Section 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 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; amended July 28, 2000, the provisions under Act 20 effective July 1, 1995, the provisions under Act 35 effective retroactive June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211622) to (211624).

Notation

Authority

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)).