Library: Policy
317:35-5-42. Determination of countable income for individuals categorically related to aged, blind and disabled
Rule text available at Oklahoma Health Care Authority website.
INSTRUCTIONS TO STAFF 317:35-5-42
Revised 6-1-21
1. When income is below the Supplemental Security Income (SSI) standard, individuals related to aged, blind, or disabled (ABD) must apply for SSI benefits to be eligible for the State Supplemental Payment (SSP) cash assistance.
2. For data exchange information refer to:
(1) Oklahoma Administrative Code (OAC) 340:65-3-4; and
(2) Quest articles "State Data Exchange (SDX) Payment Status Codes," "State Data Exchange (SDX) Recipient Payee Codes," and "Benefits Data Exchange Inquiry (BENDEX) Codes."
3. Refer to Quest articles "Asset Verification System: Asset Verification System (AVS)" and "How to Access Asset Verification System in FACS" for information regarding AVS. Refer to OAC 340:65-3-4 for information regarding data exchange screens, public records, and collateral contacts.
4. SSI is notified as soon as possible when the individual is expected to remain in the nursing facility for longer than three months.
5. The Veteran's Affairs (VA) benefit is not reduced to $90 until the individual is residing in the nursing facility, is approved for SoonerCare (Medicaid), and the VA is notified. The VA income cannot be disregarded until it is reduced to $90, no matter how long the individual resides in the nursing facility.
6. Refer to Quest article "Countable In-Kind Income" for more information.
7. Refer to Quest article "One Third Reduction Rule" for more information.
8. Medical insurance secured through the employer, whether purchased or as a benefit, is not considered in-kind but is recorded in the Family Assistance/Client Services Interview Notebook TPL tab for coordination with SoonerCare (Medicaid) benefits.
9. (a) The Oklahoma State Treasurer is responsible for certifying an achieving a better life experience (ABLE) account through the Oklahoma STABLE program. The Oklahoma STABLE program is administered through a partnership with Ohio's STABLE Accounts. ABLE account rules state:
(1) only individuals whose disability was established before 26 years of age can set up an ABLE account, and one account is allowed per individual;
(2) there is no limit to the number of persons who can contribute to the ABLE account;
(3) upon the death of an ABLE participant, qualified disability expenses (QDE) may be paid from the account. All remaining funds in the account must be paid to the state Medicaid agency to repay costs of care received by the individual up to the amount of Medicaid paid after establishment of the ABLE account; and
(4) when money is withdrawn to pay a QDE, the amount withdrawn is excluded from income or resource consideration. QDE means any expenses related to the eligible individual's blindness or disability and approved, per Section 529A of the Internal Revenue Code that are made for the benefit of an eligible individual who is the designated beneficiary, including, but not limited to, expenses for:
(A) education;
(B) housing;
(C) transportation;
(D) employment, training, and support;
(E) assistive technology and personal support services;
(F) health, prevention and wellness, financial management, and administrative expenses;
(G) legal fees;
(H) oversight and monitoring; and
(I) funeral and burial expenses.
(b) Centers for Medicare and Medicaid Services guidance states that, per Section 103 of the ABLE Act, contributions to an ABLE account, distributions from the account for qualified disability expenses, and the account balance are disregarded in determining the individual's SoonerCare (Medicaid) eligibility. This disregard also applies to the ABLE accounts of individuals whose income or resources are deemed available to a SoonerCare (Medicaid) applicant who receives Supplemental Security Income (SSI), such as a spouse.
(c) Any money deposited in the ABLE account in a calendar year that is in excess of the annual federal gift tax exclusion is considered as a countable resource. A distribution from an ABLE account is only considered as a countable resource when it is retained after the distribution month and is used for a non-QDE. Distributions are never considered countable income. The current gift tax exclusion amount is $15,000 per calendar year and the maximum balance in an ABLE account is $468,000. Refer to okstable.org for current eligibility information.
(d) When an individual receives SSI and his or her ABLE account balance exceeds $100,000, the Social Security Administration suspends the individual's SSI based on excess resources. When this occurs, the individual continues to be eligible for SoonerCare (Medicaid) benefits.
(e) Once the client provides documents that verify the account is a valid ABLE account, no further account verification is required. When the individual receives SSI and is passively renewed, no further inquiry regarding the ABLE account is made at renewal. At renewal, when the individual does not receive SSI, the worker asks if the account is still open and if he or she believes the deposits in and expenditures from the account are in compliance with the terms and requirements of that particular 529 account. When the individual answers yes, no further inquiry is needed.
10. Programs based on need that use income as an eligibility factor and are wholly or partially funded by the federal government or a nongovernmental agency include, but are not limited to:
(1) SSI;
(2) SSP program;
(3) Temporary Assistance for Needy Families;
(4) Refugee cash assistance;
(5) assistance provided under the Disaster Relief and Emergency Assistance Act;
(6) Bureau of Indian Affairs (BIA) general assistance programs;
(7) state or local government assistance programs based on need; or
(8) VA payments based on need.
11. (a) Expenses are deductible as paid but may not exceed the earned income amount. When the individual has a spouse who is also eligible due to blindness and both are working, ordinary and necessary expense amounts that are attributable to each of their earnings may be deducted for each of them. The expense does not need to be directly related to the individual's blindness to be deductible.
(b) When the individual has Medicare, refer to OAC 317:35-7-40, 317:35-7-43, and 317:35-7-46, to determine Medicare buy-in eligibility.
12. (a) When using BENDEX to verify Retirement, Survivors, and Disability Insurance (RSDI) benefits, the worker drops any cents from the gross benefit amount in BENDEX Field B27 and uses only the whole dollar figure. For example, drop $349.50 to $349.00.
(1) When the person is dually entitled to receive RSDI benefits under two RSDI claim numbers, the person may receive benefits under one or both claim numbers.
(2) When the person receives a combined benefit, BENDEX displays two records for the person. Each record displays a "D" for dual entitlement in Field C21 and the cross referenced RSDI claim number in BENDEX Field B20.
(A) The worker counts the income displayed under the BENDEX record with a current pay (CP) payment status code in Field B20. The person receives the combined RSDI benefit amount under this RSDI claim number.
(B) The BENDEX record that displays adjusted for dual entitlement (AD) in payment status code Field B20 means the person does not receive income under that BENDEX record.
(3) The benefit issuance process used by the SSA may cause a $1 or $2 difference in the actual payment made to a person who receives combined benefits.
(4) When the person receives benefits under both RSDI claim numbers, each BENDEX record displays a CP in the payment status code Field B20. The worker adds the whole dollar figures in Field B20 together and drops the cents to arrive at the person's RSDI benefit. For example, when one record shows $202.51 and the other shows $361.23, the worker adds $202 to $361 to arrive at the person's countable income of $563.
(b) The SDX file contains data for SSI applicants and recipients. To view this data, enter SDX space Social Security number. When using SDX to verify SSI income, the worker rounds the amount shown to the nearest dollar. For example, 1¢ to 49¢ is rounded down and 50¢ to 99¢ is rounded up. Refer to Quest articles "How to Read SDX Screens, State Data Exchange (SDX) Payment Status Codes" and "State Data Exchange (SDX) Recipient Payee Codes."
13. The worker disregards earned income of $30 or less, or unearned income of $60 or less, received from the same source only once per quarter because it is irregular income.
(1) When income is received more than once a quarter from the same source or is received in subsequent months, it must be counted because it is not considered to be irregular income. For example, when an individual receives earned income of $20 in March and $20 in April, it is counted in both months because it was received in subsequent months although in different quarters.
(2) When an individual receives irregular income from more than one source, the worker adds the incomes together and disregards the first $30 of earned income or the first $60 of unearned income per quarter, when both incomes are received only once. For example, in May an individual receives a birthday gift of $50 and in June he or she receives royalty income of $20. The individual only receives royalty income when the accumulated royalties reach $15, so he or she rarely gets a check more than once a year. Since the total is $70 from two sources, the first $60 is disregarded and $10 is counted as unearned income in May.
14. After computing the new countable income amount, when the individual continues to be eligible for at least one dollar of SSI, no action is taken on the SoonerCare benefit or SSP amount because SSI makes the correction in retrospective cycle.
15. The $20 general income exclusion may be subtracted from the combined earned income or the unearned income, but not both. It is coded in the Income tab of the Family Assistance/Client Services (FACS) Eligibility notebook. The rest of the allowable earned income deductions are coded in the Non-Temporary Assistance for Needy Families (TANF) expense block in the Income tab.
16. An automated calculation transaction is available for computing the income amount to be deemed from a parent and spouse to an eligible child with disabilities or blindness. Refer to the Quest article "CID (Calculation for Income Deeming)" for income examples and information on how to enter information into the CID transaction.
17. The child must first be approved through Developmental Disabilities Services for one of the Home and Community-Based Services waivers.
