820            BUDGETING MONTHLY INCOME

To determine monthly income using client stated information or documentation of wages and deductions, use the standardized budgeting procedures in this section.

820 A.            DETERMINING ELIGIBILITY

The ETEligibility Technician determines a household's eligibility on a calendar month basis by considering the household’s circumstances for the entire month. The ETEligibility Technician estimates the amount of monthly income used in this determination by following the guidance in this manual.

820 B.  PROSPECTIVE DETERMINATION

Other than retroactive Medicaid, eligibility for Medicaid is always determined prospectively.

Except as provided for under the continuous eligibility policy (see section 816-1 C(1)), if the household has income that prospectively exceeds the income limit for a Medicaid eligibility category, medical assistance is denied for that month. For an ongoing case, if it appears the reason for the ineligibility will continue, the case is closed. If appropriate, review the case for Transitional Medicaid eligibility (section 828).

820 C.        COMMON TERMS AND DEFINITIONS

Adjusted Gross Income: Gross income minus specific itemized deductions using IRSInternal Revenue Service rules.

Adjusted gross self-employment income: Adjusted gross self-employment income means the gross self-employment income minus IRSInternal Revenue Service adjustments, or costs of business, that are claimed. To determine adjusted gross self-employment income, subtract the total amount of allowable costs of doing business from the gross self-employment income. This amount is the adjusted gross self-employment income and is used as the countable income for MAGIModified Adjusted Gross Income Medicaid. Other terms commonly used include the following: 1) net profit, 2) income minus costs of business, expenses, or IRSInternal Revenue Service adjustments.

Anticipate means expecting a future event; predicting an event.

Average payment is a basic math calculation that adds payments in a period and divides the total by the number of payments added.

Bi-weekly payments are payments received every other week.

Conversion factor is a basic math calculation used to change (convert) a weekly or bi-weekly payment amount into a monthly amount. It factors in the 3rd and 5th pay check received in some months by multiplying by 4.3 weeks when using a weekly payment, and 2.15 weeks when using a bi-weekly payment.

Crowdfunding is the practice of obtaining needed funding by soliciting contributions from a large number of people, typically from the online community.

Estimate means calculating an approximate value. For example, an ETEligibility Technician will estimate how much income to count.

Full payment period is the period a payment is intended to cover. For example, the full payment period for earnings is the pay period defined by the employer. The full payment period for public assistance payments is a calendar month. The full payment period for unemployment benefits is generally a two-week period, based on the claimant receiving two weekly benefits per payment. Payments cover a full payment period even if the individual did not receive the maximum payment he or she could have received. For example, lower payments for full payment periods when the employee is employed continuously and was on unpaid leave (including illness) for part of the pay period; or a person is disqualified for part of the UIBUnemployment Insurance Benefit two-week benefit period.

Gross income means the amount of earned income actually received in the month by a person, before any deductions are made for any expenses of earning such as taxes, child care, transportation, etc. "Gross monthly earned income,” means the amount of gross income actually received from employment or expected to be received. It includes full or partial in-kind compensation and monies earned directly by the employee such as tips.

Gross self-employment income means the total amount of money the trade or business produces. Gross self-employment income is computed by totaling the gross business income for the business enterprise. Allowable adjustments, or costs of business, are not deducted in determining gross self-employment income.

Irregular income is income received in unpredictable amounts, on unpredictable dates, or infrequently, and typically not in consecutive months. Unexpected income that cannot reasonably be expected to recur.

Internal Revenue Service (IRS) is the federal agency responsible for administering and enforcing the U.S.United States Treasury Department’s revenue laws.

IRSInternal Revenue Service deductions are deductions that are subtracted from the taxable income for certain expenses defined by the IRSInternal Revenue Service.

Monthly payment is a payment received once a month.

Normal payment is a payment in a typical or usual amount.

Pretax deductions are IRSInternal Revenue Service defined deductions before Federal, State, and Medicare taxes are subtracted from gross wages.

Scheduled payment is a payment that will be made by the source at prescribed intervals or on specific dates. For example, unemployment benefits are scheduled to be paid every two weeks; a weekly paycheck is scheduled to be paid once a week; and salaries are paid on specific dates decided by the employer. With new or ending income, the individual may not receive all of the scheduled payments in a month, or some of the scheduled payments they receive may not be for a full payment period.

Total gross monthly income means the total of the gross monthly earned and unearned income of all persons in the household.

Twice a month payments are payments received two times in the month on specific dates. For example, the monthly pay dates are the 5th and 20th of each month.

Weekly payment is a payment received once a week.