Deeming

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Deeming Section 1619b

• Presented by
• Bob Monahan, AWIC
• SSA Wisconsin
• Connie DaValt, WIL
• SSA Madison Office

a Wisconsins Disability Benefits Network (WDBN)
Training
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• Click the Ask Button at any time during the
  presentation to type a question.
• Download a copy of this powerpoint and any other
  materials at
  http//www.eri-wi.org/Training.htm

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Deeming

• The process of considering another persons
  income and resources to be available for meeting
  an SSI recipient's basic needs

SI 01310.001ff
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Whose Income/Resources Do We Deem?

• Living with
• Ineligible Spouse
• Ineligible Parents (including spouse of a parent)
• Sponsor of SSI eligible alien

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Resources

• Countable resources same rules apply as for
  eligible individual (bank accounts, stocks,
  bonds, etc)
• Excluded resources same rules apply as for
  eligible individual (home, one vehicle per
  household, term life insurance, irrevocable
  burial funds)
• Excluded Deemor resources pension funds (IRA,
  401K) owned by an ineligible spouse or parent

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Resource Limits

• Resource Limits
• Couple 3000
• Child 2000 plus an additional
• 2000 with one parent household or
• 3000 with two parent households
• Resources of the ineligible spouse/parent are
  deemed whether or not they are available to the
  recipient

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Income

• Countable Income same rules apply as for
  eligible individual
• Excluded Income same rules apply as for
  eligible individual (including cafeteria
  plan/pretax deductions)
• Excluded Deemor income
• support payments made under a court order
• income used in figuring public income maintenance
  payments

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Allocation

• Amount deducted from deemor income for support of
  others
• Allocations for ineligible parents and ineligible
  children (under age 18 or under 22 and a student)
  in the household
• A childs allocation is reduced by the amount of
  their income

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Spouse to Spouse Deeming Chart
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Spouse to Spouse DeemingDetermining Eligibility

• Order of Applying Deeming Rules
• Determine amount of spouses earned and unearned
  income
• Deduct allocations for ineligible children
• If remaining income is equal to or less than 337
  (the difference between FBR for a couple and FBR
  of individual) no income to deem
• If more than 337, the ineligible spouse and
  eligible individual are treated as an eligible
  couple

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Determining Eligibility cont

• Apply all appropriate income exclusions,
  including the 20 unearned/65 and ½ earned
  income
• Subtract the couples countable income from the
  FBR for an eligible couple
• If the couples countable income is less than the
  FBR for an eligible couple (1011) the individual
  is eligible

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Determining Payment

• The countable income from the budget month is
  subtracted from the FBR for an eligible couple in
  the computation month

SI 01320.720 Exhibit of Form SSA-8015
https//secure.ssa.gov/apps10/poms.nsf/lnx/050132
0720!opendocument
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Example of Spouse to Spouse Deeming

• Harold lives with his ineligible spouse (Lillie)
  who earns 1000 mo. Harold receives Social
  Security of 300 mo.
• Eligibility Since Lillies income is greater
  than 337, treat as couple
• Apply income exclusions
• Harold 300 - 20 280
• Lillie 1000 - 65 935/2 467.50
• Total Income 747.50 is less than couples FBR,
  therefore Harold is eligible based on deeming

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Example, cont

• Payment Couple FBR 1011 minus countable income
  747.50
• SSI payment 263.50 based on couples computation
• COMPARE WITH
• SSI payment 394.00 based on individual
  computation (674-280)
• Harold is paid the lesser of the computations or
  263.50 a month

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Example of Spouse to Spouse Deeming with Children

• Harold and his 2 ineligible children live with
  his ineligible spouse (Lillie) who earns 1000
  mo. Harold receives Social Security of 300 mo.
• Eligibility Since Lillies income is greater
  than 337, treat as couple
• Apply child allocations Lillie 1000 - 674 (2
  child allocations) 326
• Lillies income is less than 337 (difference
  between couple FBR and individual FBR) so no
  income is deemed
• Payment Based on Harolds income alone 674 -
  280 394

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Parent to Child Deeming Chart
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Parent to Child Deeming

• Order of Applying Deeming Rules
• Determine amount of parents earned and unearned
  income
• Deduct allocations for ineligible children (first
  from unearned income then from earned)
• Deduct the general earned/unearned exclusions
• Deduct allocations for the living with parents

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Determining Payment

• The countable income from the budget month is
  subtracted from the FBR for an individual in the
  computation month

SI 01320.740 Exhibit of Form SSA-8017
https//secure.ssa.gov/apps10/poms.nsf/lnx/050132
0740!opendocument
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Example of Parent to Child Deeming

• Chloe, an eligible child lives with her
  ineligible brother (Duke) and two parents. Dad
  receives unemployment of 200 mo and Mom has
  wages of 3000 mo.
• Subtract Dukes allocation of 337 from Dads
  200 UC -137 and then from Moms 3000 wages
  2863
• Deduct general exclusions from parents income.
  2863 85/2 1389
• Deduct allocation for parents (couples FBR) 1389
  -1011 378
• Deemed income 378 - 20 general exclusion
  countable income
• FBR 674 - 358 316 SSI payment

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Retrospective Monthly Accounting

• Income in one month is used to calculate the SSI
  payment 2 months later
• Example An individuals countable income in July
  is used to compute his payment for September
• Exceptions
• Income is so high that the person is ineligible
  for payment in a month, a new computation cycle
  begins
• Income received in only the first month of a new
  cycle only counts in that month

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1619b SSI Work Incentive

• 1619b provides for continued coverage of
  Medicaid benefits after eligibility for regular
  SSI has ended because EARNED INCOME is too high
  to permit any payment

SI 02302.001ff
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Eligibility Determination

• Prerequisite month
• Before eligibility for 1619b provisions can be
  established a prerequisite month must be
  established.
• All non-medical requirements must be met
  (citizenship, residency, income and resources)
• All medical requirements are met
• Is not engaging in SGA (SGA only considered in
  the initial disability determination)
• Is eligible for an SSI payment of at least 1

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Section 1619b Rules

• Must continue to have a disabling impairment
• Must be eligible for SSI under all nondisability
  requirements except earnings
• Must depend on Medicaid coverage to continue
  working
• Cannot have sufficient earnings to replace lost
  SSI cash benefits and Medicaid coverage
• As long as the above rules are met, 1619b
  coverage can continue indefinitely

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Break-Even Point

• FBR 674 x 2 1348 85 1433
• If an individual has unearned income in addition
  to earned income, the break even point is the
  benefit payable based on unearned income only x 2
  65
• A person is reinstated to cash benefits any time
  countable income drops below the break-even point
• Reinstatement is possible at all times unless
  eligibility is terminated. Termination occurs
  after 12 months of ineligibility.
• report changes in earnings to your local office
  immediately

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Medicaid Needs Tests

• Income threshold or insufficiency of earnings
  test does not have the ability to replace SSI,
  Medicaid and publicly funded attendant care,
  which would be lost if SSI eligibility stopped
• Medicaid use test must have used Medicaid/MA
  Waiver in the past year or expect to use
  Medicaid/MA Waiver in the next year

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Example

• Seymour has been receiving an SSI check for the
  past 2 years. He started earning 900 mo in
  9/09. He also receives 320 mo in Social
  Security benefits.
• Before he started working, his SSI benefit was
  374 mo (320-20300 countable income, payment
  674-300374)
• Beginning 9/09 320-20300 plus
  900-65/2417.50, total countable income
  717.50
• FBR 674 717.50 no payment due

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Example, continued

• Next step is the Medicaid use test
• Seymour has used MA in the past year and expects
  to use it in the future
• Final step is the Insufficiency of Earnings Test
• Seymours projected yearly earnings of
  900x1210800 is below WI charted threshold
  amount of 32,156

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Charted Threshold

• 2 x Annual State Supplementation rate (83.78)
  2 x the FBR 85 x 12 the base amount
• Add the average per capita Medicaid expenses by
  State (12,949 in WI) Threshold Amount
• WI 2009 Charted Threshold - 32,156

SI 02302.200
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Individualized Threshold Test

• Used when gross earnings exceed the charted
  threshold (discuss with Claims Representative)
• The calculation begins with the base amount and
  adds
• Higher of the individuals actual Medicaid
  expenses or the average per capita expenditure
• Higher State Supplement rate
• Any IRWE,BWE or PASS funds
• The value of publicly funded personal/attendant
  care

SI 02302.050
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Verification Period

• The determination is made prospectively for a
  12-month period when 1619b status begins
• Subsequent determinations are made at each
  redetermination
• Medicaid expenses and personal/attendant care
  costs are verified for the past 12 months

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Individualized Threshold Calculation

• SI 02302.300 Individualized Threshold Calculation
  Worksheet - Exhibit
• https//secure.ssa.gov/apps10/poms.nsf/lnx/0502302
  300!opendocument
• SSA will verify Medicaid expenditures and Waiver
  costs via fax to EDS

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Couples cases

• 1619b Medicaid provides protection only for the
  working individual
• A non working SSI eligible spouse has no
  protection under 1619b and loses Medicaid when
  the earned income of their spouse causes
  ineligibility for payment
• However, both members of an SSI couple will be
  eligible for 1619b if they are both working

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More Information

• POMS Sections SI 01310.001ff SI 02302.00ff
• Bob Monahan, SSA
• bob.monahan_at_ssa.gov
• Connie DaValt, SSA
• connie.davalt_at_ssa.gov
• More about the WDBN online
• www.eri-wi.org/WDBN.htm

a Wisconsins Disability Benefits Network (WDBN)
Training