Section 22.24. Income provisions

(a) Income limits. Applicants shall have an annual income of $11,999.99 or less in the case of a single individual, or $14,999.99 or less combined income in the case of married couples, with the following exceptions:

(1) Married applicants will be subject to the income provisions for single individuals if each spouse maintains a separate residence and neither spouse has access to, or receives support from, the other’s income during the year for which income is declared as provided for in subsections (d) and (f).

(2) Married applicants will be subject to the income provisions for single individuals if either spouse is a resident of a long-term care facility during the year for which income is declared as provided for in subsections (d) and (f).

(3) Recently widowed or divorced applicants, will be subject to the income provisions for married couples if they had access to, or received support from, the former spouse’s income during the year for which income is declared as provided for in subsections (d) and (f).

(b) Income inclusions. Income includes income from whatever source derived, including but not limited to the following:

(1) Salaries.

(2) Wages.

(3) Bonuses.

(4) Commissions.

(5) Income from self-employment or partnership income.

(6) Alimony.

(7) Support money.

(8) Cash public assistance and relief.

(9) The gross amount of pensions or annuities including Railroad Retirement benefits.

(10) The gross amount of cash benefits received under the Federal Social Security Act, except Medicare benefits.

(11) Benefits received under State unemployment insurance laws.

(12) Veteran’s disability payments.

(13) Interest, including interest received from the Federal government, State government or an instrumentality or political subdivision thereof.

(14) Realized capital gains except as provided in subsection (c).

(15) Rental income.

(16) Workmen’s compensation benefits and the gross amount of loss of time insurance benefits, except those benefits granted under section 306(c) of the Workmen’s Compensation Act (77 P. S. § 513).

(17) Life insurance benefits and proceeds, except as provided in subsection (c).

(18) Gifts or bequests of cash or property, other than transfers by gift between members of a household, in excess of a total value of $300.

(19) Any amount of money or the fair market value of a prize, such as an automobile or a trip won in a lottery, a contest or by a form of gambling.

(20) Royalties.

(21) Dividends.

(c) Income exclusions. Income does not include the following:

(1) Surplus food or other noncash relief, including food stamps, supplied by a government agency.

(2) Property tax rebate payments, rent rebate payments, and inflation dividends received under the Senior Citizens Rebate and Assistance Act (72 P. S. § § 4751-1—4751-12).

(3) Medicare benefits.

(4) The first $5,000 of the total of death benefit payments received upon the death of each person from whom the benefits may be due.

(5) The difference between the purchase price of a person’s residence and its selling price, to the extent that the person uses the proceeds from the sale of the residence to purchase a different residence within 2 years of the sale of the former residence.

(6) The amount of damages received, whether by civil suit or settlement agreement, on account of personal injuries. Damages received means an amount received through prosecution of a legal suit, action or other claim based on tort or tort type rights, or through a settlement agreement entered into in lieu of litigation, except to the extent that the amount duplicates reimbursements previously received. Damages include black lung benefits and benefits granted under section 306(c) of the Workmen’s Compensation Act (77 P. S. § 513).

(7) Payments provided to eligible low income households under the Commonwealth’s Low Income Home Energy Assistance Program.

(8) With reference to client payments received by home providers of the domiciliary care program administered by the Department under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), that portion of the payments which, for any specific income year, does not exceed the actual expenses of providing domiciliary care services.

(d) Declaration of income. An applicant shall declare the total annual income for the calendar year immediately preceding the year in which the applicant applies to participate in PACE.

Example—An applicant applies to participate in the PACE Program on August 16, 1990. The applicant shall declare his total annual income for the previous year, which is calendar year 1989. Accordingly, the applicant shall declare all of the income which he received from January 1, 1989 up to and including December 31, 1989.

(1) The applicant shall indicate, in spaces provided on the PACE Application Form, the source and amount of each type of annual income.

(2) The applicant shall declare all income, as defined in this section, identifying each source separately.

(3) A married applicant, unless covered under subsection (a), shall declare all applicable income of the spouse, identifying each source separately. If only one spouse is applying for PACE benefits, that spouse shall declare all applicable income of both spouses.

(4) The failure to provide truthful information with respect to this section will subject the applicant to the criminal penalties provided in § 22.72 (relating to prohibited acts and criminal penalties).

(e) Documentation of income. An applicant or a claimant may be required to document the annual receipt of income, derived from all sources, when requested to do so by the Department. Whenever this is the case, the following are examples of documents, photocopies of which shall be provided as reasonable proof of income:

(1) Federal, State or local income tax returns.

(2) Pension checks, annuity checks or checks from other sources of income. When the checks are issued monthly, or on some other less-than-annual basis, a photocopy of the check for a single month, or other applicable period, will suffice. United States Treasury checks may not be photocopied.

(3) Statements from a financial institution where direct deposit is made for the applicant or claimant or statements from a government agency, such as the Social Security Administration or the Railroad Retirement Board.

(4) Another type of document which is likely to verify the type and amount of income.

(f) Period used to determine income. For purposes of PACE eligibility, the income, as defined in § 22.2 (relating to definitions) and this section, used to determine eligibility will be that income received by an applicant during the calendar year immediately preceding the year in which the applicant applies to participate in PACE.

The provisions of this § 22.24 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, except subsection (a) which shall take effect April 1, 1985, 15 Pa.B. 1163; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96825) to (96828).

Notation

Notes of Decisions

Declaration of Income

The Department of Aging did not err in denying the claimant benefits based upon the receipt of past due Social Security benefits in 1999 when, in fact, those benefits were attributable to years prior to 1997, since this regulation illustrates that all income acquired between January and December of a given year is to be considered as income. Scanlon v. Department of Public Welfare, 739 A.2d 635 (Pa. Cmwlth. 1999).

Participation in PACE Based on Preceding Year’s Income

Department of Aging Pharmaceutical Assistance Contract for the Elderly (PACE) regulation that eligibility is based on income received by applicant during calendar year immediately preceding year in which applicant applies to participate is not an unreasonable interpretation of the statute. Peek v. Department of Aging, 873 A.2d 43, 47 (Pa. Cmwlth. 2005).

Cross References

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.21 (relating to general claimant eligibility policy); 6 Pa. Code § 22.33 (relating to responsibilities of the applicant in the application process); and 6 Pa. Code § 22.42 (relating to responsibilities of the claimant in the eligibility redetermination process).