940              FINANCIAL ELIGIBILITY

940-1           CAMAChronic and Acute Medical Assistance HOUSEHOLD

The following individuals are included in the household and must have their needs, income, and resources considered in determining financial eligibility for CAMAChronic and Acute Medical Assistance:

1. The applicant;
    
2. A legally responsible relative  (see Section 930-2) who, at the time of application, has continuously resided with the applicant for a period of 30 days, and who does not maintain a separate residence from the applicant, and is financially able to provide support.
    

Note:

A legally responsible relative who is receiving a cash assistance grant from the Alaska Temporary Assistance Program, Adult Public Assistance (including Interim Assistance), or Supplemental Security Income will not have their needs, income or resources considered in determining financial eligibility or household size.

Likewise, A legally responsible relative who is both categorically and financially eligible as a “potential” cash assistance program is considered unable to provide financial support and will not have their needs, income, or resources considered in determining financial eligibility or household size.

Example:

The legally responsible relative must have a child under the age of 18 to “ potentially” be a TATemporary Assistance recipient, and if so, the income and resources of the TATemporary Assistance program  would be used.  To be considered a “potential” APAAdult Public Assistance recipient, the individual would need either to have been determined disabled, or age 65 and older, and if so, the income and resources of the APAAdult Public Assistance program would be used.  

940-2           COUNTABLE RESOURCES

Before eligibility can be determined, the caseworker must verify that countable resources (liquid, property, or a combination of the two) do not or are not expected to exceed $500 on the first moment of the benefit month.  If necessary, the caseworker may pend an application for verification of resources before making an eligibility determination.  

Example 1:

Application received 11/05.  The bank account has $900 and the client indicates this money is going to be used to pay off a debt and that it will not be available next month.  Caseworker pends the case for verification.  Bank statement received on 11/15 shows a balance of $200.  The caseworker has no reason to expect other resources will be available on the first moment of December (benefit month) and approves the application for December benefits.

Example 2:

Application received 11/25.  The bank account has $800 and the client indicates this money will not be available next month.  Caseworker pends the case for verification.  Bank statement received on 12/3 shows a balance of $400 on 12/1.  The caseworker approves the application for December benefits.

Example 3:

Application received 11/05.  The bank account has $300 and the caseworker has no reason to expect other resources will be available on the first moment of benefit month (December).  Caseworker approves application for December benefits.

Example 4:

Application received 11/24.  The bank account has $1,500 and the client indicates this money will not be available next month.  Caseworker pends the case for verification.  Bank statement received on 12/04 shows the balance is over $500 on 12/01.  Eligibility for December is denied.

Note:

An applicant who is denied eligibility because of excess resources may reapply in the same month if the applicant’s financial situation changes.

Countable resources include the following:

1. Liquid assets such as cash, savings, stocks and bonds.  Some people have investments that mature over a specific time and have financial penalties for withdrawing any amounts prior to the maturity date.  For resources that fit within this description, the value of the resource is the amount of the original investment, less the amount of penalty for early withdrawl.
    
2. Real or personal property with equity value.

Real or personal property does NOT include:

1. the home in which the applicant resides and the land on which it stands unless the land has been surveyed for subdivision; if the land has been surveyed for subdivision, only the lot on which the home stands is excluded;
    
2. property actively marketed for sale at fair market value or less;
    
3. property that is producing "reasonable income";
    
4. property that is essential to employment;
    
5. either one automobile or motorcycle regardless of value, plus a boat, snowmobile, or all-terrain vehicle (ATV) if the applicant lives in an area where local transportation needs require an alternative.

3. Limited Entry Fishing Permit that was not used during the most recent season for reasons other than:

1. loss of essential fishing equipment prior to or during the most recent season;
    
2. serious illness of the applicant or household member for the period prior to and including the most recent season; or
    
3. lease off the Limited Entry Fishing Permit at fair market value to produce income for the applicant's household.
    

4. Credit sufficient to meet the covered need.

940-3           DEFINITIONS RELATED TO COUNTABLE RESOURCES

Fair Market Value:  Fair market value is the probable value of the resource if it were to be sold.  A caseworker can determine fair market value by checking with real estate agents, classified advertisement listings, the tax assessor’s office, stockbrokers, or insurance agents.  If the fair market value of a particular resource cannot be determined, the caseworker may establish fair market value by determining the value of comparable property in the vicinity that is being offered for sale or has recently sold.

Reasonable Income:  Reasonable income is determined by checking with real estate agents, rental agencies, classified advertisement listings, etc. to determine whether the income produced is comparable to that being produced by similar properties in the vicinity.  Producing income does not necessarily imply making a profit.  Property may be producing income comparable to that normally produced by other property in the same area and yet it may be losing money after deductions for expenses are allowed.  Any profit gained from income-producing property must be considered income to the applicant or recipient.  However, the property itself is an exempt resource.

940-4           DETERMINING MONTHLY NET INCOME

Eligibility for Chronic and Acute Medical Assistance exists only if the household’s prospective income for the benefit month does not exceed the need standard in the following table:

If the income is equal to or higher than the need standard, the applicant is not eligible for CAMAChronic and Acute Medical Assistance.

If the income is under the need standard and all other eligibility criteria are met, the applicant is eligible for CAMAChronic and Acute Medical Assistance.

To determine monthly net income:

1. COUNT all prospective earned, unearned, or in-kind income expected to be received from any source in the calendar month after which application is made, and all income reasonably expected to be received in time to meet the specific needs.  Note:  income received weekly is multiplied by 4.3, that received every two weeks by 2.15, that received twice monthly by 2, and that received monthly by 1.
    
2. SUBTRACT from gross earned income all payroll deductions required by the employer, including federal income tax, FICA, unemployment    insurance, union dues, insurance premiums, and retirement from gross earned income.  If some, but not all, of the above deductions were made, subtract only those deductions actually made, incurred, or due.  If none of these deductions has been made, apply a standard 20% deduction from gross income and

• SUBTRACT from earned and unearned income, all voluntary health insurance premiums which are paid for persons included in the household; and
  
  
• SUBTRACT from unearned income, all mandatory deductions (e.g. taxes and child support garnishments from UIBUnemployment Insurance Benefit).
  
   

3. DO NOT COUNT income received in the month of application.  Consider this income a resource if retained.

Eligibility for CAMAChronic and Acute Medical Assistance is determined using the GMAS screen on EISEligibility Information System.  A manual determination can also be made using the CAMAChronic and Acute Medical Assistance Budget Worksheet.  See Appendix B.

940-5          DEFINITIONS RELATED TO INCOME

Income:  Money and benefits received by an individual, usually on a regular basis, which must be considered when making an eligibility determination.

Earned Income:  Income earned through the receipt of wages, salaries, commissions, profits from self-employment or obtained as an employee.

In-Kind Income: Income received by barter for subsistence needs, including housing in exchange for building management.

Unearned Income:  Income received (but is not limited to) unsecured loans, Social Security benefits, child support, alimony, dividends (including native corporation distributions), unemployment benefits, BIA benefits if paid directly to the client, strike benefits, and tax refunds.

940-6          SPECIAL INCOME PROVISIONS

The following items are not counted as income for CAMAChronic and Acute Medical Assistance purposes:

PFDPermanent Fund Dividend:  An Alaska Permanent Fund Dividend.

Vendor Payments:  A vendor payment is any payment made directly to a vendor (i.e., landlord, utility company, grocery store) from a third party that does not pass through the hands of the CAMAChronic and Acute Medical Assistance recipient.

Loans:  Loans used to obtain necessary medical services, including medically related transportation and accommodations.  Any portion of the loan in excess of the amount used to pay for medical services is considered income in the month received.  Any portion of the loan not spent in the month received is considered a resource in following months.  

Alaska Student Loans:  The use of Alaska student loans is guided by state statute, which indicates that the funds cannot be used to pay for medical services. Since these loans are not intended to be used to pay for medical bills, any portion of the loan not spent when application is made will not be considered available to the applicant and is not considered income or a resource to the applicant.

Other Student Loans and Grants:  If a student loan (i.e., Stafford loan) or student grant (i.e., Pell Grant) is paid directly to the school, it is considered a vendor payment.  If monies are sent directly to the applicant from the student loan or grant and those monies are left over, or if the entire student loan or grant was sent to the applicant and has not been spent on school as it was intended, that amount is considered income in the month received or a resource if retained the month after receipt.  If the applicant can document that the conditions of the loan or grant prohibit spending the money for a non-educational purpose or require that the student document the purchase of tuition, books, etc., the caseworker should use “prudent person judgment” (PPJ) to exclude that amount from income and/or resources.

Contributions:  A cash contribution received from an individual or organization intended to defray medical costs, including medically related transportation.  Any portion of that contribution not spent in the month of receipt is considered a resource in the following months.  Cash contributions must be clearly identifiable from the applicant’s other income and resources and its intended use must be verified.

Foster Care Payments:  A foster care payment or guardian subsidy that is used for the welfare or support of a child living in the home. Any additional compensation for the time and effort of caring for a child (i.e., a payment that is not for the food, clothing, or shelter costs for a foster child) that is not used for the direct welfare and support for the child is counted as income.  This does not apply to subsidized adoption payments, which are counted as income for CAMAChronic and Acute Medical Assistance purposes.

Americorps Payments: Any payments paid to volunteers under Americorps programs of the Corporation for National and Community Service are excluded income. Americorps programs include Americorps *State and National, Americorps *VISTAVolunteers in Service to America, and Americorps *NCCC (National Civilian Community Corps.).