing information and documentation necessary to complete the reconciliation computation. This information includes, but is not limited to, the recipient’s income tax return—IRS Form 1040, 1040A or 1040EZ—and the income tax refund check received or a photostatic copy of the income tax refund check.

   (1)  If the amount of the advance payments counted by the Department is less than the EITC verified on the income tax return—IRS Form 1040, 1040A or 1040EZ—and the income tax refund check or a copy of the income tax refund check, the additional EITC is treated as lump sum payment in the month of receipt. The EITC is attributed to the person who was employed during the tax year. Each person who was employed is considered to have an equal share of the EITC.

   (2)  If the amount of the advance payments counted by the Department is equal to, or more than, the EITC verified on the income tax return, no further adjustment is necessary.

   (3)  If the recipient fails to provide the necessary verification—IRS Form 1040, 1040A or 1040EZ and the income tax refund check or a copy of the income tax refund check—the entire amount of the available EITC (the maximum EITC the recipient could receive less the amount of the advance payments counted by the Department) is counted as the EITC refund and as a lump sum payment in the month of receipt.

   The provisions of this §  181.96 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.96 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   This section cited in 55 Pa. Code §  181.71 (relating to special NMP-MA income limit for institutionalized aged, blind and disabled persons); and 55 Pa. Code §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care).

TYPES OF UNEARNED INCOME COUNTED FOR THE
AGED, BLIND AND DISABLED CATEGORIES

§ 181.101. Benefits, dividends and interest.

 Annuities, pensions and other periodic payments which include, but are not limited to, private pensions, social security benefits including Part B Medicare premiums, disability benefits, veterans benefits, worker’s compensation, railroad retirement, unemployment insurance benefits, dividends, interest and royalties are counted as unearned income. In some cases, the amount counted as unearned income is more than the actual amount received by the applicant/recipient. This occurs when the amount received by the applicant/recipient is reduced for a debt resulting from an overpayment of a previously received benefit, or by deduction of an insurance premium. In this situation, the actual amount to count as unearned income is the amount of the unearned income benefit to which the applicant/recipient is entitled before the deduction of an insurance premium or the reduction to recover an overpayment unless §  181.123(14) (relating to unearned income exclusions) applies.

   The provisions of this §  181.101 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.101 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   Disability Benefits

   Disability benefits are unearned income even though the stub of the disability check from employer’s insurance carrier designated the income as sick pay. Goldstein v. Department of Public Welfare, 654 A.2d 295 (Pa. Cmwlth. 1995).

   Workers’ Compensation Benefits

   Pursuant to 55 Pa. Code § §  181.2, 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).

 A prize, which is generally something won in a contest, lottery or game of chance, is counted as unearned income. An award, which is usually something received as the result of a decision by a court, board of arbitration or something similar, is counted as unearned income.

   The provisions of this §  181.102 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.102 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 An inheritance, which is something received as a result of someone’s death, is counted as unearned income. An inheritance can be cash, or a right or interest in real or personal property.

   The provisions of this §  181.103 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.103 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 Child support, spousal support and alimony are counted as unearned income, regardless of whether the payment or support is voluntary or court-ordered.

   The provisions of this §  181.104 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.104 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 Profit from rental property income is the payment received by the applicant/recipient for the use of real or personal property, including payments for room and board and room rent less the deductions in §  181.135 (relating to deductions from rental income). Profit from rental property income is counted as unearned income.

   The provisions of this §  181.107 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.107 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 A payment received by the applicant/recipient as a beneficiary of a life insurance policy, except for an amount up to $1,500 that the applicant/recipient verifies that he spent on the insured’s last illness and burial expense, is counted as unearned income. Illness and burial expenses include, but are not limited to, related hospital and medical expenses, funeral, burial plot and interment expenses and other related costs.

   The provisions of this §  181.109 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.109 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 (a)  Income that is considered available to an applicant/recipient from his spouse who lives in the same household and who is not receiving, or applying for, MA is counted as unearned income.

 (b)  Income is not deemed available if the spouses are living separate and apart, including when one spouse is institutionalized. Income deeming stops for any month including partial months when one spouse becomes an institutionalized spouse as defined in §  181.2 (relating to definitions). Income deeming stops the first full month after the month of separation, institutionalization, other than that defined for an institutionalized spouse, or death of a spouse, even if only 1 day has elapsed since the separation began, unless the separation is temporary. Deeming continues during a temporary separation. A temporary separation, for purposes of deeming, occurs when either spouse leaves the household but intends to, and does, return to the household in the same month or the month immediately following.

 (c)  The following types and amounts of income of the spouse are not counted when determining deemed income for the applicant/recipient and shall be excluded in the order listed:

   (1)  Income identified in §  181.121 (relating to income exempt by Federal statutes).

   (2)  A cash assistance payment received by the spouse and income which was counted or excluded in determining the amount of the cash assistance payment for the spouse.

   (3)  Income of the spouse that was counted in determining the amount of a cash assistance payment for another person.

   (4)  The amount of a grant, scholarship or fellowship used to pay tuition or fees.

   (5)  Money received for providing foster care to a child who was placed in the spouse’s home by a public or private nonprofit child placement or child care agency.

   (6)  The value of food stamps and the value of United States Department of Agriculture donated foods.

   (7)  The value of food produced by the spouse which is used by him and his household for their own personal consumption and not for sale.

   (8)  Tax refunds on income, real property or food purchased.

   (9)  The amount of income used to comply with the terms of a court-ordered support payment or support payments enforced under Title IV-D of the Social Security Act (42 U.S.C.A. § §  651—667).

   (10)  Periodic payments made by a state under a program established before July 1, 1973, and based solely on length of residence and attainment of 65 years of age.

   (11)  Income identified in § §  181.122 and 181.123(4)—(7) (relating to earned income exclusion; and unearned income exclusions).

   (12)  Income paid under a Federal, State or local government program to provide the spouse with chore, attendant or homemaker services.

   (13)  Certain support and maintenance assistance benefits furnished in-kind by a certified private, nonprofit organization or furnished as cash or in-kind assistance by a certified supplier of home heating oil or gas, by a certified entity providing home energy whose revenues are primarily derived on a rate-of-return basis and regulated by the Pennsylvania Public Utility Commission or by a certified municipal utility providing home energy. Support and maintenance assistance includes Home Energy Assistance (HEA). HEA benefits may include, but are not limited to, payments for heating or cooling, storm doors, weatherization services and blankets. HEA benefits do not include food or clothing.

 (d)  If the spouse meets the eligibility conditions as a blind person, the work expenses specified in §  181.132(5) (relating to deductions from earned income) are deducted from the spouse’s earned income.

 (e)  If the spouse has a dependent child living in his household who is not part of the applicant/recipient group and is not receiving a type of public maintenance payments based on need, the spouse is entitled to a deduction from his income for that dependent child. The child is dependent if he is not married, not the head of a household and is under 18 years of age or if a student, under 22 years of age. Eligibility for this deduction is determined in the following manner:

   (1)  The income of the dependent child is considered in determining the amount of the deduction from the spouse’s income. The following types and amounts of income are exempt when determining the income of the dependent child:

     (i)   The exemptions listed in subsection (c)(2).

     (ii)   Earned income up to $1,200 a calendar quarter, but not more than $1,620 per year if the dependent child is a student.

   (2)  The income remaining after the application of appropriate exemptions in paragraph (1) is deducted from the amount in Appendix D, Item 1 for one person. The resulting figure is the dependent child deduction for the spouse for purposes of deeming the amount of income available from the spouse.

 (f)  If the spouse’s income after application of the appropriate exemptions in subsection (c) and the deductions in subsections (d) and (e) is less than, or equal to, the amount in Appendix D, Item 1, no income is deemed available from the spouse to the applicant/recipient.

 (g)  If the spouse’s income after the allowable exemptions in subsection (c) and the applicable deductions in subsections (d) and (e) is greater than the amount in Appendix D, Item 1, the amount of income deemed available from the spouse and the income eligibility of the applicant/recipient is determined in the following manner:

   (1)  Combine the spouse’s remaining unearned income after deductions and exemptions with the unearned income of the applicant/recipient, and combine the spouse’s remaining earned income with the earned income of the applicant/recipient.

   (2)  Apply the applicable exemptions, exclusions and deductions including items that are income under the following provisions:

     (i)   Section 181.81 (relating to items that are not income).

     (ii)   Section 181.121.

     (iii)   Section 181.122.

     (iv)   Section 181.123.

     (v)   Section 181.131 (relating to deductions from unearned income).

     (vi)   Section 181.132.

     (vii)   Section 181.133 (relating to deductions from self-employment).

     (viii)   Section 181.134 (relating to guardian fee deductions).

     (ix)   Section 181.135 (relating to deductions from rental income).

   (3)  Using the combined income of both spouses, apply the income limit for a two person household in Appendix A for the NMP-MA categories and Appendix F or G for the MNO-MA categories dependent upon whether a semiannual or monthly income limit is needed when determining income eligibility for the applicant/recipient.

   The provisions of this §  181.110 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.110 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. Immediately preceding text appears at serial pages (130594) to (130596).

   This section cited in 55 Pa. Code §  181.71 (relating to special NMP-MA income limit for institutionalized aged, blind and disabled persons); 55 Pa. Code §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care); and 55 Pa.Code §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care).

INCOME EXCLUSIONS FOR THE AGED, BLIND
AND DISABLED CATEGORIES

§ 181.121. Income exempt by Federal statutes.

 The following types of income do not count when determining income eligibility for MA:

   (1)  Food Stamp Program benefits. The value of food stamps received by an applicant/recipient who is participating in the Food Stamp Program (7 U.S.C.A. § §  2011—2029).

   (2)  Value of United States Department of Agriculture surplus food donation. The value of United States Department of Agriculture donated foods-surplus commodities-distributed under section 32 of the act of August 24, 1935 (7 U.S.C.A. §  612c).

   (3)  Value of free or reduced price food. The value of free or reduced price food received by women and children under section 11(b) of the Child Nutrition Act of 1966 (42 U.S.C.A. §  1780(b)) and section 17 of that act (42 U.S.C.A. §  1786); and section 13(h)(3) of the National School Lunch Act (42 U.S.C.A. §  1761(h)(3)).

   (4)  Assistance to prevent fuel cutoffs. Assistance received under the Energy Crisis Assistance Program or the Emergency Energy Conservation Services Program under section 222 (a)(5) of the Economic Opportunity Act of 1964 (42 U.S.C.A. §  2809(a)(5)).

   (5)  Fuel assistance payments. Fuel assistance payments and allowances under the Low Income Home Energy Assistance Act of 1981 (42 U.S.C.A. § §  8621—8629) as amended by the Human Services Reauthorization Act of 1986 (Pub. L. 99-425) (100 Stat. 966).

   (6)  Housing subsidies. Housing subsidies paid under the United States Housing Act of 1937 (includes section 8 housing) (12 U.S.C.A. § §  1437—1437g), the National Housing Act (12 U.S.C.A. § §  1706(b)—1749bbb-21), section 101 of the Housing and Urban Development Act of 1965 (12 U.S.C.A. §  1701s), Title V of the Housing Act of 1949 (42 U.S.C.A. § §  1471—1490o) or other Federal housing subsidy statutes.

   (7)  Uniform relocation assistance and real property acquisition policies. Payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies of 1970 (42 U.S.C.A. § §  4621—4638).

   (8)  Job Training Partnership Act. Payments received under the Job Training Partnership Act of 1982 (29 U.S.C.A. § §  1501—1781).

   (9)  Grants or loans to undergraduate students. Grants or loans to undergraduate students for educational purposes made or insured under programs administered by the Secretary of the United States Department of Education under section 507 of the Higher Education Amendments of 1968 (20 U.S.C.A. §  1060 note and §  1091 note).

   (10)  Wages, allowances or reimbursement for transportation and attendant care costs received by an eligible handicapped individual under Title VI of the Rehabilitation Act. Wages, allowances or reimbursement for transportation and attendant care costs, unless excepted on a case-by-case basis, when received by an eligible handicapped person employed in a project under section 611(b) and (c) of Title VI of the Rehabilitation Act of 1973 (29 U.S.C.A. §  795(b) and (c)).

   (11)  Alaska Native Claims Settlement Act. Payments under section 21(a) of the Alaska Native Claims Settlement Act (43 U.S.C.A. §  1620(a)).

   (12)  Payments based on age and residence in Alaska. Payments made under a program established in Alaska before July 1, 1973, and based solely on length of residence in Alaska and attainment of 65 years of age. This includes money received in accordance with the Alaska longevity bonus which is exempt under section 1612(b)(2)(B) of the Social Security Act (42 U.S.C.A. §  1382(b)(2)(B)).

   (13)  Indian Tribe per capita judgment funds. Per capita judgment funds received by the following Indian tribes:

     (i)   The Blackfeet and Gros Ventre Tribes under section 4 of the act of March 18, 1972 (Pub. L. 92-254) (86 Stat. 65) (25 U.S.C.A. §  1264).

     (ii)   The Grand River Band of Ottawa Indians under the act of October 18, 1976 (Pub. L. 94-540) (90 Stat. 2503).

     (iii)   Tribes or groups under section 7 of the act of October 9, 1973 (Pub. L. 93-134) (87 Stat. 468) (25 U.S.C.A. §  1407).

     (iv)   The Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation under section 2 of the act of October 10, 1978 (Pub. L. 95-433) (92 Stat. 1047) (25 U.S.C.A. §  609 c-1).

   (14)  Receipts from land to certain Indian tribes. Receipts from land held in trust by the Federal government and distributed to members of certain Indian tribes under section 6 of the act of October 17, 1975 (Pub. L. 94-114) (89 Stat. 579) (25 U.S.C.A. §  459e).

   (15)  Payment to volunteers. Payment to volunteers in the Foster Grandparent Program and other similar programs under sections 404(g) and 418 of the Domestic Volunteer Service Act of 1973 (42 U.S.C.A. § §  5044(g) and 5058).

   (16)  Older Americans Act benefits. Benefits received other than wages or salaries under section 210 of the Older Americans Act of 1965 (42 U.S.C.A. §  3020a).

   (17)  Retroactive SSI and RSDI Payments. Retroactive payments received under Title II or Title XVI of the Social Security Act (42 U.S.C.A. § §  401—433 or 1381—1383c) are exempt for 6 months after the month in which the retroactive payment is received. If a portion of the retroactive payment remains after the 6th month, it is counted as a resource under section 1613 of the act (42 U.S.C.A. §  1382b) under Chapter 178 (relating to resource provisions for categorically NMP-MA and MNO-MA).

   (18)  Japanese-American and Aleutian restitution payments. Restitution payments made by the United States government to eligible Japanese-Americans and Aleuts who were interned or relocated during World War II. If the eligible Japanese-Americans are deceased at the time of payments, payments will be made to certain of their survivors as specified under the Civil Liberties Act of 1988 (50 App. § §  1989b and 1989b-1—1989b-9). This payment is also excluded. This paragraph does not apply to eligible Aleuts who are covered under the Aleutian and Pribilof Islands Restitution Act (50 App. § §  1989c and 1989c-1—1989c-8). Interest received on retained restitution payments is also not excluded but is subject to the usual regulations governing interest as specified in this chapter.

   (19)  Agent orange settlement payments. Payments made from the Agent Orange Settlement Fund or another fund established pursuant to the settlement in the agent orange product liability litigation.

   (20)  Interest from certain burial space arrangements. Interest earned on agreements representing the purchase of burial spaces which are excluded under Chapter 178 (relating to resource provisions for categorically NMP-MA and MNO-MA) if the interest is left to accumulate. Interest that is not left to accumulate is counted as interest income.

   The provisions of this §  181.121 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.121 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended March 22, 1991, effective upon publication in the Pennsylvania Bulletin, and applies retroactively to August 10, 1988, 21 Pa.B. 1182; amended August 27, 1993, effective August 28, 1993, with the exception of the Agent Orange Settlement Payments requirement which is retroactive to January 1, 1989, 23 Pa.B. 4071. Immediately preceding text appears at serial pages (130597) to (130598) and (157085).

 Earned income that does not exceed $10 in a month is excluded if it is irregular or infrequent and received from a single source.

   The provisions of this §  181.122 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.122 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 The following do not count when determining income eligibility for MA and shall be excluded in the order noted:

   (1)  Refund or return of taxes paid on real property. A refund or return from a public agency of taxes paid on real property.

   (2)  Educational expenses. The amount of a grant, scholarship or fellowship used for paying tuition, fees or other necessary educational expenses.

   (3)  Home produce. The value of food produced by an applicant/recipient which is used by him and his household for their own personal consumption and not for sale.

   (4)  Disaster relief assistance.

     (i)   Support and maintenance provided as disaster relief assistance, including income-in-kind, received as the result of a catastrophe declared by the President as a major disaster under the Disaster Relief Act of 1974 (42 U.S.C.A. § §  5121—5202) or another Federal statute, if the following conditions are met:

       (A)   At the time of the catastrophe, the applicant/recipient was living in and maintaining his own home but discontinued living in his home because of the catastrophe.

       (B)   The applicant/recipient began to receive disaster assistance within 30 days after the last day of the catastrophe.

       (C)   The applicant/recipient received the disaster assistance while living in a residential facility, including a private household maintained by another person.

       (D)   The exclusion applies for a period beginning on the date the assistance is received and ending on the last day of the 18th full month following the month the cash was received.

     (ii)   Other assistance is not counted as income if received under the Disaster Relief Act of 1974 or under another Federal statute because of a catastrophe which the President declares to be a major disaster.

   (5)  Interest on disaster relief assistance. Interest earned on disaster relief assistance for a period beginning on the date the assistance is received and ending on the last day of the 9th full month following the month the cash was received. Interest earned for a period beginning on the date the assistance is received and ending on the last day of the 18th full month following the month the cash was received, if the applicant/recipient has good cause for not repairing or replacing the property or contracting for the repair or replacement of the property for which the disaster relief assistance was given.

   (6)  German reparations payments. Payments made under the Republic of Germany’s federal law for compensation or Nationalist Socialist Persecution—German Restitution Act—to certain survivors of the Holocaust. The payments may be made periodically or as a lump sum.

   (7)  Unearned income not exceeding $20 in a month. Unearned income that does not exceed $20 in a month, if it is received irregularly or infrequently. If the total amount of infrequent or irregular unearned income received in a month exceeds $20 or the unearned income is received more than once in a quarter, this exclusion is not given.

   (8)  Periodic payments by a state based solely on residence. Periodic payments made by a state under a program established before July 1, 1973, and based solely on the length of residence and attainment of 65 years of age.

   (9)  Payments for providing foster care. Payments for providing foster care to a child who is not receiving, or applying for, MA as part of the applicant/recipient group and who was placed in the applicant’s/recipient’s home by a public or private nonprofit child placement or child care agency.

   (10)  Interest earned on burial funds. Interest earned on burial funds if the burial fund is excluded as a resource under Chapter 178 (relating to resource provisions for categorically NMP-MA and MNO-MA) and the interest is left to accumulate and become part of the burial fund.

   (11)  Certain support and maintenance assistance. In-kind support or maintenance assistance benefits furnished in-kind or by a certified private, nonprofit organization or furnished as cash or in-kind assistance by a certified supplier of home heating oil or gas, by a certified entity providing home energy whose revenues are primarily derived on a rate-of-return basis and regulated by the Pennsylvania Public Utility Commission or by a certified municipal utility providing home energy. Support and maintenance assistance includes Home Energy Assistance (HEA) and may include, but is not limited to, payments for heating or cooling, storm doors, weatherization services and blankets. HEA benefits do not include food or clothing.

   (12)  Interest income. Interest income if it is received only once during a calendar quarter and the total of the interest income plus infrequent or irregular unearned income received in the month in which the interest income is received does not exceed $20.

   (13)  Property tax and rent rebate payments. Property tax and rent rebate payments and inflation dividend payments received under the Senior Citizens Rebate and Assistance Act (72 P. S. § §  4751-1—4751-12) originally enacted March 11, 1971.

   (14)  Reduction in unearned income to recover a previous overpayment. If unearned income of the applicant/recipient is reduced to cover a previous overpayment, the amount of the reduction is exempt from consideration as current income if the amount of the overpayment was considered in determining financial eligibility for MA at the time the overpayment was received.

   (15)  Advance payments against expenses of obtaining income. A lump sum advance to cover expenses to obtain income. The advance is considered reimbursement for expenses of obtaining the income.

   The provisions of this §  181.123 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.123 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended August 27, 1993, effective August 28, 1993, with the exception of the Agent Orange Settlement Payments requirement which is retroactive to January 1, 1989, 23 Pa.B. 4071.

   This section cited in 55 Pa. Code §  181.71 (relating to special NMP-MA income limit for institutionalized aged, blind and disabled); 55 Pa. Code §  181.101 (relating to benefits, dividends and interest); 55 Pa. Code §  181.110 (relating to income deemed available from the spouse); and 55 Pa. Code §  181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care).

DEDUCTIONS FROM INCOME FOR THE AGED,
BLIND AND DISABLED CATEGORIES

§ 181.131. Deductions from unearned income.

 (a)  Unearned income expenses. For each applicant/recipient, the expenses which the applicant/recipient pays to be eligible for, or to receive, unearned income are deducted. These unearned income expenses include, but are not limited to, attorney fees, court costs and transportation costs. Personal income taxes are not expenses the applicant/recipient had to pay to get this income and are not allowable deductions.

 (b)  First $20 of income in a month other than income based on need. The first $20 of income received in a calendar month by an applicant/recipient group is deducted after allowable expense deductions in subsection (a) are deducted. The application of the deduction is as follows:

   (1)  The deduction does not apply to unearned income based on need and funded in whole or in part by the Federal government or by a nongoverment agency.

   (2)  The deduction applies to income based on need and funded wholly by the State.

   (3)  The deduction applies to veterans benefits received by an applicant/recipient who is a veteran or is a dependent of a veteran on the basis of one of the following:

     (i)   A special act of Congress.

     (ii)   Service in the Indian Wars: January 8, 1817—December 31, 1881.

     (iii)   Service in the Civil War: 1861—1865.

     (iv)   Service in the Spanish-American War: April 12, 1898—July 4, 1902.

   (4)  The deduction is first applied to the unearned income received by the applicant/recipient.

   (5)  If the applicant/recipient does not have unearned income or has less than $20 of unearned income in a calendar month, the remaining portion of the $20 deduction is applied to the earned income received in the calendar month under §  181.132(1) (relating to deductions from earned income).

   The provisions of this §  181.131 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.131 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 The following amounts are deducted from earned income in the order listed in determining income eligibility:

   (1)  Portion of $20 monthly deduction not deducted from unearned income. The portion of the $20 monthly deduction in §  181.131(b) (relating to deductions from unearned income) which has not been deducted from unearned income is deducted from earned income in the same month for each applicant/recipient group.

   (2)  Sixty five dollars of earned income in a month. An employed aged, blind or disabled applicant/recipient is entitled to an earned income deduction of $65 of his gross earned income per month.

   (3)  Earned income of a disabled applicant/recipient used to pay impairment-related work expenses. Earned income used by an applicant/recipient who is disabled and under 65 years of age to pay impairment-related work expenses is excluded. This exclusion is given to an applicant/recipient who is disabled and 65 years of age or older if he had received MA benefits as a disabled recipient in at least one of the 12 consecutive months prior to the month that he reached 65 years of age. This exclusion is also given to an applicant/recipient who is disabled and 65 years of age or older if it can be determined that the person should have been determined eligible for MA benefits as a disabled MA recipient in at least one of the 24 consecutive months prior to the month that he reached 65 years of age and was denied. This exclusion is not given to blind applicants/recipients. Impairment-related work expenses include, but are not limited to:

     (i)   Payments for attendant care services if assistance is needed by the applicant/recipient in traveling to and from work, while at work, and at home because of his impairment.

     (ii)   Payments for a medical device if the applicant’s/recipient’s impairment requires him to use the device to work.

     (iii)   Payments for a prosthetic device if the applicant’s/recipient’s impairment requires him to use the prosthetic device to work.

     (iv)   Payments for impairment related nonmedical appliances and equipment and residential modifications needed by the applicant/recipient for his employment.

     (v)   Payments for drugs and medical services if necessary to the applicant/recipient to control his impairment.

     (vi)   Payments for installing, maintaining and repairing the items listed in subparagraphs (i)—(v) that are necessary for the applicant’s/recipient’s employment.

     (vii)   Payments for similar items and services not listed in subparagraphs (i)—(vi) which are directly related to the applicant’s/recipient’s impairment and needed by him to work.

   (4)  One-Half of remaining earned income in a month. An employed aged, blind or disabled applicant/recipient is entitled to a deduction of 1/2 of the remaining earned income after the deduction in paragraph (2), and when applicable, the deductions in paragraphs (1) and (3).

   (5)  Earned income of a blind applicant/recipient used to pay expenses attributable to earning the income. Earned income of an applicant/recipient who is blind and under 65 years of age which is used to pay expenses reasonably attributable to the earning of the income. This exclusion is given to an applicant/recipient who is blind and 65 years of age or older if he had received MA benefits as a blind recipient in at least one of the 12 consecutive months prior to the month that he reached 65 years of age. This exclusion is also given to an applicant/recipient who is blind and 65 years of age or older if it can be determined that the person should have been determined eligible for MA benefits as a blind MA recipient in at least one of the 24 consecutive months prior to the month that he reached 65 years of age and was denied. An employed applicant/recipient who is blind and under 65 years of age is entitled to deductions from his earned income for the following expenses:

     (i)   Transportation expenses which include cane travel instruction, a guide dog and the dog’s upkeep expenses, and public transportation such as bus or cab fare. If the transportation is provided by private automobile, the deduction is the actual cost up to 15¢ per mile.

     (ii)   Job performance expenses such as, but not limited to, braille instruction, child care costs if not otherwise provided, equipment needed on the job, lunches, optical aids, uniforms and care of the uniforms, a wheelchair if necessary due to disability, translation of materials into braille and a reader.

     (iii)   Job improvement expenses which include, but are not limited to, stenotype instruction for a blind typist, key punch training and computer program training courses.

   The provisions of this §  181.132 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.132 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   Workers’ Compensation Benefits

   Pursuant to 55 Pa. Code § §  181.2, 181.101 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).

 For a self-employed person, the verified costs to produce or continue the income are deducted. The deductible costs include expenses reported on the Federal income tax return except depreciation, personal business, entertainment expenses and depletion.

   The provisions of this §  181.133 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.133 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 Guardian fees are deducted from earned or unearned income if having a guardian is a requirement for receiving the income.

   The provisions of this §  181.134 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.134 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

 (a)  Expense deductions from rental income include:

   (1)  Necessary expenses paid for the production or collection of the rental income.

   (2)  Real estate insurance costs related to the rental property, whether or not the mortgage holder requires the insurance.

   (3)  The interest portion of a mortgage payment.

   (4)  A repair which is an incidental correction to an existing structure, or to a piece of equipment.

 (b)  Items such as depreciation or depletion, personal expenses which are not related to the rental income and capital expenditures are not allowable deductions. A capital expenditure represents an expenditure for an addition or increase in the value of fixed assets, and is subject to depreciation for income tax purposes.

 (c)  Allowable expenses are prorated if only a portion of the total property is designated for rent, regardless of whether it is actually rented.

   The provisions of this §  181.135 issued under section 403(b) of the Public Welfare Code (62 P. S. §  403(b)).

   The provisions of this §  181.135 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949.

   This section cited in 55 Pa. Code §  181.107 (relating to profit from rental property income); and 55 Pa. Code §  181.110 (relating to income deemed available from the spouse).

Subchapter C. THE TANF AND GA CA