MAP Income Policy

Income Policy

Purpose: To determine income for eligibility purposes for the Medical Access Program (MAP).

I.     MAP and MAP/CAP Income Guidelines

Clients may be eligible for MAP and MAP/CAP based on the income guidelines and situations listed below:

1.  MAP: Up to 100% of the Federal Poverty Guideline

A.  Travis County residents who meet the U. S. Residency Policy.

B.  Travis County residents identified in the eligibility database with the marker: MAP Income Limit: This person is eligible to be screened for MAP at the 100% FPIL income limit.

2.  MAP: Up to 200% of the Federal Poverty Guideline

A. Travis County residents who meet one of the following criteria:

     i.  Have been determined disabled through the Social Security   Administration including the homeless and do not have Medicare; or

     ii.  Elderly (67 or older) and do not have or do not qualify for Medicare; or

     iii.  Are undocumented and elderly (67 years or older) and can show  20 continuous years of residency in the United States.

3.  MAP/CAP: Up to 50% of the Federal Poverty Guideline

A.  Travis County residents who are undocumented.

II.  Sponsor’s Income Requirements

If a client presents a Permanent Resident Card (I-551) received within the last 3 years and was sponsored into the United States, count both the client’s and sponsor’s earned and unearned income unless one of the following exceptions applies:

 A.  The sponsor receives SSI or TANF and also has Medicaid.

 B.  The individual’s Permanent Resident Card (I-551) has a code that indicates the individual is in one of the following immigrant categories:

a.  Abused spouse or children, parents of abused children, or children of abused spouse

b.  Afghan and Iraqi Special Immigrant

c.  Conditional Entrant (Refugee)

d.  Asylee

e.  Cuban/Haitian Entrant

f.  Conditional Permanent Resident

g.  Parolee

h.  NACARA 203 Relief (Immigrant under Nicaraguan Adjustment and Central American Relief Act, Section 203)

i. Victim of Trafficking or Crime

j.  Refugee

C. The individual claims to be a victim of battery, abuse, or cruelty from their sponsor and he/she is no longer living with that sponsor:

Example A: Client X applies for MAP and presents a Permanent Resident Card. In addition to other documentation, she is asked to produce a statement from her sponsor regarding his income. The client states that the sponsor is her uncle and he works as a gardener. However, she is unable to ask for a statement from him because she called the police and charged him with assault. Assuming the client meets all other criteria and she states she no longer lives with her sponsor, the client would be exempt from providing a statement from her sponsor, and determined eligible for the MAP Program.

Example B: Client Z applies for MAP and presents a Permanent Resident Card. In addition to other documentation, she is asked to produce a statement from her sponsor regarding his income. The Client states that her sponsor was her mother but she is now dead. As a result, she is not able to provide a statement regarding her sponsor’s income. While examining her Permanent Resident Card, the interviewer notices a code on her card identifies her sponsor as a sibling. The client admits that the sponsor is her brother and that he works as a gardener. However, she is unable to ask for a statement from him because she called the police and charged him with assault. Assuming the Client meets all other criteria, the interviewer will also ask for information regarding her brother’s arrest. In this case, a police report. Only after this criterion is met will the client be determined eligible for MAP. The client misrepresented who her sponsor was and now must provide evidence of abuse.

D. If client has a passport stamped with an I-551 do not count the sponsor’s income until client presents a Permanent Resident Card.

III. Income Frequency and Multipliers

MAP and MAP/CAP eligibility is based on the last 4 weeks of income including the day of their appointment and is determined by the frequency with which the client receives the income.

1. Weekly

A. The last 4 weeks of income including income received the day of their appointment (e.g., if the client is paid every Friday and the initial appointment is Wednesday, the 4-week period would begin with the last Friday the client received income).

B. The weekly income multiplier is 4.33.

2. Bi-weekly/Every Two Weeks

A. The last 2 payments the client received including payment received the day of their appointment.

B. The bi-weekly/every two weeks income multiplier is 2.17.

3. Semi-monthly

A. The last 2 payments the client received including payment received the day of their appointment.

B. The semi-monthly income multiplier is 2.

 4.  Monthly

A. The last payment the client has received including payment the day of their appointment.

IV. Counted Income

1. The following income should be counted:

A.  Wages, salaries and commissions for each household member unless otherwise exempted

B.  Vacation Pay

C.  Income from loans received on a regular monthly or weekly basis

D.  Earned income received by a student on a regular monthly or weekly basis except for income received from a work-study program

E.  Long and Short-Term Disability Insurance payments

F.  Social Security Disability Income (SSDI) (exclude income for individuals with both SSDI and SSI as they are eligible for Medicaid)

G. Workforce Investment Act (WIA) On-the-Job (OJT) Program payments to adults (Note: payments to a child under 19 are exempt)

H.  Military pay minus pay withheld to fund education under the G.I. Bill

I.  Pension or retirement benefits

J.  Retirement, Survivors, and Disability Insurance (RSDI) benefit amount for a child not on Medicaid minus any amount being recouped for prior overpayment

K.  Regular trust fund income

L.  Regular Contributions

M.  Tip income

N.  Unemployment Compensation Payments minus any amount being recouped for prior overpayment

O.  Veteran’s Administration Payments minus any amount being recouped for prior overpayment

P.  Workers’ Compensation Payments except for payments paid to reimburse the household for out-of-pocket health care expenses

Q.  Dividend, interest and royalty income

R.  Lump sum payments received more than once a year

V. Exempt Income

1.  The following income should not be counted:

A.  Child Support payments for children in the household

B.  Crime Victim’s Compensation payments

C.  Federal Income Tax Refunds

D.  Mileage Reimbursement

E.  Energy Assistance payments

F.  Earned income received by a family member under 18 years of age if the minor is enrolled in school full or part-time (e.g., high school, GED, or any vocational institution). Verification of school attendance is not required.

G.  A client’s income that ceases during the four week period

H.  Educational assistance (i.e. work-study income and loans, scholarships, and grants received in a lump sum payment, to the institution or student)

I.  Adoption payments

J.  Foster care payments

K.  Government disaster payments

L.   In-kind income (i.e. clothing, public housing, food, etc.)

M.  Workforce Investment Act (WIA) On-the-Job Program payments to a child under 19

N.  Earned and unearned income from an individual receiving both RSDI and Supplemental Security Income (SSI) or SSDI and   SSI, only SSI or TANF (Note: These individuals also receive Medicaid.)

O.  Retirement, Survivors, Disability Insurance (RSDI) benefit amount for a child on active Medicaid

P.  Money received that is intended and used for the maintenance of a person who is not a member of the household

Q.  Amounts being recouped for prior overpayments for RSDI, unemployment compensation, VA and worker’s compensation payments.

R. Refugee Cash Assistance

S.  Payments made under any of the following programs:

a)       AmeriCorps

b)      Food Stamp Program, Supplemental Nutrition Assistance Program (SNAP)

c)       Foster Grandparents

d)      Learn and Serve

e)       National Senior Services Corps (Senior Corps)

f)       Nutrition Program for the Elderly (Title III, Older American Act of 1965)

g)      Senior Companion Program

h)      Volunteers in Service to America (VISTA)

i)        Women, Infants, and Children (WIC) Program

VI. Deductions
1.  Deduct Child Support paid out

VII. Additional Considerations in Counting Income

1.   If a client recently began employment (verification not required) use the rate of pay and the number of hours to be worked per week to calculate the monthly income.

2.   If a client receives sporadic income from any source (excluding mileage reimbursement), the average weekly amount will be converted to a monthly figure.

3.   Seasonal workers such as teachers or school employees and agricultural workers will have their annual income from this source divided by 12 to determine average monthly income. Verification of seasonal income includes:

A.  Telephone verification

B.  Employment Verification Form

C.  IRS document

VIII. No Income

Clients are not allowed to self-declare they have no income. Clients who declare they have no income must complete and sign a Zero Income Statement.

IX. Self-Employment

Self-employment income is earned or unearned income (i.e. rental income) available from one’s own business, trade, or profession rather than from an employer. In addition, if an employer does not withhold FICA of income taxes, even if required to do so by law, the person is considered self-employed (i.e. day laborer, house cleaning, etc.).

Self-employment income is calculated on a monthly basis, using the monthly income calculation. The client completes an Applicant Statement of Self-Employment form and provides verification of income (e.g., checks, income log generated by the client). Receipts for allowable expenses must be provided for 30 days prior to the date of the interview if the client wishes to deduct allowable expenses. Listed below are the allowable and unallowable expenses.

1.   Allowable Expenses (all allowable expenses listed as deductions must be verified by a receipt)

A. Labor (Letter from employee stating income received)

B.  Fuel for equipment (e.g., lawn mowers and chain saws)

C.  Machinery/ equipment repairs

D.   Lease or rent for office space

E.   Utilities for office space

F.   Supplies (e.g., paint brush, shovels, hammer, food for business purposes only)

G.   Transportation costs

a)  The client may choose to use the IRS mileage rate per business use mile or keep track of expenses. Mileage logs indicating all business related mileage is counted at 100% but no other vehicle expenses will be deducted (e.g., insurance, repairs, or fuel). The log must have the following information: date of trip, number of miles driven, and the purpose of the trip. Example: If the client presents a mileage log that states 500 miles were driven for business only expenses, then multiply the number of miles and the IRS mileage rate to determine the allowable expense.

b)  Repairs, insurance, and fuel are prorated on the percent of the time that the client states that the vehicle is used for business- related activities.

Example: If the client states that the vehicle is used 60% of the time for business purposes, then 60% of the total of the business vehicle expense receipts will be counted as an expense.

H.   Business travel related expenses (e.g., parking and hotels)

I.   Communication devices (e.g., pagers and cell phones)

a)  Prorate bills on the percent of the time that the Client states the device is used for business-related activities. Example: If the client states that the device is used 50% of the time for business purposes, then 50% of the bill/receipt will be counted as an expense.

J.   Capital asset improvements

K.   Capital asset purchases such as real property, equipment, machinery and other durable goods expected to last at least 12 months (e.g., vehicle, lawn mower, and refrigerator)

L.   Identifiable costs of seed and fertilizer

M.   Insurance premiums

N.   Interest from and principal payments for business loans on income-producing property

O.   Linen service

P.   Property tax

Q.   Raw materials

R.   Sales tax

S.   Credit card charges for any of the above

2.   Unallowable Expenses

A.   Primary residence mortgage/lease

B.   Primary residence utilities

C.   Meals

C.   Recreational expenses

D.   Costs related to producing income gained from illegal activities such as prostitution and the sale of illegal drugs

E.   Depreciation

3. The allowable/unallowable expense list above is not all-inclusive and each case may be reviewed on a case-by-case basis. All allowable expenses listed as deductions, must be verified by a receipt.

 X. Required Documentation

One of the following is required for income documentation to verify each source of income received by all family members:

Frequency of Income/ Type of Income	Required Documentation	Agency to Supply Documentation
1. Weekly income	The last 4 weeks including pay received the day of their appointment for which the Clients have received payment (e.g., if the Client is paid every Friday and the initial appointment is Wednesday, the 4-week period would begin with the last Friday the Client received income).	Client’s employer
2. Biweekly/Every two weeks income	The last 2 payments the Client has received including pay received the day of their appointment.	Client’s employer
3. Semi-monthly income	The last 2 payments the Client has received including pay received the day of their appointment.	Client’s employer
4. Monthly income	The last payment the Client has received including pay received the day of their appointment.	Client’s employer
5. If the Client cannot provide any of the above documentation, the Client’s employer may complete a Central Health Employment Verification Form	———-	Client’s employer
6.  Central Health Applicant Statement of Self-Employment Form	Checkbook(s)/ check register is not considered proof of income or expenses. Receipts for allowable expenses must be provided for the 30 days prior to the date of the interview if the Client wishes to deduct allowable expenses. Please see list of allowable/unallowable expenses listed in Section IX.A and B.	Client
7.   V.A. Benefits	Benefits letter	Veteran’s Administration
8. Retirement Benefits	Benefits letter	Client’s retirement program
9. Bank statements (for interest payments)	Bank statement(s)	Client’s bank
10. Retirement, Survivor’s, Disability Insurance Benefits	RSDI benefits letter	Social Security Administration
11. If the Client is being supported by someone else, the Client can provide a written statement from the person supporting them or the supporter can complete a Central Health Residence and Financial Support Statement	Central Health Residence and Financial Support Statement	Client’s supporter
12. Worker’s Compensation	Worker’s Compensation Benefits letter	Texas Department of Insurance Division of Workers’ Compensation
13. Unemployment Benefits	Unemployment Benefits letter or check stubs	Texas Workforce Commission
14. Day laborer income	Other Earned Income Form or Self Employment Ledger	Client
15. Workforce Investment Act (WIA) On-the-Job Training Program payments	Copy of WIA OJT acceptance letter and/or training plan	Texas agency case managing participant
16. Zero Income	Signed Zero Income Statement	Client
17. MAP Exempt Income (Child Support and/or SSI)	Blank Affidavit Optional   NOTE: For DSHS Grants, proof of child support received is required and must be dated within the last 30 days (OAG payment print, child support letter, etc.)	Client
18. Child Support Deduction	-30 day print out from OAG Office -Current check stubs showing child support deductions -SSA Letter (within 30 days) showing child support withheld/garnished. Record in budget Group Deduction section of the Certification Form	Client

 

 

XI.  Clients screened at higher FPIL-MAP expansion

All clients identified in the eligibility database with the marker: MAP Income Limit: This person is eligible to be screened for MAP at the 100% FPIL income limit must provide one of the acceptable documents listed in section IX. The documentation must be dated:

a.  For External MAP Referrals-Within 30 days of the EXT SFS date on the MAP track or

b.  For Internal MAP Referrals-Within 30 days of the Certification Date on the CCHC/SFS track

c.  For Both External and Internal MAP Referrals-Within 30 days of the File Date