[30 Pa.B. 3779]
[Continued from previous Web Page]
Annex A
TITLE 55. PUBLIC WELFARE
PART II. PUBLIC ASSISTANCE MANUAL
Subpart A. ASSISTANCE POLICIES AND PROCEDURES
CHAPTER 101. GENERAL PROVISIONS § 101.1. Policy.
(a) Scope. The policies, procedures and standards for determining eligibility, the amount of the grant and for making payments for all types of assistance administered by the Department are included in this part. The types of assistance are TANF, General Assistance and State Blind Pension. Social services in Public Assistance, medical care, including nursing home care, burial and employment are also included.
(1) Although the TANF Program replaces the AFDC Program, most of the rules and procedures under which the Department administered AFDC, including those for the job opportunities and Basic Skills (JOBS) Training Program, will continue in effect as part of the new TANF Program.
(2) The references to AFDC found within this title are to be read and considered as applicable to the TANF Program or to a TANF applicant or recipient, unless doing so would be inconsistent with the TANF requirements or with this section.
* * * * * (d) Purpose of TANF. TANF has the following purposes:
(1) TANF is intended to provide money for dependent children who are in need because support from the usual source, parents, is not available. The money will be provided so that these children may live in family homes with their own parents, or with certain relatives who take the place of parents. Thus, it is the purpose of the TANF Program to prevent a child from being forced to be away from his own family for economic reasons alone. TANF recognizes the importance to a child of his own home and family relationships.
(2) TANF is a time-limited money payment to an adult on behalf of children because the program recognizes the child needs an adult to look after him. The parents are the persons who have the right and obligation to rear, care for, support and make major decisions for the child. Usually, it is a parent who applies for assistance. Whichever one applies, both share responsibility for the child, and the other parent should, if possible and advisable, have some part in the decision on going through with an application for assistance. For parents who are living together, this means a joint application. For other parents, this means clarifying the role of the absent parent in support and care of the child.
* * * * * § 101.2. Definitions.
The following words and terms, when used in this part, have the following meanings, unless the context clearly indicates otherwise:
* * * * * AFDC--The Aid to Families with Dependent Children Program, replaced by the TANF Program effective March 3, 1997.
* * * * * TANF--The Temporary Assistance for Needy Families Program.
* * * * *
Subpart B. INTAKE AND REDETERMINATION
CHAPTER 125. THE APPLICATION PROCESS
AFDC/GA PROVISIONS FOR THE APPLICATION PROCESS § 125.21. Policy.
* * * * * (b) Verification. Conditions of eligibility, need, which includes need for special need allowances, and resource items will be verified at the application interview and prior to authorizing cash assistance and at the time of each redetermination, complete or partial, as specified in Chapter 133 (relating to redetermining eligibility).
(1) If necessary verification is pending from a third party including certification of cooperation from the Domestic Relations Section of the Court of Common Pleas and the client has cooperated in the verification attempt, initial authorization of cash assistance will not be delayed more than 30-calendar days from the date of receipt of a completed, signed application.
* * * * * § 125.24. Procedures.
* * * * * (c) The application interview. The application interview shall be held within 13-calendar days of the date the CAO receives the application. The interview will be conducted in accordance with the following principles:
(1) The facts necessary for a decision on eligibility are assembled at the application interview. The maximum lapse of time between the receipt of a completed, signed application and authorization of the first assistance payment or other disposition of the application will be 30-calendar days. In accordance with section 432.19 of the Public Welfare Code (62 P. S. § 432.19), an application will not be denied for lack of verification if the applicant has cooperated in seeking verification which is pending from a third party including certification of cooperation with the Domestic Relations Section.
* * * * * (7) The application interview shall conform with the following:
* * * * * (v) A decision concerning the applicant's eligibility shall be made without delay based on the verification factors and information provided by the applicant. A decision on eligibility shall be made within 30-calendar days of the receipt of an application. In accordance with section 432.19 of the Public Welfare Code (62 P. S. § 432.19), assistance may not be denied for lack of verification if the applicant has cooperated in seeking verification which is pending from a third party including certification of cooperation from the Domestic Relations Section.
* * * * *
CHAPTER 133. REDETERMINING ELIGIBILITY
REDETERMINING ELIGIBILITY PROVISIONS FOR TANF/GA § 133.23. Requirements.
(a) Reapplication. A reapplication or complete redetermination of eligibility shall conform with the following:
* * * * * (2) Items subject to review. A redetermination shall conform with the following:
* * * * * (ii) In the redetermination of eligibility, the worker shall make a finding as to whether the client who is the payment name wants assistance to continue, what plans the client may have or be developing for self-support or self-care and when the plans may mature. This redetermination shall include at least one interview with the person who is the payment name for the budget group. If the client wants assistance continued, the worker shall redetermine those eligibility factors which are subject to change. The redetermination shall include a review of the need and resource items and verification of items subject to change:
* * * * * (L) Criteria that establish GA categorical eligibility.
* * * * *
Subpart C. ELIGIBILITY REQUIREMENTS
CHAPTER 141. GENERAL ELIGIBILITY PROVISIONS
ELIGIBILITY PROVISIONS FOR TANF/GA § 141.21. Policy.
* * * * * (r) Neither the income eligibility limits nor the cash benefits for three or more GA recipients residing in the same household may exceed the limits for a TANF budget group with the same number of recipients. The term ''household'' is defined as a common residence and does not include single-room occupancy residences, rooming houses, shelters for the homeless, nonprofit residential programs or personal care home facilities receiving charitable or government funds including funds from Federal, State or local units.
(s) An applicant or recipient of GA who has been convicted of violating section 481(a) of the Public Welfare Code (62 P. S. § 481(a)), that is, has been convicted of securing or attempting to secure, or aiding or abetting or attempting to aid or abet any person in securing GA, TANF, MA or Federal food stamps by means of a willful false statement or misrepresentation, or by impersonation or by willfully failing to disclose a material fact regarding eligibility either prior to or at the time of, or subsequent to the application for assistance is ineligible for GA as follows:
(1) For 6 months from the date of first conviction.
(2) For 12 months from the date of a second conviction.
(3) Permanently from the date of a third conviction.
(t) An applicant or recipient of TANF who has been convicted of violating section 481(a) of the Public Welfare Code, that is, has been convicted of securing TANF by means of a willful false statement or misrepresentation, or by impersonation or by willfully failing to disclose a material fact regarding eligibility either prior to or at the time of, or subsequent to the application for TANF or GA is ineligible for TANF and GA as follows:
(1) For 6 months from the date of first conviction.
(2) For 12 months from the date of a second conviction.
(3) Permanently from the date of a third conviction.
ELIGIBILITY PROVISIONS FOR GA § 141.61. Policy.
(a) Conditions of eligibility. The following relates to eligibility for GA:
(1) A person is eligible for GA under the requirements established in subsection (d) and if the appropriate eligibility conditions in the following chapters are met:
* * * * * (xii) Furthermore, eligibility for GA requires that the person be ineligible for TANF because of failure to meet TANF definitive conditions. An applicant or recipient who does not meet a definitive condition for TANF solely because of a refusal to establish eligibility for TANF is ineligible for GA. A person meeting definitive conditions but ineligible for TANF because of income, resources or participation in a strike is not eligible for GA. A person who refuses without good cause to cooperate in establishing paternity or support as required in the TANF program is not eligible for GA.
* * * * * (xiv) A GA cash assistance applicant is ineligible for 30 days after the termination of employment if the applicant voluntarily terminates the employment without good cause. Good cause includes the circumstances beyond a person's control specified § 165.52(a) (relating to good cause).
* * * * * (d) Determining GA categorical eligibility. An applicant for, or recipient of, GA is determined to be eligible in accordance with the following:
(1) A person is eligible to receive GA for an indeterminate period due to medical, social or related circumstances. Persons who may qualify for GA are limited to the following:
(i) A child who is under age 18; or who is 18 through 20 years of age and is attending a secondary or equivalent vocational or technical school full-time and may reasonably be expected to complete the program before reaching 21 years of age. Age, school enrollment and attendance shall be verified.
(ii) Parents residing in a two-parent household with their child who is under 13 years of age or their child who is under 21 years of age and who has a disability. The age, residence and disability (if applicable) of the child shall be verified. Both parents as well as the child shall be included in the application. If the family is ineligible under this provision, either parent or child may qualify under another criterion.
(iii) A person who has been assessed by a physician or psychologist as having a temporary or permanent disability which precludes him from working in any gainful employment. The following conditions apply:
(A) Documentation which demonstrates the relationship between the disability and the inability to work shall be provided by the client during the application interview for cash assistance or, in the case of recipients, within 30-calendar days after the date of the redetermination.
(B) With the exception of documentation under subclause (II), documentation shall be on a form provided by the Department and completed by a physician or a psychologist.
(I) The CAO's medical consultant may be used in those cases that the IMU worker is unable to establish the inability to work based on the disability.
(II) The verification may also be provided by sources including, but not limited to, the SSA indicating approval for disability benefits or on a disability determination of 50% or greater made by the Department of Veterans Affairs (DVA). A medical certification of disability provided by the Department's Medical Review Team (MRT) is also acceptable documentation of illness or disability. Documentation from sources other than the SSA, DVA or MRT is also acceptable if it clearly states the relationship between the disability and the person's employability. In addition, this documentation shall be less than 6 months old at the time of application or redetermination unless the condition to which it refers is permanent or chronic. The verification of physical or mental disability shall be based on acceptable clinical and laboratory diagnostic techniques rather than a statement of symptoms by the applicant or recipient.
(C) An applicant or recipient who claims a physical or mental disability which temporarily or permanently precludes the applicant or recipient from any gainful employment but who does not have the documentation at the application or within 30 days of the redetermination interview shall be determined ineligible for GA until the documentation is presented to the CAO. The CAO shall determine eligibility for the MNO Program to cover the cost of the employability assessment only for persons who allege eligibility based on a physical or mental disability. Reasonable accommodations to assist a person to secure documentation during this period shall be provided to a person who is prevented from cooperating due to a physical or mental disability.
(D) A person who has a serious physical or mental disability which prevents employment and which is documented in accordance with this subparagraph may be authorized as GA even if the person is undergoing active treatment or has undergone treatment for substance abuse in a drug or alcohol treatment program. Eligibility for GA on the basis of having a serious physical or mental disability is not contingent upon participation in a drug or alcohol treatment program as long as the person remains disabled after the substance abuse is successfully treated.
(E) A person who has a disability solely related to substance abuse that prevents employment and which has been documented in accordance with this subparagraph may be authorized as GA. Eligibility for GA on this basis is contingent upon accepting and participating in available drug or alcohol treatment services.
(F) An applicant or recipient who has a verified physical or mental disability which is temporary shall seek appropriate treatment as a condition of eligibility.
(iv) A nonparental caretaker of a child under 13 years of age or a caretaker of an individual who is ill or disabled. The caretaker shall reside with the individual for whom he provides care and his presence must be required. A caretaker's presence in the home will not be considered as required if there is another person in the home who is able to provide the care without the need for GA. The caretaker shall provide documentation of the age of the child or the illness or disability of the individual needing care.
(v) A person who is undergoing active treatment for substance abuse in a drug or alcohol treatment program licensed or approved by the Department of Health or administered by an agency of the Federal government as long as the treatment precludes the person from engaging in any form of employment. Eligibility under this criterion is limited to a maximum of 9 months in the lifetime of the person regardless of whether or not treatment is continuing upon expiration of the 9-month time limit.
(vi) A pregnant woman whose pregnancy has been medically verified and who is ineligible for TANF.
(vii) A person who is a victim of domestic violence or another abusive living situation and is receiving protective services. It is not necessary that the service be continuous or rendered on a daily, weekly or monthly basis. Eligibility under this criterion is limited to a maximum of 9 months in the lifetime of the person, regardless of whether or not protective services are continuing upon expiration of the 9-month time limit. The person shall verify that the person is receiving one of the following protective services, or is involved in one of the following activities:
(A) Residing in an emergency shelter or emergency housing for abused persons.
(B) Receiving supportive counseling from a professional counseling source.
(C) Receiving social services to prevent further potential abuse.
(D) Receiving social services necessary to enable the person to remain in his own home.
(E) Filing of assault or battery or other charges with a law enforcement agency related to seeking protection from the abuser.
(F) Obtaining a restraining order or peace bond against the abuser.
(G) Receiving services from any branch of government (including the courts or the police) or agency meant to counsel or protect the individual from abuse. Information provided by or on behalf of a victim of abuse is confidential and subject to Chapter 105 (relating to safeguarding information).
(2) GA recipients are eligible for the MNO level of benefits. In addition, these persons receive coverage for prescribed medications. GA recipients eligible for Federally-funded MA receive additional benefits under the MA Program. Children under age 21, pregnant women, migrants, refugees eligible for MA up to 8 months from date of entry into the United States, as specified in 45 CFR 400.90 (relating to basis and scope), repatriated nationals and persons who have applied for or been referred to the SSA for Social Security or SSI disability benefits qualify for Federally-funded MA.
ELIGIBILITY PROVISIONS FOR MA FOR THE CATEGORICALLY NEEDY § 141.71. Policy.
* * * * * (c) Money payment recipients. The following persons will be eligible for MA services provided the recipient does not have resources such as medical insurance or governmental benefits that cover the costs of the services at MA standards:
* * * * * (2) Persons who meet the definitive conditions of TANF, GA or SBP. GA persons, who are not eligible for Federally-funded MA and who are eligible to receive a cash payment are entitled to MNO level of benefits if otherwise eligible. In addition, these persons receive coverage for prescribed medications. GA-related MA recipients eligible for Federally-funded MA receive additional benefits under the MA Program. Children under 21 years of age, pregnant women, migrants, refugees eligible for MA up to 8 months from date of entry into the United States, as specified in 45 CFR 400.90 (relating to basis and scope), repatriated nationals and persons who have applied for or been referred to the SSA for Social Security or SSI Disability benefits qualify for Federally-funded MA.
* * * * * (g) PD (Categorically Needy NMP-GA) requirements. The policy and procedures in § 141.61 apply. A person who does not receive a cash payment and who is not eligible for Federally-funded MA as described in subsection (c)(2) is entitled to the MNO level of benefits if otherwise eligible. In addition, these persons receive coverage for prescribed medications.
ELIGIBILITY PROVISIONS FOR MNO-MA § 141.81. Eligibility policy for MNO.
(a) Conditions of eligibility.
(1) To be eligible for MNO-MA, the person shall comply with the following:
(i) Meet financial and nonfinancial eligibility standards established by the Department and approved by the Governor and the appropriate conditions of eligibility set forth in the following chapters or sections:
(A) Chapter 147 (relating to residence).
(B) Chapter 149 (relating to citizenship and alienage).
(C) Chapter 161 (relating to persons in institutions).
(D) Chapters 177--179 and 181.
(E) Chapter 183 (relating to income).
(F) Section 175.84 (relating to procedures).
(G) Section 175.73(b) (relating to requirements).
(2) To be eligible for MA, the person shall supply evidence, as required, of the following factors:
(i) Chapter 145 (relating to age).
(ii) Dependent children (subsection (c)(3)(ii)).
(iii) Blind (subsection (c)(3)(iii)).
(iv) Permanent and total disability (subsection (c)(3)(iv)).
(3) To be eligible for MA, the person shall provide other information as is requested by the Department (subsection (b)).
(4) To be eligible for MA, the person shall sign forms.
* * * * * (c) Other eligibility conditions and categories. Other eligibility conditions and categories are as follows:
* * * * * (3) The categories of MA and the eligibility conditions for them are set forth as follows. A decision that the client does not meet the definitive conditions for old age, dependent children, blind or permanent and total disability must be supported in the case record.
* * * * * (ii) Dependent Child Category (TC). A parent will be considered incapacitated during the period institutional medical care, hospital-home care or nursing services in the home are received. The suffix ''E'' will be added to the category symbols, such as TCE, to identify migrant worker applicant groups with children who are eligible for emergency MA services. This category applies to the following:
* * * * * (C) Pregnant women.
* * * * * (iv) Permanent and total disability category (TJ). This category applies to a person 18 years of age or older but under 65 who is permanently and totally disabled, a person with a disability who is receiving Social Security disability benefits who has been referred to the SSA for a determination of eligibility for SSI disability benefits or a person under review for a disability by the Department based upon Social Security disability criteria. For MA purposes, a person will be considered permanently and totally disabled under the following circumstances:
* * * * * (v) General Category (TD). Category TD will be treated as follows:
(A) This category is financed by Commonwealth funds only. It applies to persons who do not meet the conditions for the Federally-aided categories of MA (TA, TC, TB, TD (migrants or refugees), TU or TJ) and meet one of the following conditions:
(I) A custodial parent of a dependent child under 21 years of age.
(II) A person 59 years of age or older.
(III) A person who verifies employment of at least 100 hours per month earning at least the minimum wage. For persons whose eligibility is based upon the work requirement, past, present and continuing employment will be evaluated to determine compliance with the 100 hours per month requirement. If an episode of illness or injury is the reason for the interruption of work and it is verified that 100 hours per month employment will resume subsequent to recovery from that illness or injury, the applicant will be considered to have met the work requirement.
* * * * *
CHAPTER 145. AGE
GA AGE PROVISIONS § 145.63. Requirements.
* * * * * (c) Attending school or training. The following will constitute GA age requirements for youths attending school or training:
(1) A youth under 21 years of age will be considered to have met the requirements of attending secondary school or an equivalent course of vocational training full time, if he is enrolled in a program of supervised education or vocational training approved by the authorities of the school district or by the Department of Education of the Commonwealth. The program may be part of the regular school program, or one especially arranged for the individual youth's educational or vocational needs and approved by the school authorities. A vocational training course may be a course established under section 2508.3 of the Public School Code of 1949 (24 P. S. § 25-2508.3), a program under the Economic Opportunity Act (42 U.S.C.A. §§ 2991--2996l), or an organized training program under recognized sponsorship with a specified vocational training objective, for example, apprenticeships or training arrangements sponsored by business or industrial firms.
* * * * * (3) GA payment will be made for the following:
* * * * * (ii) The month the youth completes or discontinues secondary school or equivalent vocational or technical school before age 21. The date the secondary school or equivalent vocational or technical school records show the youth ended his full-time status as a student or trainee will be the date of his completion or discontinuance of secondary school or an equivalent vocational or technical school.
§ 145.64. Procedures.
* * * * * (b) Attending school or training. The procedure for school or training attendance will be as follows:
(1) Certification by the school of enrollment in and attendance at a secondary school or equivalent vocational or technical school is required within the fiscal month in which the youth has his 18th birthday. After the initial certification for a youth attending a secondary or equivalent vocational or technical school, attendance will be redetermined in March, June, September and December until the youth reaches age 21. A partial redetermination will be made if there is any indication that he may no longer be enrolled as a full-time student.
* * * * *
CHAPTER 166. EMPLOYMENT AND COMMUNITY WORK EXPERIENCE PROGRAM § 166.23. Requirements.
* * * * * (c) Community work experience program. Requirements for the Community Work Experience Program (CWEP) will be as follows:
* * * * * (2) Project assignment. The EU may refer any nonexempt member of a TANF or GA unit to a project assignment at any time, including the following persons:
* * * * *
Subpart D. DETERMINATION OF NEED AND AMOUNT OF ASSISTANCE
CHAPTER 175. ALLOWANCES AND BENEFITS
ALLOWANCES AND BENEFITS PROVISIONS FOR TANF/GA § 175.23. Requirements.
* * * * * (e) Grant reduction. The family size allowance, plus special need allowance, shall be reduced by the amounts obtained by cashing an assistance check at a gambling casino, racetrack, bingo hall or other establishment that derives more than 50% of its gross revenues from gambling.
* * * * *
CHAPTER 177. RESOURCES
GENERAL RESOURCE PROVISIONS FOR TANF/GA § 177.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Budget group--One or more related or unrelated individuals who occupy a common residence or would occupy a common residence if they were not homeless and whose needs are considered together in determining eligibility for cash assistance under one category of assistance.
* * * * *
TREATMENT OF RESOURCES § 177.21. Personal property.
(a) Applicants and recipients. For an applicant and recipient, the following personal property is not counted in determining eligibility:
* * * * * (11) An educational savings account established by an individual at a bank or other financial institution to pay for tuition, books and incidental expenses related to attendance at a vocational school, community college, college or university. The account shall be clearly identified as having been established for or restricted to payment of educational expenses.
(i) The savings account, its ownership, the account balance and the fact that the account is restricted for payment of educational expenses shall be verified by written documentation. Documentation may include, but is not limited to, a copy of the passbook or a copy of the current account statement from the bank or other financial institution.
(ii) Monies deposited in an account plus interest earned on the account shall be exempt in determining eligibility as long as the funds remain on deposit.
(iii) Monies withdrawn to pay for educational expenses are exempt. Documentation shall be provided that verifies the expenses were incurred.
(iv) Monies withdrawn from an educational savings account that are used for a purpose unrelated to education shall be added to the budget group's resource amount and used to determine eligibility beginning with the date of withdrawal.
(12) Savings accounts established and bonds purchased under the Tuition Account Program and College Savings Bond Act (24 P. S. §§ 6901.101--6901.509).
* * * * *
CHAPTER 178. RESOURCE PROVISIONS FOR CATEGORICALLY NMP-MA AND MNO-MA
Subchapter A. GENERAL PROVISIONS FOR MA RESOURCES COMMON TO ALL CATEGORIES OF MA
CATEGORIES OF MA § 178.11. Categories of NMP-MA.
NMP-MA applicants/recipients shall meet the resource requirements of the category of NMP-MA for which they are eligible. The following explains the different NMP-MA categories:
* * * * * (4) The PC category is a TANF-related category and designates an NMP person who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
* * * * * (6) The PD category is a GA-related category and designates an NMP person who is 21 years of age or older and under 65 years of age, who meets the eligibility requirements for GA and who chooses to receive only MA.
§ 178.12. Categories of MNO-MA.
MNO-MA applicants/recipients shall meet the resource requirements of the category of MNO-MA for which they are eligible. The following explains the different MNO-MA categories:
(1) The TA category designates an MNO person who is 65 years of age or older. This category is an SSI-related category.
(2) The TJ category designates an MNO person who meets the eligibility conditions as a disabled person. This category is an SSI-related category.
(3) The TM category designates an MNO person who meets the eligibility conditions as a blind person. This category is an SSI-related category.
(4) The TB category designates an MNO person who receives a SBP.
(5) The TC category is an AFDC-related category and designates an MNO person who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
(ii) A person 21 years of age or older and under 65 years of age who meets the requirements of a specified relative under § 151.42 (relating to definitions) and is responsible for the care and control of a dependent child. For purposes of determining if the person 21 years of age or older and under 65 years of age is a specified relative, a dependent child, including the child who is receiving SSI, is a child under 18 years of age or under 19 years of age if the child is a full-time student in secondary school or the equivalent level of a vocational or technical school and reasonably expected to complete the program before reaching 19 years of age, and who meets the deprivation of support conditions under § 153.43(a)--(c) (relating to AFDC deprivation of support or care requirements).
(iii) A pregnant woman 21 years of age or older who is a member of a two parent household which does not meet the unemployed principal wage earner definition in § 153.44(d) (relating to procedures).
(6) The TU category is an AFDC-related category and designates an MNO person who is one of the following:
(i) The parents in a two parent household that includes a dependent child as defined in paragraph (5)(ii) and an unemployed principal wage earner as defined in § 153.44(d).
(ii) A pregnant woman who is 21 years of age or older, with no other children, in a two parent household with an unemployed principal wage earner as defined in § 153.44(d).
(7) The TD category is a GA-related category and designates an MNO person who does not meet the requirements for another category of MNO.
Subchapter C. TANF-RELATED AND GA-RELATED CATEGORIES OF MA
ADDITIONAL RESOURCE EXCLUSIONS FOR GA CATEGORIES OF MA § 178.165. Educational savings accounts.
(a) For GA categories of MA, an educational savings account established by an individual at a bank or other financial institution to pay for tuition, books and incidental expenses related to attendance at a vocational school, community college, college or university is not counted in determining eligibility.
(1) The account shall be clearly identified as having been established for or restricted to payment of educational expenses.
(2) The savings account, its ownership, the account balance and the fact that the account is restricted for payment of educational expenses shall be verified by written documentation. Documentation may include, but is not limited to, a copy of the passbook or a copy of a current account statement from the bank or other financial institution.
(3) Moneys deposited in an account plus interest earned on the account shall be exempt in determining eligibility for GA as long as the funds remain on deposit.
(4) Moneys withdrawn to pay for educational expenses are exempt. Documentation shall be provided that verifies the expenses were incurred.
(5) Moneys withdrawn from an educational savings account that are used for a purpose unrelated to education shall be added to the budget group's resource amount and used to determine eligibility beginning with the date of withdrawal.
(b) For GA categories of MA, savings accounts established and bonds purchased under the Tuition Account Program and College Savings Bond Act (24 P. S. §§ 6901.101--6901.509) are not counted in determining eligibility.
CHAPTER 181. INCOME PROVISIONS FOR CATEGORICALLY NEEDY NMP-MA AND MNO-MA
Subchapter A. GENERAL PROVISIONS FOR MA INCOME COMMON TO ALL CATEGORIES OF MA
GENERAL PROVISIONS FOR MA INCOME § 181.1. General policy on MA income common to all categories of MA.
* * * * * (b) In determining income eligibility for MNO-MA, the total amount of income available to the applicants/recipients in a consecutive 6-calendar month period is used. In determining income eligibility for retroactive eligibility coverage for MNO-MA, the total amount of income available to the applicants/recipients in the combined retroactive and prospective period, consecutive 6-calendar month period, is used. The combined period can be less than 6 months only if the applicant/recipient is deceased.
* * * * * (d) As a condition of eligibility for MA, an applicant/ recipient shall take necessary steps to obtain and make available potential sources of income available to him, such as, but not limited to, benefits under retirement, unemployment compensation, workers compensation, State or county retirement and disability benefits, veterans benefits, union pensions and employer's pensions and annuities.
(1) An applicant, except a PD or TD applicant--see §§ 181.41 and 181.42 (relating to categories of NMP-MA; and categories of MNO-MA)--or a recipient who, without good cause, fails to cooperate in an effort to establish eligibility for SSI, Retirement, Survivors and Disability Insurance (RSDI), or another potential benefit is ineligible for MA until the applicant complies with the cooperation requirement.
(2) A PD or TD applicant--see §§ 181.41 and 181.42--who, without good cause, fails to cooperate in establishing eligibility for a potential benefit is ineligible for MA for a minimum of 60 calendar days. Ineligibility for MA continues after the minimum of 60 calendar days until the applicant complies with the cooperation requirement.
* * * * * § 181.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Applicant/recipient--A person who is applying for, or receiving, MA or a group of related persons who are living together and who choose to apply for, or receive, MA as one group.
Calendar quarter--A period of 3 full calendar months beginning with January, April, July or October.
Community spouse--The spouse living at home who has a spouse who had lived at home but is now an institutionalized spouse.
Countable net income--Income counted in determining income eligibility for MA, which is actual and deemed income less appropriate exemptions, deductions and disregards.
Deemed income--Income which is attributed to the applicant/recipient whether or not the income is actually received.
Earned income--Money or other compensation received in return for services rendered.
Full-time employment--Employment which averages at least 30 hours per week in a calendar month.
IRC--Internal Revenue Code (26 U.S.C.A. §§ 1--1043).
Infrequent income--Income that is received not more than once in a calendar quarter.
Institutionalized spouse--The spouse who is receiving skilled care, heavy care/intermediate services or intermediate care in a nursing facility or other medical institution, including services in an ICF/MR facility, for a period likely to last for at least 30 consecutive days.
Irregular income--Income that is not subject to scheduling or is unpredictable.
LRR--Legally Responsible Relative--The spouse of a person, or the natural or adoptive parent of a child under 21 years of age.
Legal guardian--A person who is court appointed as the legal guardian.
MCCA--The Medicare Catastrophic Coverage Act of 1988 (Pub. L. 100-360, 102 Stat. 602) (July 1, 1988).
NFC--Nursing Facility Care--Skilled care, heavy care/intermediate services or intermediate care in a nursing facility or other medical institution.
Nonrecurring income--Income that is received in a single payment and not expected to continue.
Parent--The natural or adoptive father or mother of a child under 21 years of age.
Part-time employment--Employment which averages less than 30 hours per week in a calendar month.
Personal property--Privately-owned possessions. The term includes, but is not limited to, cash, bank accounts, stocks, bonds, mortgages, cash value of life insurance policies, household furnishings, personal effects, motor vehicles, boats and Federal, State and local tax refunds. The term does not include real property.
Real property--Land, buildings, mobile homes and improvements thereto.
Restricted income--Income limited by the payer for the use of a specified person.
SSI--Supplemental Security Income--The benefit amount paid to an eligible person or to an eligible person and his eligible spouse under Title XIV of the Social Security Act (42 U.S.C.A. §§ 1381--1383c).
Spouse--A person who is married to another by legal ceremony or by common-law.
Unearned income--Money or other compensation received for which a service is not rendered.
CONTINUING AND RETROACTIVE ELIGIBILITY PROVISIONS FOR ALL CATEGORIES OF MA § 181.11. Continuing eligibility.
(a) Eligibility for continuing MA benefits begins with the date eligibility is established or the date of application, if the applicant/recipient is otherwise eligible.
(1) If the applicant is ineligible in the month of application, eligibility begins with the first day of the following month if the applicant is eligible beginning from the first day of that month.
(2) Authorization of MA benefits in the GA-related NMP category begins when all eligibility factors are verified, verification is received from a third party or the client has cooperated in the verification attempt and the applicant/recipient is otherwise eligible.
* * * * * § 181.12. Retroactive eligibility.
(a) The earliest possible date for retroactive MA benefits to begin is the first day of the third month preceding the month of application.
(1) The period of eligibility for retroactive MA benefits under NMP-MA begins with the first day of the month in the retroactive period in which the first medical service was incurred, if the applicant was otherwise eligible during that month.
(2) The period of eligibility for retroactive MA benefits under MNO-MA begins with the first day of the month in the retroactive period in which the first medical service was incurred, if the applicant was otherwise eligible during that month.
* * * * * (c) For MNO-MA categories, income eligibility for retroactive MA benefits exists if one of the following applies:
(1) The applicant's/recipient's countable net income in the combined retroactive/prospective period, less medical expenses is equal to, or less than, the appropriate MNO-MA 6-month period income limits in Appendix F.
(2) The applicant's/recipient's countable net income in the combined retroactive/prospective period, less medical expenses is equal to, or less than, the appropriate MNO-MA 6-month period income limits in Appendix F. Unpaid medical expenses that are not subject to payment by a third-party, which remain the legal obligation of the applicant/recipient, and are not to be paid for under the MA Program once MA is authorized and paid medical expenses, are deducted from the countable net income in the combined retroactive/prospective period as provided under § 181.14(e)(1)--(6) (relating to eligibility under MNO-MA spend-down). This includes medical expenses incurred before the retroactive period.
§ 181.14. Eligibility under MNO-MA spend-down.
* * * * * (d) Deductible medical expenses include:
* * * * * (3) Medical and remedial expenses paid by a public program if the following apply:
(i) The public program is not financed in whole or in part by Federal funds.
(ii) The expenses are wholly financed by the State or a subdivision of the State, for example, county or municipality.
(iii) The expenses have been paid in the month of application, or any month in the retroactive period, or a combination of both, for which the individual is applying.
(iv) The expenses have not been previously used as a deduction in the determination of eligibility for a prior authorization of MA.
(e) Medical expenses meeting the requirements in subsection (d) are deducted from the countable net income in the following order:
* * * * * (6) Medical and remedial expenses paid by a public program meeting the requirements in subsection (d)(3).
(7) For an applicant/recipient receiving skilled nursing care or intermediate care, the projected cost of his care, for a period not to exceed 6 months, at the private rate for the appropriate level of care anticipated to be received by the applicant/recipient in the skilled nursing or intermediate care facility.
CATEGORIES OF MA § 181.41. Categories of NMP-MA.
An NMP-MA applicant/recipient shall meet the income requirements of the category of NMP-MA for which the applicant/recipient is eligible. The following explains the different NMP-MA categories:
* * * * * (4) The PC category is a TANF-related category and designates an NMP person who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
* * * * * (6) The PD category is a GA-related category and designates an NMP person who is 21 years of age or older and under 65 years of age, who meets the GA eligibility requirements and who chooses to receive only NMP-MA.
§ 181.42. Categories of MNO-MA.
An MNO-MA applicant/recipient shall meet the income requirements of the category of MNO-MA for which the applicant/recipient is eligible. The following explains the different MNO-MA categories:
(1) The TA category designates an MNO person who is 65 years of age or older. This category is an SSI-related category.
(2) The TJ category designates an MNO person who meets the eligibility conditions as a disabled person. This category is an SSI-related category.
(3) The TM category designates an MNO person who meets the eligibility conditions as a blind person. This category is an SSI-related category.
(4) The TB category designates an MNO person who receives a SBP.
(5) The TC category is an AFDC-related category and designates an MNO person who is one of the following:
(i) A person under 21 years of age, regardless of school attendance, emancipation or marital status.
(ii) A person 21 years of age or older and under 65 years of age who meets the requirements of a specified relative under § 151.42 (relating to definitions) and is responsible for the care and control of a dependent child. For purposes of determining if the person 21 years of age or older and under 65 years of age is a specified relative, a dependent child, including the child who is receiving SSI, is a child under 18 years of age or under 19 years of age if the child is a full-time student in secondary school or the equivalent level of a vocational or technical school and reasonably expected to complete the program before reaching 19 years of age, and who meets the deprivation of support conditions under § 153.43(a)--(c) (relating to AFDC deprivation of support or care requirements).
(iii) A pregnant woman 21 years of age or older who is a member of a two parent household which does not meet the unemployed principal wage earner definition in § 153.44(d) (relating to procedures).
(6) The TU category is an AFDC-related category and designates an MNO person who is one of the following:
(i) The parents in a two parent household that includes a dependent child as defined in paragraph (5)(ii) and an unemployed principal wage earner as defined in § 153.44(d).
(ii) A pregnant woman who is 21 years of age or older, with no other children, in a two parent household with an unemployed principal wage earner as defined in § 153.44(d).
(7) The TD category is a GA-related category and designates an MNO person who does not meet the requirements for another category of MA.
CHAPTER 183. INCOME
INCOME PROVISIONS FOR TANF/GA § 183.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Budget group--One or more related or unrelated individuals who occupy a common residence or would occupy a common residence if they were not homeless and whose needs and eligibility are considered together in determining eligibility for cash assistance under one category of assistance.
* * * * *
MONTHLY ASSISTANCE PAYMENT DETERMINATION § 183.104a. Additions to or deletions from a budget group--statement of policy.
(a) Cash assistance.
* * * * * (3) In addition to removing persons promptly in accordance with established deadlines, the CAO shall ensure that persons are authorized initially or added to existing budget groups as quickly as possible. Consistent with the requirements of Chapters 125 and 133 (relating to the application process; and redetermining eligibility), a person shall receive eligibility determinations no later than 30 days from the date of receipt of a completed, signed Common Application Form (CAF). The procedures to be followed when an applicant requests removal from an existing budget group and authorization of assistance in his own name; or from a person who wishes to add someone to his budget group are as follows:
* * * * *
[Pa.B. Doc. No. 00-1277. Filed for public inspection July 28, 2000, 9:00 a.m.]
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