Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 15.
MEDICAID ELIGIBILITY
Subchapter E. INCOME
40 TAC §15.460
The Texas Department of Human Services (DHS) adopts a federally-
mandated amendment to §15.460, concerning income exemptions, in its Medicaid
Eligibility chapter.
DHS has a contract with the Social Security Administration under section
1634 of the Social Security Act that requires it to use policy for the Supplemental
Security Income program in determining eligibility for Medicaid in its long
term care programs.
Federal regulations (Volume 65, Number 251, pages 82905-82912) effective
January 1, 2001, increased the student earned income exclusion from $400 to
$1290 monthly, with an annual limit increase from $1620 to $5200. These amounts
will now increase annually, with amounts set by the Social Security Administration.
Justification for this amendment is to incorporate these federally mandated
changes.
The amendment is adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which authorizes the department to administer public
and medical assistance programs and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assistance funds.
The amendment implements the Human Resources Code, §§22.001-
22.030 and §§32.001-32.042. The amendment is adopted in compliance
with federal requirements effective January 1, 2001.
§15.460.Income Exemptions.
(a)
The income described in this section is not counted in
eligibility or payment-plan determination. The disregarding of this income
is called an exemption. An exemption is not an exclusion. Exempt income is
never counted in eligibility or payment-plan determination.
(b)
The Texas Department of Human Services exempts income that
a client receives from any of the following sources:
(1)
cash received from the sale of a resource. This cash is
a resource, not income.
(2)
value of medical services provided to a client free of
charge or paid for with direct payment to the provider by someone else. Medical
services, including in-kind medical items, are never income regardless of
the source of the service or the source of payment for the service. Payments
by a third party of an individual's medical insurance premiums are not considered
a medical service, but they are not income. Items which do not qualify as
a medical service may qualify as items received in conjunction with a social
service and may not be income.
(3)
premium payment for supplementary medical insurance benefits
(SMIB) under Title XVIII (Medicare), paid by a third party directly to the
Social Security Administration.
(4)
cash or in-kind payments for social services provided by
a federal, state, or local government program.
(5)
reimbursement for medically-related payments that a client
has previously made or for payments that he owes because of medically- related
services already received. Cash contributions from family members to the client
for Medically-related payments (made or owed by the client) are not considered
income exemptions.
(6)
the amount of income of a dependent who is receiving Supplemental
Security Income (SSI) or Temporary Assistance for Needy Families (TANF).
This income has already been considered in determining the dependent's need
for SSI or TANF.
(7)
grant, scholarship, and fellowship funds used to pay tuition
and fees at an educational institution (including vocational and technical
schools). Any portion of a grant, scholarship, or fellowship used to pay any
other expense, such as room, board, or books, cannot be exempt.
(8)
home produce for home consumption.
(9)
infrequent or irregular income. Infrequent or irregular
income is excluded from the eligibility determination if the total per month
is $20 or less in unearned income and $10 or less in earned income; and if
the income is received only once per calendar quarter from a single source
or cannot be reasonably anticipated. If received in a larger amount or more
frequently than specified, the entire amount is included in determining eligibility.
(A)
Income need not be both infrequent and irregular to be
excluded. The exclusion applies only to infrequent or irregular income in
which the total income from all sources does not exceed the dollar limits.
The frequency is evaluated for the quarter, but the dollar amount is evaluated
for the month.
(B)
Irregular payments that do not exceed the dollar limits
when combined with other irregular and infrequent incomes received in the
same month are not counted as income.
(10)
payments for foster care of a child if the child
(A)
is not eligible for SSI; and
(B)
was placed in the client's home by a public or private,
nonprofit child-placement or child-care agency.
(11)
one-third of the total amount of child support payments
for an eligible child.
(12)
earnings of a child who is a student regularly attending
school, with limits set by the Social Security Administration for the Supplemental
Security Income program and published annually in the Federal Register. This
exemption applies until the child is 22.
(13)
benefits received under Title III, Public Law 100-175.
(14)
value of meals and benefits provided under the Child Nutrition
Act of 1966.
(15)
value of meals provided under the National School Lunch
Act as amended by Public Law 90-302 of 1968.
(16)
benefits received from Title II of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970.
(17)
salaries, value of meals, and travel allowances to participate
in the Retired Senior Volunteer Program and in the Foster Grandparent Program
of Title II of the Domestic Volunteer Service Act of 1973 (formerly Title
VI of the Older Americans Act). Also included are payments from Title III
of the same act, which include the Service Corps of Retired Executives (SCORE),
the Active Corps of Executives (ACE), and the Action Cooperative Volunteer
Program (ACV). Wages and salaries from Title V of the Older Americans Act,
such as Green Thumb and Senior Texan Employment Program (STEP) are not exempt
income.
(18)
payments by the Federal Disaster Assistance Administration
authorized by the Disaster Relief Act, as amended.
(19)
value of any housing assistance payment paid on a house
under the United States Housing Act of 1937, the National Housing Act, the
Housing and Urban Development Act of 1965, §101, or Title V of the Housing
Act of 1949, as authorized by Public Law 94-375.
(20)
home energy assistance, except food or clothing under
Public Laws 97-377 and 97-424. Home energy assistance is assistance in cash
or in- kind that is provided by a private, nonprofit organization or a utility
company. Some examples of home energy assistance are heating, cooling, weatherization,
storm windows, and blankets.
(21)
proceeds of either a commercial loan or an informal loan,
for which repayment is required with or without interest. The proceeds (amount
borrowed) are not counted as income in the month in which they are received
but are considered to be a resource in the following month(s). To claim exemption
of the proceeds of a loan, a client must prove that he acknowledges an obligation
to repay and that some plan for repayment exists. If these conditions can
be verified, no written contract is required.
(22)
interest earned on excluded burial funds and any appreciation
in the value of an excluded burial arrangement that are left to accumulate
and become a part of separately identifiable burial fund. If the burial funds
increase by more than $1,500 because of contributions by client actions, the
amount in excess of $1,500 is a countable resource.
(23)
value of any noncash item (other than food, clothing,
or shelter) for the month of receipt, if that item would become a partially
or totally excluded resource were it kept into the month after the month of
receipt.
(24)
Agent Orange Settlement Fund or any other fund established
in settlement of the Agent Orange product liability litigation. Public Law
101-239 excludes the payments from countable income and resources. The law
covers both disability and death benefits and is retroactive as of January
1, 1989.
(25)
reparation payments received by Holocaust survivors from
the Federal Republic of Germany. The payments may be made periodically or
as a lump sum. DHS accepts the client's signed statement of amounts involved
and dates of payment.
(26)
payments from a state-administered fund to aid victims
of crime.
(27)
payments a state or local government may make as relocation
assistance.
(28)
compensation received under the Radiation Exposure Compensation
Act for injuries resulting from exposure to radiation from nuclear testing
and uranium mining.
(29)
payments to an ICF-MR client by the MR facility, intended
to enhance the client's social skills and functional abilities. The use of
such payments must be included in the client's active treatment plan.
(30)
hazardous duty pay of a spouse or parent absent from the
home because of active military service.
(31)
restitution payments made by the United States government
under Public Law 100-383 to Japanese-Americans (or, if deceased, to their
survivors) and Aleuts who were interned or relocated during World War II.
(32)
reparation payments received under Sections 500-506 of
the Austrian General Social Insurance Act.
(33)
payments under the Netherlands' Act on Benefits for Victims
of Persecution 1940-1945 (Dutch acronym, WUV).
(34)
payments from any source made to individuals because of
their status as victims of Nazi persecution.
(35)
interest or other earnings on any designated account established
for Supplemental Security Income (SSI) clients under age 18 for retroactive
benefits, as required by Public Law 104-193, effective August 22, 1996.
(36)
payments made in the class settlement of the Susan Walker
vs. Bayer Corporation lawsuit, as required by Public Law 105-33, effective
August 5, 1997.
(37)
payments from the Department of Veterans Affairs made
to or on behalf of certain Vietnam veterans' natural children regardless of
their age or marital status, for any disability resulting from spina bifida
suffered by such children as required by Public Law 104-204, effective October
1, 1997. Interest earned on unspent payments is not excluded.
(38)
gifts from tax-exempt organizations, such as the Make-A-Wish
Foundation, to children with life-threatening conditions, as required by Public
Law 105-306, effective retroactively to October 28, 1996. The exclusions apply
to children under age 18. The gift must be from an organization described
in Section 501(c)(3) of the Internal Revenue Code of 1986 and which is exempt
from taxation under Section 501(c). The eligibility specialist documents the
case record with an oral or written statement from the organization that the
gift was made based on the child having a life-threatening condition. No additional
medical development is necessary.
(A)
The following gifts to or for the benefit of a child described
above are excluded from income:
(i)
Any in-kind gift, not converted to cash; and
(ii)
A cash gift to the extent that the cash excluded under
this provision does not exceed $2,000 in any calendar year. Cash in excess
of $2,000 received in a calendar year is subject to regular income counting
rules.
(B)
If an in-kind gift is converted to cash, the cash counts
as income in the month converted. For purposes of this exclusion, an in-kind
gift is any gift other than cash, including gifts of food, clothing, or shelter.
(C)
The exclusion also applies to a deeming situation if the
gift is made to a parent for the benefit of a child with a life-threatening
condition.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of
the Secretary of State on April 30, 2001.
TRD-200102443
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: January 1, 2001
For further information, please call: (512) 438-3108
Chapter 371.
INACTIVE/RETIREE STATUS
Part 12.
TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS