|Release 70B: Effective August 1, 2013|
Medical Assistance Programs -
The Medical Assistance Assumed program provides medical assistance to low-income families when children are deprived of parental support because of continued absence, death, incapacity or unemployment. Eligibility is based in part on TANF program (formerly Aid to Families with Dependent Children) standards and methodologies instituted by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA).
The Application for Oregon Health Plan and Healthy Kids (OHA 7210), Oregon Health Plan (OHP) Standard Reservation List - OHP Application (OHP 7210R), Oregon Health Plan Application (online application) (OHP 7210W) or the Application for Services (MSC 415F) may be used by new applicants.
Medical applicants who are current recipients of any other Department of Human Services (DHS) or Oregon Health Authority (OHA) Self Sufficiency program are not required to submit an application at initial application or redetermination. The department may determine or redetermine medical eligibility without a new application, or by amending the current application.
To be eligible for MAA, a client must be a dependent child or a caretaker relative of a dependent child. However, a dependent child or caretaker relative cannot receive MAA while foster care payments are being made for the child, with one exception. If a child in foster care is expected to return within 30 days, the caretaker relative may be eligible for MAA based on the expected return of the child. Confirm the expected return date with Child Welfare (CW).
A dependent child must be under the age of 18, or 18 and regularly attending high school or equivalent full time.
Definitions for Chapter 461: 461-001-0000
Age Requirements for Clients to Receive Benefits: 461-120-0510
Regular School Attendance: 461-120-0530
Caretaker relatives can also receive MAA if their only child is an SSI recipient, if they are not requesting medical benefits for their child, or their child is ineligible for MAA only because citizenship has not been documented yet. In each of these cases, there is still a dependent child in the household.
Either parent whose only child is an unborn child can qualify for MAA if the mother's pregnancy has reached the calendar month before the month in which the due date falls.
Either parent of the unborn child can receive MAA even before the mother's pregnancy has reached the calendar month before the month in which the due date falls if there is another dependent child in the filing group.
For ongoing MAA/MAF/EXT/OSIPM clients who then become pregnant, add the pregnancy related coding (DUE and UB coding) without a redetermination.
|Note:||A redetermination for a current MAA benefit group may be necessary if a pregnancy now brings the father of the unborn into the filing group. Although the pregnant woman would have protected eligibility, the rest of the family may no longer be eligible for MAA.|
A minor parent will continue to be eligible for MAA if they lose TANF eligibility because they refuse to live with a parent or adult relative, or if they go over income due to deeming when they are required to return to live with a parent for TANF eligibility. The minor parent must also continue to meet all other MAA eligibility requirements.
People disqualified from TANF only because they have not cooperated with JOBS or substance abuse/mental health requirements are still eligible for MAA as long as they continue to meet all other MAA eligibility requirements.
Persons serving a TANF or SNAP intentional program violation (IPV) penalty may still qualify for MAA, even if not pregnant.
Assumed Eligibility for Medical Programs: 461-135-0010
Specific requirements; MAA, MAF, and TANF: 461-135-0070
TANF Eligibility for Minor Parents: 461-135-0080
Deemed Assets, Parents of Minor Parent; MAA, MAF, TANF: 461-145-0860
Household group (who is in the household?)
A household consists of people who live in the same house, apartment, or other dwelling. A dwelling can contain more than one household if it is divided into separate living units, or if a landlord/tenant relationship exists. To have a valid landlord/tenant relationship, the landlord must live independently and bill the tenant for rent at fair market value. They may share bathroom and kitchen facilities, but only in a commercial room and/or board establishment.
For homeless groups, the household is the people who consider themselves as living together.
Do not use a legal custody agreement to determine whether a child resides with the mother or the father. Instead, ask the parent where the child resided during the budget month. Be specific; you may need to ask questions about the particulars. For example, ask: Did the child reside with you on the first of the month? Where does the child live during the week? What days of the week does the child spend the night at your home?
Once you have the answers, determine the number of days the child resided in each household and calculate the percentage.
A person who leaves the household for short periods is considered to still be in the household if they intend to return. If they are gone for 30 continuous days or more, they are no longer in the household unless they must still be included under one of the following:
Household Group: 461-110-0210
Filing group (who must apply together?)
The filing group is the people from the household group whose circumstances are considered in the eligibility determination process. The filing group includes people who must apply together because of their relationship to eligible people.
When a person is in more than one filing group for the same program, the filing groups must be combined, unless specified otherwise in administrative rule.
For MAA, the filing group must include a parent or caretaker relative and dependent child or unborn.
People in the household group are included in the MAA filing group because of their relationship as follows:
People in the household group may be excluded from the MAA filing group as follows:
Filing Group; Overview: 461-110-0310
Filing Group; EXT, MAA, TANF: 461-110-0330
Financial group (whose income and resources are counted?)
The financial group consists of the filing group members whose income and resources count in determining eligibility and benefits.
For MAA, the financial group includes all the people in the filing group except the following:
When a minor parent lives with their parent, the income of the parent must be deemed to the minor parent unless the minor parent has been married or legally emancipated.
Financial Group; Overview: 461-110-0530
Deemed Assets, Parent of Minor Parent; MAA, MAF, TANF: 461-145-0860
Need group (what income standard is used?)
The need group consists of the people whose basic and special needs are used in determining eligibility. The number in the need group determines which income standard to use.
For MAA, the need group includes financial group members who meet all nonfinancial eligibility requirements, except that noncitizens do not need to meet the alien status requirement to be included.
There are some MAA financial group members who cannot be included in the need group:
Need Group: 461-110-0630
Noncitizens who meet all the financial and nonfinancial requirements of MAA except for their citizenship/alien status are eligible for limited emergency medical assistance. The policy for forming eligibility determination groups for CAWEM MAA is the same policy for the MAA program if they did meet the citizenship/alien status requirement.
Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070
Determining deprivation for a child
In order to receive MAA or MAF, a dependent child must be deprived of parental support or care because of absence, death, incapacity, unemployment or underemployment of a parent.
When a child lives with one parent or does not live with any parent, the basis of deprivation is the continued absence or death of a parent. When a child lives with both parents, the basis of deprivation is unemployment, underemployment, or incapacity of a parent.
|Note:||Not all children in a MAA or MAF need group will have the same basis of deprivation.|
Deprivation based on death
If either parent of a child is deceased and the other parent has not remarried, or has remarried but the stepparent is not living in the home, the child meets deprivation based on death.
Deprivation Based on Death: 461-125-0060
Deprivation based on continued absence
Continued absence may exist when the child lives with only one parent or does not live with any parent and the absent parent has been or is expected to be gone from the household for at least 30 days. The parent is considered absent when any of the following is true:
The parent is not considered absent when:
When parents have shared custody of a child it will be necessary to determine what percentage of nights the child sleeps in the home of each parent. A worker may need to ask the client what nights of the week the child sleeps in the home of the absent parent. Once this information is made available, calculate the percentage by dividing the total number of nights a month the child sleeps in the home of the absent parent by the number of days in that month. If the percentage is 30 percent or greater AND both parents make day-to-day decisions about the child’s life, there is no deprivation based on continued absence.
|Example 1:||Sarah and her child Charlie turn in an application requesting medical benefits, DOR 01/25/12. Sarah indicates that Charlie's father, Robert, helps make day-to-day decisions concerning Charlie. She also indicates that Charlie stays every other weekend, Friday and Saturday night, at Robert's house. In January he stayed with Robert every other weekend starting with the weekend of January 1. Using a calendar and the information provided, the worker determines that Charlie slept at Robert's house five nights in the month of January. Calculation: 5 nights/31 days in January = 16%. Even though Robert and Sarah both make day-to-day decisions about Charlie, Charlie only sleeps 16 percent of the time during the calendar month in Robert's home. Deprivation is met based on continued absence.|
|Example 2:||Dawn and her child Travis request medical benefits. Dawn reports that she has joint custody of Travis with his father John. Both parents make day-to-day decisions concerning Travis. Dawn states that Travis consistently stays with her from after school on Monday until Friday morning when he leaves for school (four nights a week). John picks him up from school on Friday, and Travis stays with him until Monday morning (three nights a week). Although Travis is in Dawn's household the majority of the time, because he sleeps in each parent's house at least 30 percent of the time (Calculation: 3 nights/7nights = 42%) and both parents make day-to-day decisions about Travis, there is no deprivation based on continued absence for the MAA or MAF programs. Eligibility for OHP should be considered.|
OAR 461-001-0000 defines "parent" as the biological or legal (step or adoptive) mother or father of an individual or unborn child. This means that the worker may need to determine that the dependent child is deprived of parental support or care from both a biological parent and a step-parent for deprivation based on absence to exist.
|Example 3:||Julia and her husband Rocky are currently separated but attempting to reconcile. Julia has a child from a previous relationship, Andy, for whom she is requesting benefits. When asked about how often Rocky visits her child, Julia explains that while Rocky does maintain a separate residence, he stays at her home and spends time with them every weekend from Friday after work until Monday morning when he leaves for work.
Even though Andy does not see or hear from his biological father, Rocky is also considered a parent, and visits Andy in his home in excess of 30 hours per week. Based on this, there is no deprivation for MAA. Review for OHP eligibility.
Deprivation Based on Continued Absence of a Parent: 461-125-0090
Situations of Deprivation Based on Continued Absence: 461-125-0110
Situations of No Deprivation Based on Continued Absence: 461-125-0120
Evidence of Deprivation Based on Continued Absence; MAA, MAF, TANF: 461-125-0130
Deprivation based on incapacity
Deprivation based on incapacity exists when a child lives with both parents and one parent is unable to work or has a physical or mental condition that is expected to last at least 30 days and substantially reduces the parent's ability to provide adequate care or support for the child. Deprivation based on incapacity is also considered met when a child lives with both parents and at least one parent is receiving SSI or SSB/SSDI based on disability or blindness.
Unless receiving SSI or SSB/SSDI based on disability or blindness, incapacity must be verified with written medical documentation. The medical documentation must be in writing and contain all of the following:
To determine eligibility, the department will accept medical evaluations from medical and osteopathic doctors, visual evaluations from optometrists, and mental evaluations from licensed clinical psychologists and psychiatrists. The department will accept supplemental medical and vocational information from a licensed social worker, licensed physical or occupational therapist, or licensed nurse practitioner to augment evaluations from acceptable medical sources.
Deprivation Based on the Incapacity of a Parent: 461-125-0230
If the applicant is unable to provide medical documentation, authorize an administrative examination payment. The payment must only be for the report from the doctor or for a medical or psychological evaluation and report.
|F||FOR MORE INFORMATION ABOUT ADMINISTRATIVE EXAMS, PLEASE SEE THE DMAP WORKER GUIDE.|
Deprivation based on unemployment or underemployment
Deprivation based on unemployment or underemployment exists when a child lives with two parents and the household meets the following criteria.
The following are not considered to be misconduct:
|Note:||If an individual's most recent employment ended because they were unable to work due to a disability or medical condition documented by a qualified and appropriate professional, and it is expected to last 30 days or more, consider deprivation based on incapacity.|
Once a parent is determined to be the PWE, their status cannot change while the family remains continuously eligible for MAA/MAF, unless:
Deprivation Based on Unemployment or Underemployment of the Primary Wage Earner (PWE); MAA, TANF: 461-125-0170
Unemployment or Underemployment of the Principal Wage Earner (PWE): 461-125-0190
Determining Primary Wage Earner (PWE); MAA, MAF and TANF: 461-125-0150
What is the most recent employment?
The most recent employment is the last job the PWE had prior to the date of request for medical benefits that meets the two tests below:
If the PWE does not have a job that meets the two tests above, the family has cleared deprivation based on under or unemployment.
If the PWE does have a job that meets the two tests above, the reason for separation from the most recent employment must be determined. Eligibility workers can make a decision about whether or not an individual has good cause for their most recent job quit without waiting for a decision from the Employment Department.
|Example:||Thomas, Maria and their two children are applying for medical benefits. Maria is determined to be the PWE. Maria's most recent employment was at McDonald's last month (less than 60 days ago). She was hired to work 90 hours/month and worked 80 hours her last month at McDonald's.
Prior to working at McDonald;s, Maria worked at Target. Her employment with Target ended eight months ago. She worked 120 hours her last month at Target.
Question: What job would be considered as Maria's most recent employment for the purposes of determining deprivation?
Answer: McDonald's is the last job that Maria had but she was not hired to work 100 hours or more per month and she did not work at least 100 hours in her final month on the job. Even though Maria's job at Target was 100 hours in her final month on the job, it was not within the 60 days previous to the DOR. Maria has no job that qualifies as "most recent employment," and thus the children meet deprivation based on unemployment.
Jobs that would not be considered under this rule
|Note:||An individual who is on Family Medical Leave Act (FMLA) from their current job is considered to still be working. Therefore, the employment separation would not be a factor because they have not been separated from their job.|
Guidance for determining good cause
If the client is separated from their most recent employment, consider whether or not they have good cause for the separation.
Reasons for good cause include but are not limited to:
|Example:||Faduma, who is pregnant, her husband, and their child apply for medical. Faduma is the PWE and indicates she quit her last job due to complications with her pregnancy. She was unable to continue doing the work at her most recent employment and the employer was unwilling to change her duties and make accommodations. Faduma indicates she is still having complications due to her pregnancy.
The eligibility worker determines she had good cause for her most recent job separation, and also gives her good cause not to pursue UC. The worker determines deprivation based on under/ unemployment and narrates how this decision was made.
|Example:||John, his wife Petra and their children apply for medical. John is the PWE and indicates last week he was terminated from Lowe's where he was working 40 hours a week. His job at Lowe's is the job considered to meet the most recent employment definition. John states he was terminated due to attendance issues, was provided multiple warnings with requirements for improvement, but did not improve.
The eligibility worker determines that John does not have good cause for the job separation from Lowe's and determines that no un/underemployment deprivation exists.
|Note:||A separate eligibility requirement is pursuing UC. If an otherwise eligible client has a potential UC claim, consider whether or not they must pursue the UC claim.|
|Example:||Samuel and Carrie and their child are applying for medical. Samuel is determined to be the PWE. Samuel was working for FedEX when he quit two weeks ago to accept employment with UPS. He worked 120 hours in his last month at FedEx. He was hired to work at UPS and had a start date to begin one week after his job with FedEx ended. Samuel was told he would be working only 90 hours a month but would be making $3.00 more an hour. Before he could begin working, UPS retracted the job offer due to the declining economy. He is now unemployed.
FedEX would be considered as Samuel's most recent employer. Samuel left FedEx to accept employment at UPS. His job with UPS met the following conditions: it was a definite offer; his start date was within a reasonable amount of time from his end date with FedEx; at the time he accepted the position with UPS it was reasonably expected he would continue; and he was being paid more then his work at FedEx. The worker can give good cause for the FedEx job ending.
If the eligibility worker determines the PWE has good cause for their most recent job separation and it is later determined the PWE was denied UC, consider good cause for the UC denial. If the PWE does have good cause, narrate the findings and continue benefits at the current level. If the PWE does not have good cause look at converting the case to OHP.
|Example:||Carl, his wife and children apply for medical. Carl is the PWE and indicates his most recent employment ended due to a lay off. The eligibility worker determines deprivation exists and narrates this decision. A month later a SNAP application is processed for the family and the eligibility worker views Carl's ECLM screen. The screen indicates Carl was denied UC due to theft. The eligibility worker determines there was no good cause for the most recent job separation and there is no deprivation. The worker reviews for OHP using the day this decision was made as the DOR.|
Reasons that would not be considered good cause include:
When the PWE is self-employed
A PWE who is self-employed is also affected by these eligibility requirements. First, the worker will determine if the self-employment job would be considered the PWE's most recent employment. The calculation to determine if the client worked at the self-employment job for at least 100 hours a month is based on the gross income made per month divided by Oregon minimum wage. If the self-employment job meets the definition of most recent employment, the worker needs to decide whether or not the client has good cause for their job ending.
|Example:||Frank, Sheila and their children are applying for medical benefits. Frank is determined to be the PWE. He last worked three weeks ago in his self-employment job. He was selling goods at the Saturday Market. He earned $600.00 in the final month.
Question: Would Frank's self-employment job be considered his most recent employment?
Answer: No. $600/$8.50 (current minimum wage) = 78.6 hours, which is less than 100 hours. Since Frank does not have a job that meets the definition of most recent employment, the children meet deprivation based on unemployment.
Determining deprivation for a child/unborn without legal paternity
If the mother and the alleged father of the dependent child or unborn are living together, and either the mother or the alleged father claims he is the father, and no other man has been identified as the father, deprivation for the child is based on two parents in the household: i.e., incapacity or un/underemployment.
After MAA/MAF benefits have been approved, both parents must cooperate with DCS to establish paternity. The parent who refuses to cooperate will be disqualified according to the rule on DCS disqualifications.
|Note:||Medicaid clients at application or at redetermination have minimal DCS cooperation requirements. They must complete and sign the application, but cannot be required to complete paternity affidavits or any additional tasks.|
Determining Deprivation for Child/Unborn Without Legal Paternity: 461-125-0050
Change in basis of deprivation
When a change occurs that could affect a child's deprivation status, initiate a redetermination using the date the household reported the change as the date of request (DOR). Give the filing group up to 45 days from the DOR to establish their eligibility using a different basis of deprivation. If they do not provide documentation by the 45th day and do not have good cause, send a 10-day notice of closure. No DHS 462A is required. If the case has been BED coded, the CM system will automatically send the 77B BED closure notice. If the MAA N/R date on each individual is prior to the BED N/R date, the case will close notice automatically.
Budgeting is the process of determining whether a person meets all the nonfinancial and financial eligibility requirements in a calendar (budget) month.
Prospective budgeting: For MAA in the Change Reporting System (CRS), use actual anticipated income in the initial month. Actual anticipated income is the income already received in the initial month plus all the income that is reasonably expected to be received within the initial month. To arrive at the anticipated income, the client and the worker jointly determine the anticipated income to be counted. Workers will count only income that is reasonably certain to be available. Do not convert, annualize, or average income for new applicants or when adding a new applicant to an existing MAA/MAF/SAC filing group).
There is no overpayment based on incorrectly anticipated information unless the client withheld information or provided false information.
For ongoing months, income is budgeted prospectively so that anticipated income is the same for each month. Convert, average, annualize or otherwise budget the income so that it is the same for each month.
|Example:||Joe and his two children apply for medical in April. Joe is self-employed and his last year's income is representative of his current self-employment income. In April, Joe expects his income to be $450. Initial eligibility for MAA is determined by using the $450 actual anticipated income from the budget month, April.
For May, determine prospective income for ongoing medical assistance. Use Joe's gross self-employment history from last year and divide by 12 to annualize his income. If the annualized income exceeds the MAA income limit, consider MAF situation #5. If still over the income limit convert Joe and his children to EXT effective May 1.
Budgeting using the OHA 945 medical pend notice
The Medical Notice: It's time to renew your medical benefits (OHA 945) is a medical pend notice mailed to SSP medical program clients. The OHA 945 establishes a date of request (DOR) for medical and is used for SSP medical program redeterminations only.
For MAA, the initial budget month is the date of request (DOR) month. For ongoing months, MAA uses prospective budgeting and unlike OHP and HKC, is not certified. It is a requirement to act on reported changes at any time during the MAA eligibility period, including changes reported on the OHA 945.
|Example 1:||A client reports an increase in income in the DOR month that makes the family over income for MAA. Acting on the change reported for the DOR budget month, redetermine eligibility, converting to EXT, OHP or another program if necessary.|
|Example 2:||A client reports a child has returned to the MAA filing group in the DOR month. Redetermine eligibility for the filing group using the DOR month as the budget month. If eligible for MAA, begin the child's medical on the DOR.|
For MAA, the DOR month is reviewed and the worker determines whether or not there are changes being reported that require using the DOR month as the budget month. If not, use the next month (the last month of the 12-month MAA eligibility period) as the budget month and redetermine eligibility.
|Example 1:||The client reports a child has moved back to the household in the DOR month. Redetermine eligibility using the DOR month as the budget month.|
|Example 2:||Client and her two children are receiving MAA, eligibility period ending 06/30/11. The OHA 945 is mailed and a DOR of 05/15/11 is established. The client is not reporting any changes that would otherwise trigger a redetermination in May. The budget month, June, is then used to redetermine eligibility (June is the last month of the current MAA eligibility period).|
|Example 3:||Susie and her son are on OHP. She submits her OHA 945 with a DOR of 9/15, for an OHP eligibility period that ends 10/31. On the OHA 945, she requests medical for her daughter, who just moved back in with her. The family is now under the MAA income limits.
Determine eligibility for the family based on the DOR 9/15, budget month of September, using actual income. Once MAA eligibility is determined, open everyone in the filing on MAA, effective September 15.
Converting, averaging and annualizing
Converting Stable Income: For stable income received once a month, the monthly amount is used to anticipate what the group's income will be for each month.
|Example:||Mom and child in filing group; mom is receiving OPU and child is currently receiving OPC. An OHA 945 is submitted; both mom and child are requesting benefits, mom was working at local motel and received her final check in budget month of $150.00 and two UC checks of $100.00 each. For MAA eligibility the budget month is considered an ongoing month for prospective budgeting. Because the earned income has ended and is not anticipated to continue, count actual earned income received in the budget month. UC is anticipated to continue and is considered stable income and so it is converted to a monthly anticipated amount by multiplying the gross weekly amount by 4.3. The MAA countable income for the budget month is: $150 earned income + $430 UC ($100 x 4.3) = $580.00.|
Averaging variable income: For ongoing months of MAA, the worker must determine what the prospective income will be. In all cases, narrate the way prospective income was determined. To arrive at the average amount for prospective budgeting, first convert to a monthly income amount:
Annualizing income: For all medical but OHP, HKC and REFM, when a full year's income is received in less than a 12-month period (such as school employees and contract employees earned income), the income must be annualized to determine what the prospective income will be. To annualize income (other than self-employment income), add the income from a 12-month period and divide by 12. The resulting figure is the annualized income. If past income is not representative of expected future income, use anticipated income.
Contract income that is not intended to be a full year's income, and is not paid on hourly or piecework basis, is prorated over the period of time the income is intended to cover.
|Note:||Income received on an hourly or piecework basis or monthly over the term of the contract period it is not annualized. It is treated as stable income.|
Annualize self-employment income when it is received during less than a 12-month period but is intended as a full year's income. Also annualize self-employment income when the business has operated for a full year and the previous year is representative of the income and costs expected during the budget month.
Use the gross income on the most recent state and federal income tax forms if available and there will be no substantial increase or decrease in the next year's self-employment income. If a substantial change is expected or there is no tax form available, accept the estimates of next year's anticipated income. Divide the income - reported or anticipated - by 12 to arrive at the income for each month.
|Example 4:||Macy and her two children apply for medical assistance on July 15. Macy is a teacher's assistant and her yearly income is paid over nine months while she teaches. In the summer months, she is not paid. Macy and her children are found eligible for initial MAA based on zero income in July, using actual anticipated income for the budget month.
Macy and her worker talk about her prospective income to assign to the following month, August. Prospective income for Macy is determined by averaging the previous year's income. Using prospective income methods, Macy and her children are eligible for EXT effective August 1.
|Note:||If Macy reports zero income in the following summer months when she was not working for the school, she is not a new applicant and there has been no break in medical benefits, and she would have her eligibility determined using prospective eligibility (not actual anticipated income). She would not be eligible for MAA at that time. Macy and her child would be able to continue on her EXT until the end of the 12-month eligibility period and then could potentially be eligible for OHP.|
|F||SEE COUNTING CLIENT ASSETS, SECTION C (CA-C) FOR MORE INFORMATION ON SELF-EMPLOYMENT INCOME, INCLUDING MICROENTERPRISE INCOME.|
Minor parents living with their parents
When a minor parent has formed a separate filing group from their parents, deem the parents' income as follows:
There are times when a minor parent must return home to live with his/her parents in order to be eligible for TANF. In those cases, if the parent's deemed income is over the TANF payment standard, the minor parent can still be eligible for MAA if the minor parent attends high school or its equivalent full-time, or participates in JOBS or another training program to develop employment or self-sufficiency skills.
Prospective Eligibility and Budgeting: 461-150-0020
Prospective or Retrospective Eligibility and Budgeting; ERDC, MAA, MAF, REF, REFM, SNAP, TANF: 461-150-0060
Prospective Budgeting of Stable Income: 461-150-0070
Prospective Budgeting of Variable Income; Not OHP; Not MRS: 461-150-0080
Prospective Budgeting: Annualizing and Prorating Contracted or Self-employment Income: 461-150-0090
Resources limits and transfers
Resource limits: For MAA, the need group is not eligible for benefits if the financial group has countable resources equal to or greater than the need group resource limit.
The resource limit for MAA is $2,500. However, an MAA need group that includes a Pre-TANF Program participant or TANF recipient who is progressing in a JOBS plan has a resource limit of $10,000. If at any time a Pre-TANF Program participant or a TANF recipient no longer cooperates with their case plan, the resource limit is then reduced back to $2,500.
Asset transfer: To qualify for MAA benefits, a member of the financial group must not have made a disqualifying transfer of their assets within the preceding three years if they are an inpatient in a nursing facility or an inpatient in a medical institution in which payment for the client is based on a level of care provided in a nursing facility. Any potentially disqualifying transfer of assets must be reported at application, redetermination, and when the transfer occurs. A disqualifying transfer of assets during the preceding three years or during the eligibility period for the purpose of establishing or maintaining eligibility for benefits will result in termination and/or disqualification of benefits for the filing group.
When the client is ineligible for benefits because of a disqualifying transfer of assets, the client remains ineligible until the disqualification period ends, when the full equity rights of the asset are transferred back to the client, or when the client receives adequate compensation.
Availability of Resources: 461-140-0020
Asset Transfer; General Information and Timelines: 461-140-0210
Resource Limits: 461-160-0015
Income deductions and exclusions
Exclusions are subtracted prior to the countable income test.
Deductions are subtracted after the client has passed the countable income test.
Child support disregard:
|F||SEE CHILD SUPPORT CHAPTER H (CS-H) FOR MORE INFORMATION ABOUT THE CHILD SUPPORT PASS-THROUGH AND DISREGARD, INCLUDING EXAMPLES.|
Earned income deduction: MAA clients who are not in the microenterprise component of JOBS receive one income deduction; the earned income deduction. All individuals in the financial group with earned income are allowed a deduction of 50 percent of their gross earned income. This includes all self-employment income. Clients are eligible for the deduction as long as they have earned income in the budget month. MAA applicants must first pass the countable earned income test to be eligible for the earned income deduction.
For individuals in the MAA financial group who are in the microenterprise component of the JOBS program and who have earned income from a microenterprise, business expenses are deducted from the business's gross receipts. This is done according to general accounting principles and OAR 461-145-0920 by an accounting professional such as a certified public accountant or bookkeeper. The remainder is the individual's countable income.
Compare the microenterprise income, together with the financial group's other countable income, to the Countable Income Standard. If the income is at or over the standard, the group is ineligible. If it is under the standard, apply the 50 percent earned income deduction to the microenterprise income and other countable earned income.
Child Support and Cash Medical Support: 461-145-0080
Earned Income Tax Credit (EITC) and Making Work Pay (MWP) Tax Credit: 461-145-0140
Self-Employment; Costs That Are Excluded To Determine Countable Income: 461-145-0920
Self-Employment; Determination of Countable Income: 461-145-0930
Dependent Care Costs; Deduction and Coverage: 461-160-0040
Earned Income Deduction; MAA, REF, TANF: 461-160-0160
MAA income standards
Countable income limit: This is the amount of countable income remaining after allowable exclusions.
Adjusted income/payment standard: This is countable income minus deductions.
|Adjusted Income||Countable Income|
Income and Payment Standards; JOBS, MAA, MAF, REF, SAC, TANF: 461-155-0030
How Income Affects Eligibility and Benefits; MAA, MAF, REF, SAC, SFPSS, TANF: 461-160-0100
MAA Asset Quick Reference Chart: Download the MAA Asset Quick Reference Chart in PDF format.
The effective date for starting medical benefits for an eligible client is as follows:
In the MAA program, when converting from HKC (KCE) subsidy:
|Example:||Mary establishes a DOR on June 12, requesting medical assistance for her child and herself. Using June as the initial budget month, they meet all eligibility requirements for MAA except for being over the resource limit. Mary has $3,000 in savings that she will be using to buy a car with in July.
On July 10 Mary purchases the car using $2,900 of the savings. She is now below the resource limit. The worker floats the budget month to July, asks for Mary's income for July and redetermines MAA eligibility using July as the budget month. They are now eligible for MAA. The worker opens MAA for Mary and her child with a start date of July 10, the day they met all of the MAA eligibility requirements.
N/R MAA 0711
MAA retroactive eligibility effective dates
Clients who are eligible for MAA are also potentially eligible for retroactive medical benefits.
|Example:||Mallory is applying for medical benefits for herself and her two children with a DOR of 08/10/10, and is determined eligible for MAA. She reports that in the last week of May, she was seen while she was uninsured at an urgent care clinic, with no other medical services received since then. The worker reviews income and other eligibility criteria for May, and determines that she is eligible for retroactive medical. The worker then sends a MSC 148 to Maintenance, Client to provide medical coverage for Mallory for 05/10/10 (earliest eligibility date) - 05/31/10 and codes a case/descriptor of "RM" on Mallory.|
|Example:||Douglas is a single father of one child, Chester. Douglas had employee-sponsored health insurance for himself and Chester up until five months ago when he lost his job. Chester has an ongoing medical condition for which he sees a specialist monthly.
Now, Douglas is requesting medical benefits with a DOR of 06/11/1,1 and reports that he has incurred ongoing medical expenses since his insurance ended five months ago, though Chester has not been to the doctor yet in June. The worker reviews the three months prior to the DOR (03/11/11-06/10/11) and finds that all MAA eligibility criteria is met for each of the months. Since there was no medical expense incurred in June, the worker sends a MSC 148 to CMU to provide coverage for 03/11/11-05/31/11 and codes a case/descriptor of "RM" on Chester. Their eligibility period will begin on 06/11/11.
Specific Requirements; Retroactive Medical: 461-135-0875
Effective Dates; Initial Month Medical Benefits: 461-180-0090
Effective Dates; Retroactive Medical Benefits: 461-180-0140
Non-CAWEM MAA children may qualify for Continuous Eligibility for Medicaid (CEM) if they lose eligibility for MAA prior to their next scheduled 12-month redetermination.