210-RICR-40-00-3
C. The basic tenets of the SSI methodology are established in the Social Security Administration's rules for determining eligibility for SSI which are set forth in federal regulations at 20 C.F.R. § 416.101 et seq.
3.2.2Authority
A. This Part is promulgated pursuant to Federal authorities as follows:
B. Applicable State authority is derived from R.I. Gen. Laws Title 40 and R.I. Gen. Laws Chapter 42-7.2.
A. Sections pertaining to the SSI treatment of income and resources and their application are as follows:
B. Except as otherwise noted, the provisions in this Part apply to the determination of countable income and resources for Medicaid LTSS applicants and beneficiaries in the Integrated Health Care Coverage groups (IHCC). LTSS specific provisions related to the treatment of income and resources for IHCC members are set forth in Part 50-00-6 of this Title. The income of Affordable Care Act (ACA) expansion adults in the Medicaid Affordable Care Coverage (MACC) category is evaluated in accordance with Part 30-00-3 of this Title, except that the person seeking Medicaid LTSS is treated as a family of one (1) irrespective of whether they live at home or a health institution or community-based service setting. All Medicaid LTSS applicants and beneficiaries, without regard for the method of determining financial eligibility, are subject to the transfer of asset provisions in Part 50-00-6 of this Title.
A. For the purposes of this Section, the following meanings apply:
10. “SSI methodology” means the basis for determining Medicaid eligibility that uses the definitions and calculations for evaluating income and resources established by the U.S. Social Security Administration (SSA) for the SSI program.
A. Though the application of the SSI methodology sometimes varies across coverage groups, there are several key common elements, as follows:
5. Clinical Reviews – Clinical reviews may consist of a determination of disability, an assessment of functional need and/or health status, or an evaluation whether an applicant or beneficiary requires the level of care provided in a health institution. The criteria and processes for making these determinations may vary considerably in accordance with the type of Medicaid health coverage a person is seeking and the scope of Medicaid coverage available.
a. The provisions governing clinical reviews for the determination of disability for non-LTSS, Community Medicaid are located in Part 05-1 of this Chapter. For Medicaid LTSS, the provisions governing functional/clinical eligibility are set forth in Part 50-00-5 of this Title; for Katie Beckett eligibility, clinical reviews are conducted in accordance with Part 50-10-3 of this Title.
A. The evaluation of income is the process that determines the amount that counts when determining financial eligibility using the SSI methodology. For these purposes, income is defined as follows:
C. Medically needy (MN) eligibility is an option for applicants and beneficiaries who have income above the limits established in this Part. See Part 05-2 of this Chapter for non-LTSS MN; provisions pertaining to medically needy eligibility for Medicaid LTSS are located in Part 50-00-2 of this Title.
A. A resource is cash or other liquid assets or any real or personal property that a person (or spouse, if any) owns and could convert to cash to be used for support and maintenance. For the purposes of determining financial eligibility using the SSI methodology, the following distinctions apply:
B. § 3.6 of this Part explains the types of resources and applicable exclusions in general when using the SSI method to determine financial eligibility. Part 05-1 of this Chapter focuses on Community Medicaid. Medicaid LTSS-specific provisions are located in Part 50-00-6 of this Title.
A. The following standards are used in the determination of the countable income and resources of an individual or couple when using the SSI method for determining Medicaid financial eligibility:
3. Medically Needy (MN) Monthly Income Standards – There are different MN income standards for determining eligibility for Community Medicaid and LTSS.
a. Community Medicaid. For persons seeking non-LTSS Medicaid MN coverage, previously known as the flexible test of income, eligibility is reserved for applicants with income above the eligibility standard and high health care expenses who are able to spenddown to the applicable income limit during a specified MN eligibility period of six (6) months. MN beneficiaries are eligible for Medicaid health coverage once they have spent down to this limit, as indicated below.
4. Income Guidelines – The IHCC group income limits and, where applicable, companion SSI-related limits are as follows:
| Income LimitsAll IHCC Groups | |
| Coverage Group | Income Limits |
| Elders and Adults with Disabilities (EAD) | At or below 100% FPL |
| Community Medicaid Elders and adults with DisabilitiesMedically Needy (MN) | Above 100% FPLSpenddown to Medically Needy Income Limit |
| Refugee Medicaid Assistance (RMA)MN | At or below 200% FPLSpenddown to Medically Needy Income Limit |
| Community MedicaidMACC GroupMN | Varies by population as indicated in Part 05-2 of this Chapter |
| QMB | 100% FPL |
| SLMB | 120% FPL |
| QI | 135% FPL |
| Sherlock Plan | 250% FPL |
| Ticket to Work | Not Applicable |
| LTSS – SSI Pathway | SSI Income Limit |
| LTSS – MAGI Pathway | Up to 133% of FPL and possible 5% disregard |
| LTSS Special Income/HCBS (217 lookalikes) | Up to 300% SSI Level |
| LTSS — MN Pathway | Up to cost of care |
5 .Resource Standards – Federal regulations require States that have expanded IHCC group eligibility to low-income elders and adults with disabilities up to one hundred percent (100%) of the FPL to use the same resource limits in effect for MN eligibility.
| Resource Standards for IHCC Groups | |
| Coverage Group | Limits |
| Community Medicaid – EAD and MN | $4,000.00 (I) $6,000.00 (C) |
| Community Medicaid – MACC GroupMN | Not Applicable |
| SSI – Protected Status | Varies by pathway. See Part 05-1 of this Chapter |
| SSP – State Determination (EAD) | $4,000.00 (I) $6,000.00 (C) |
| SSP – SSA Determination | $2,000.00 (I) $3,000.00 (C) |
| Breast and Cervical Cancer | None |
| Refugee Medicaid | None |
| Sherlock Plan | $10,000.00 (I) $20,000.00 (C) |
| Ticket to Work | Not Applicable |
| LTSS – SSI | $2,000.00 |
| LTSS – Special Income/HCBS (217 lookalikes) | $4,000.00 |
| LTSS – Medically Needy | $4,000.00 |
| MPPP | Varies by pathway – See Chart in Part 05-1 of this Chapter |
7. LTSS Spousal Impoverishment Standards – All values are published by the Federal Centers for Medicare and Medicaid Services (CMS).
d. Community Spouse Resources (updated January 1 annually)
e. Home Equity Limit (updated January 1 annually)
8. Medically Needy Income Limit (MNIL) (updated January 1 annually)
| Family Size | MNIL Annual January 2026 | Monthly 2026 |
| 1 | $14,400 | $1,200.00 |
| 2 | $14,900 | $1,242.00 |
| 3 | $18,300 | $1,525.00 |
| 4 | $21,000 | $1,750.00 |
| 5 | $23,600 | $1,967.00 |
| 6 | $26,300 | $2,192.00 |
| 7 | $28,900 | $2,408.00 |
| 8 | $31,600 | $2,633.00 |
| 9 | $34,200 | $2,850.00 |
| 10 | $36,900 | $3,075.00 |
A. This Section focuses on the treatment of income and, specifically, the way earned and unearned income are defined and evaluated when calculating countable income. For the purposes of this Section, countable income is the total income available to a person seeking Medicaid benefits subsequent to the application of any required exclusions, disregards, and/or deductions and, as appropriate, deeming.
A. For the purposes of this Section, the following definitions apply:
7. “Unavailable income” means the person cannot gain access to the income.
A. In calculating countable income, all sources of income a person receives or may be eligible to receive is reviewed. Not all sources of income are reviewed when renewing eligibility as indicated in § 3.3.5 of this Part. When determining initial eligibility using the SSI methodology, State responsibilities include, but are not limited to, the following:
6. Determination of Income Eligibility – Income evaluations are only one (1) facet of the eligibility determination process that must be completed within the specific timeframes required set forth in Part 2 of this Subchapter. As eligibility is considered across multiple pathways, failure to meet the income standard of one (1) coverage group does not necessarily result in an immediate denial or termination of eligibility as indicated in Part 2 of this Subchapter.
A. All persons seeking initial or continuing Medicaid health coverage are required to provide timely and accurate information on all matters related to eligibility. In addition, although attestations and electronic verifications of income are conducted to the full extent feasible, supporting documentation must be provided in the manner indicated in the application process. Failure to provide timely and accurate information may result in delays in the determination process, reapplication, or denial of eligibility due to non-cooperation.
A. When determining financial eligibility for Medicaid using the SSI methodology, income types are as follows:
1. Not Income – Some items or payment received by a person are not counted as income in the month received, though they may be treated as resources, as indicated in § 3.7 of this Part, if they are retained in the month after receipt. Items that are not income include, but are not limited to:
2. Countable Earned Income – Any earned income received as cash or an in-kind benefit a person receives in exchange for work must be considered in the financial eligibility determination process. Not all earned income is countable for Community Medicaid and several of the IHCC groups subject to the SSI methodology. In general, countable earned income includes, but is not limited to, the following with the exceptions noted:
a. Employee income. When derived from:
3. Countable Unearned Income – Unearned income is cash received that does not require performing a work or service. The following types of unearned income are countable to the extent indicated when determining eligibility using the SSI methodology:
q. Student financial aid, in the following situations:
A. When calculating countable income using the SSI methodology, certain disregards and exclusions apply: some only to earned income, others only to unearned income, and a few apply to both earned and unearned income. The availability of income also affects whether it is counted. This Section focuses on these and any other factors considered in the treatment of income for Medicaid eligibility purposes across populations. The specific Rules for how they apply when determining income eligibility for Community Medicaid are located in Part 05-1 of this Chapter; for Medicaid LTSS, all special provisions that apply are located in Part 50-00-6 of this Title.
A. The following disregards and exclusions apply to both earned and unearned income:
1. Infrequent/Irregular Income Disregards – Income is considered to be infrequent if received only once during a calendar quarter from a single source. Income is considered to be received irregularly if a person is not expected to receive such income on a routine basis. Treatment of irregular and infrequent income is as follows:
2. Twenty dollars ($20.00)/Month General Income Disregard – The first (1st) twenty dollars ($20.00) per month of unearned income is disregarded. For the disregard to apply to unearned income, the income must not be a benefit of a government funded program in which a person’s income was a factor in determining eligibility. The disregard is applied as follows:
4. Federally Mandated Exclusions – Certain Federal laws other than the U.S. Social Security Act exclude various types of earned and/or unearned income from the calculation of countable income in the financial eligibility process. A list of these exclusions is located in § 3.5 of this Part and is updated on a periodic basis.
A. Deductions to earned income as a result of disregards and exclusions are applied in accordance with certain rules. First, earned income is never reduced below zero (0) as a result of applying disregards and exclusions. Second, any unused earned income disregard or exclusion is never applied to unearned income. Last, any unused portion of a monthly exclusion cannot be carried over for use in subsequent months. Within these Rules, disregards and exclusions are applied as follows:
5. Impairment-Related Work Expenses – Earned income used by a person with disabilities to pay impairment-related work expenses is disregarded. For the disregard to apply, the person must be disabled but not blind and under age sixty-five (65) or must have received SSI as a disabled individual (or received disability payments under a former State plan) for the month before reaching age sixty-five (65). In addition, the following must be met:
7. Work-Related Expenses of Blind Persons – Earned income used to meet any expenses reasonably attributable to the earning of the income by a person who is blind and under age sixty-five (65) or received SSI as a blind person for the month before reaching the age sixty-five (65). Further, expenses may be disregarded if the person has an approved plan for self-support (PASS). The amounts must be reasonable and not exceed the earned income of the blind person or a blind spouse. See references on PASS, including types of expenses that qualify for this disregard in § 3.4.2(A)(3) of this Part.
A. Exclusions on unearned income never reduce unearned income below zero (0). Except for the twenty dollars ($20.00) general unearned income exclusion, no other unused unearned income exclusions may be applied to earned income. SSI methodology uses the following when considering whether an unearned income disregard or exclusion applies:
3. Child Support and Arrearage Payments – One third (1/3) of a child support payment made to or for a child by a non-custodial parent is excluded. A parent is considered non-custodial if the parent and the child do not reside in the same household. The other types of these support and arrearage payments that are excluded are:
4. Death Benefits – A death benefit is something received as the result of another's death.
6. Federal Housing Assistance – The U.S. Department of Housing and Urban Development (HUD) and State and local governments and housing authorities provide various forms of assistance that help pay shelter costs. This includes subsidized housing, loans for modifications, mortgage supports and guaranteed loans. Housing assistance is excluded income if payment is made in the form of cash or a voucher and provided under the authority of any of the following, as amended:
14. Reparation Payments – Reparations associated with the following are excluded from income:
16. Student Loans – Federal and State funds or insurance are provided for educational programs at middle school, secondary school, undergraduate and graduate levels under Title IV of the Higher Education Act, 20 U.S.C. §§ 1070-1099d, and student assistant programs of the Bureau of Indian Affairs. Any loan to an undergraduate student for qualified education expenses made and/or insured by the Federal government or the State’s higher education financing authority is excluded as both an income and resource.
A. Lump sum income is irregularly or infrequently received income. It can be earned or unearned income. Whether lump sum income is countable when determining financial eligibility depends on what is received, how often it is received, and the health care program for which the person is eligible. Examples of lump sum income include:
3. General Treatment of Lump Sum Income – For all IHCC groups subject to the SSI methodology, the following are excluded from lump sum income:
4. RSDI and SSI Payments – When eligibility for RSDI and SSI benefits are first approved, beneficiaries often receive a one (1) time payment that includes retroactive payments back to the date of a disability. These RSDI and SSI payments are lump sums, and are treated somewhat differently depending on the person’s Medicaid eligibility pathway:
b. Community Medicaid, MPPP, and Medicaid LTSS pathways.
5. Medicare Part B Reimbursements – A dual eligible beneficiary’s Medicare Part B premium could be reimbursed in a lump sum if determined retroactively eligible as a Specified Low-Income Medicare Beneficiary (SLMB). In such cases, the beneficiary will receive a reimbursement check from CMS after the State has provided back payment for those retroactive months. A Medicare Part B reimbursement is counted if the beneficiary used Medicare Part B premiums as all or a portion of a spenddown expense. The lump sum reimbursement is excluded if the beneficiary did not use Part B premiums as an expense for spenddown purposes. Such reimbursements may be counted in the month received for Medicaid LTSS beneficiaries receiving RSDI.
A. Self-employed beneficiaries are responsible for their own work schedules and are not covered under an employer's liability insurance or Workers' Compensation. Depending on the type of self-employment, a beneficiary may or may not have Social Security tax (FICA) deducted from pay. Examples of self-employment enterprises include but are not limited to: Farming; Product Sales (involving personal goods such as jewelry, household goods, clothing and the like); Personal Training; Professional Consulting; Small businesses; Services (personal care or day care); and Skilled Trades (roofers, painters, home design, etc.). The process for evaluating self-employed income includes:
2. Treatment of property related to self-employment income – Certain types of self-employment involve use of real property. Deductions from gross self-employment income for allowable expenses are made in accordance with Federal Internal Revenue Service (IRS) requirements associated with the business use of the home/vehicle. Special treatment is required with the following:
b. Room/Board Income. Roomer/boarder situations include the following:
c. In-home Day Care. When a person provides family child care services in a home in which they have an ownership interest, net self-employment income is countable. In such instances, allowable expenses are itemized as business expenses for tax filing purposes and include food (meal and snacks) and educational and entertainment materials in addition to transportation and shelter costs. If the care is provided in a home in which there is no ownership interest, the applicant/beneficiary is treated as a private contractor and these additional allowable expenses are not deducted from gross employment income. Payments made by the DHS to an in-home child care provider in association with the State’s Child Care Assistance Program (CCAP) are countable.
A. In-kind income, whether earned or unearned, is generally counted at market value. Special Rules apply when such income takes the form of food or shelter:
2. Unearned in-kind – When no work is performed in exchange for room and shelter, its value is determined as follows:
b. Living in household of another. When a person is living in the household of another for an entire month and they do not have an ownership interest or pay an appropriate share of the monthly expenses for maintaining that household, a portion of the value of the food and shelter they receive is excluded.
c. Living in own household. If the person lives in their own home and receives food and/or shelter in-kind, the PMV rule applies.
A. Under the following circumstances, the availability of income determines whether it is counted:
A. Federally Mandated Income Exclusions
| Federally Mandated Income Exclusions |
| Agent Orange settlement payments |
| Child care assistance under the Child Care and Development Block Grant Act of 1990, Pub. Law 113-186 |
| The first (1st) two thousand dollars ($2,000.00) per calendar year received as compensation for participation in clinical trials that meet the criteria detailed in § 1612(b) of the Social Security Act, 42 U.S.C. 1382a(b) |
| Payments made for supporting services or reimbursement of out-of-pocket expenses to volunteers participating in corporation for national and community service (CNCS, formerly ACTION) programs:AmeriCorps programSpecial and demonstration volunteer program; University year for ACTION (UYA) |
| Retired senior volunteer program (RSVP) |
| Foster grandparents program |
| Senior companion program |
| Energy employees occupational illness program payments |
| Federal food and nutrition programs: |
| Food assistance (formerly known as food stamps)U.S. department of agriculture food commodities distributed by a program (private or governmental)School breakfast, lunch, and milk programs; Women, infants, and children program (WIC); Nutrition programs for older Americans |
| Student financial assistance received under the Higher Education Act of 1965 (U.S.C. Title 20) or Bureau of Indian Affairs is excluded from income and resources, regardless of use:Pell GrantsStudent services incentivesAcademic achievement incentive scholarships; Byrd scholars;Federal supplemental education opportunity grants; Federal educational loans (federal PLUS loans, Perkins loans, Stafford loans, Ford loans, etc.); Upward bound; Gear up (gaining early awareness and readiness for undergraduate programs); State educational assistance programs funded by the leveraging educational assistance program; Work-study programs. |
| Home energy assistance provided on the basis of need, in accordance with 20 C.F.R. § 416.1157 (2023) |
| Matching funds that are deposited into individual development accounts (IDAs), either demonstration project or TANF-funded, in accordance with 42 U.S.C. § 604 |
| Japanese-American and Aleutian restitution payments |
| Payments to victims of Nazi persecution |
| Netherlands WUV payments to victims of persecution from 1940-1945 |
| Department of Defense payments to certain persons captured and interned in North Vietnam, in accordance with the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1998, Pub. Law 105-78 |
| Radiation exposure compensation trust fund payments, in accordance with the Radiation Exposure Compensation Act (“the Act” or “RECA”), Pub. Law 101-426 |
| Veterans Affairs payments made to or on behalf of: |
| Certain Vietnam veterans’ natural children regardless of age or marital status, for any disability resulting from spina bifida suffered by such childrenCertain Korea service veterans’ natural children regardless of their age or marital status, for any disability resulting from spina bifida suffered by such childrenWomen Vietnam veterans’ natural children regardless of their age or marital status, for certain birth defects |
| Austrian social insurance payments received under the provisions of the Austrian General Social Insurance Act, 20 U.S.C. § 1613(a), 20 C.F.R. § 416.1236 (2023). These payments must be documented and identifiable from countable insurance |
| Payments made to Native Americans as listed in Part IV of 20 C.F.R. Part 416 Appendix to Subpart K (2023) |
| Payments from the Ricky Ray hemophilia relief fund or the class settlement in the case of Susan Walker v. Bayer Corporation et al. under the Ricky Ray Hemophilia Relief Fund Act of 1998, Pub. Law 105-369 |
A. For the purposes of Medicaid eligibility, the assessment of resources is not tied, at least directly, to the person's availability to pay for health care. Instead, a resource is defined broadly as cash or other property that a person owns or has access to that is or could be used for personal support and maintenance. This Section describes the general treatment of resources when using the SSI methodology to determine eligibility for the IHCC groups to which it applies. There are differences in the types of resources that count and how they are reviewed for Community and LTSS Medicaid. Key differences in the review process are as follows:
2. Comprehensive Resource Review for LTSS – There are both MAGI and SSI-related eligibility pathways for LTSS that differ in terms of the treatment of income and resource limits, at least at the point in which an institutional level of care becomes required. Applicants evaluated using the SSI method (IHCC groups) are subject to a resource review and, in some instances, using specialized criteria as indicated in Part 50-00-6 of this Title; the resources of applicants seeking coverage through a MAGI pathway (MACC groups) are not an eligibility factor and therefore are not considered on that basis. However, all LTSS applicants, irrespective of eligibility pathway, are subject to an in-depth review of the transfer of assets – including income and resources – to ensure that the rules are applied equitably and in accordance with the standards set in Federal and State laws and Regulations governing estate recovery. The specific provisions applicable to the evaluation of resources and transfers of assets for Medicaid LTSS are set forth in Part 50-00-6 of this Title.
A. For the purposes of this Section the following terms apply:
18. “Trust” means property that is legally held or managed by a person or organization other than by its owners.
A. In calculating countable resources, the State’s responsibilities include, but are not limited to:
2. Factors Affecting the Evaluation of Resources – The following factors must be considered when evaluating resources:
d. Countable vs. Excluded Resources. A resource may be counted or excluded when determining financial eligibility. The State must consider whether a resource is counted or subject to a general or coverage group-specific exclusion and then assure any applicable exclusions are considered as follows:
4. Determination of Resource Eligibility – Resource eligibility is determined by comparing the countable resources of the FRU to the resource limits for the applicable IHCC group adjusted for the Medicaid eligibility group size.
A. Applicants and beneficiaries are responsible for: providing accurate information about their resources in the application process and submitting any necessary documentation and/or signed authorizations that may be necessary for verification purposes.
A. The SSI-methodology generally divides resources into non-liquid and liquid resources. Except for cash, any kind of property may be either liquid or non-liquid. A third (3rd) distinction has been added below for resources of both kinds managed by a third (3rd) party, such as trusts.
1. Non-Liquid Resources – A non-liquid resource is property that is not cash, including real and personal property that cannot be converted to cash within twenty (20) business days. Real property, life estates, life insurance and burial funds, described below, are some of the more common kinds of non-liquid resources. Certain other non-cash resources, though they may occasionally be liquid, are nearly always non-liquid including, but not limited to, household goods and personal effects, vehicles, livestock, and machinery. Types of non-liquid resources evaluated when determining eligibility for IHCC groups are as follows:
a. Home and Adjoining Land (real property). A home is a residential property which includes the shelter where a person lives, the land on which the shelter is located, related outbuildings, and surrounding property not separated from the home by intervening property owned by others. Public rights of way, such as roads that run through the surrounding property and separate it from the home, do not affect the exemption of the property. A home in which the applicant or the spouse of an applicant has an ownership interest is excluded as a resource, regardless of its value, for EAD or MN Community Medicaid. A home is also excluded for LTSS, but only up to the equity value limits established in § 3.2.8(A)(7)(e) of this Part and the provisions set forth in Part 50-00-6 of this Title with respect to the intent to remain are met. Factors affecting application of the exclusion include:
(2) Multiple Residences. Although an applicant may own residential properties either alone or in conjunction with others, only one (1) is considered a home and may be treated as an excluded resource at any given point in time. Even in situations in which both spouses in the household are applicants, the value of only one (1) home may be excluded. When the person and their spouse/dependent child make conflicting claims over which residential property is subject to the home exclusion the following decision Rules apply:
(8) Temporary Absences – A home exclusion is unaffected by temporary absences due to placement in a health facility or institutional setting, including a correctional facility, provided that the owner has not placed the home in a revocable trust and the owner and:
f. Burial Funds (personal property). Any funds clearly designated for burial expenses including burial spaces and related items and services. May take the form of contracts, revocable or irrevocable trusts, or other agreements, accounts, or instruments with a cash value. The following applying when determining the amount of burial expenses that may be excluded under one (1) of the following:
h. Life Insurance Policy. A contract between the policy holder and an insurer in which the insurer agrees to pay a designated beneficiary a sum of money in exchange for a premium, upon the death of the insured person – in this case the applicant/beneficiary (often the policy holder). Whole life insurance is permanent and builds cash value over the insured person’s lifetime because it has an added investment component along with its death benefit. The value of a whole life insurance policy is only counted if the person, or the person’s spouse (couple) is the owner. Policies on the life of a person or applicant’s spouse owned by another member of the FRU are not considered even when deeming applies (non-LTSS). Whether a policy is counted as a resource depends on two (2) factors:
2. Liquid Resources – A liquid resource is cash or other property that can be converted to cash within twenty (20) business days. Accounts in financial institutions; retirement funds; stocks, bonds, mutual funds, and money market funds; annuities; mortgages and promissory notes; and home equity conversion plans, described below, are some of the more common kinds of liquid resources.
a. Annuities. A contract reflecting payment to an insurance company, bank, charitable organization, or other registered or licensed entity; it may also be a private contract between two (2) parties. The purchase of an annuity may constitute a disqualifying transfer that results in a period of ineligibility for seeking initial or continuing Medicaid LTSS. The applicable provisions related to asset transfers are set forth in Part 50-00-6 of this Title. In addition, there are two (2) phases to an annuity, each of which also affects how it is treated as resource: an accumulation phase and a payout phase. Annuities also vary significantly by type, how beneficiaries are treated, and how they accumulate and pay out money, such as lump sum v. scheduled, usually on a monthly basis. All these factors influence whether the value of the annuity is counted or excluded. In addition, the State considers whether the annuity is a liquid resource, and ownership. Since annuities are trust-like instruments, terminology similar to trusts is used when it describes the availability of cash from annuities. The amount of any penalties paid when cashing-in an annuity is deducted from the amount of the payout. In general, exclusions are as follows:
c. Investments. Stocks, bonds, mutual funds and other investment instruments are evaluated in terms of sole or joint ownership as follows:
B. Resources, liquid and non-liquid, managed by a third (3rd) party include, but are not limited to, trusts, guardianship accounts, and retirement funds. Resources of a person managed by a third (3rd) party, such as a trustee, guardian, conservator, or agent under a power of attorney are considered available to that person as long as they can direct the third (3rd) party to dispose of the resource, or the third (3rd) party has the legal authority to dispose of the resource on the person’s behalf without the person’s direction.
A. There are several common features in the process for evaluating resources when using the SSI methodology that apply across IHCC groups, whether using a full or simplified review. The purpose of this Section is to set forth these features and identify any exceptions where appropriate.
A. The following process Rules apply generally in the evaluation of resources across IHCC groups.
2. Resource Changes – What a person owns in countable resources can change during a month, but the change is always effective with the following month's resource determination. The kinds of changes that may occur include:
3. Resource Reduction – If countable resources exceed the limit as of the first (1st) moment of a month, the applicant is not eligible for that month, unless the resources are reduced by expenditures on certain allowable expenses. In general, allowable expenses for resource reduction include:
4. Evaluation Factors – The methods for evaluating resources vary depending on the standard of review, as indicated above, as well the type of resources. In general, each type of resource has its own unique deductions, exclusions, and methods for determining its countable value. Unless a resource is excluded, the ownership interest in a resource is evaluated in accordance with the following:
b. Jointly Owned Resources. When two (2) or more parties share rights to sell, transfer, or dispose of part or all of personal or real property, the ownership share held by each person must be evaluated. This rule applies to resources such as joint checking or savings accounts and real estate held in common. In instances in which the document creating the joint interests, such as a deed to real estate or a bank account signature card, specifies the shares of the parties, the fair market value of the entire resource is divided between the joint owners according to the shares specified. The factors related to the availability and salability of jointly owned resources are taken into account in this review process. In instances in which a co-owner who must consent to the sale or redemption of a jointly owned resource is unavailable or refuses to take the actions necessary for the sale or redemption of the resource, then the resource is considered unavailable and is not included in the calculation of countable resources. Attribution of jointly owned resources is otherwise determined as indicated below:
6. Identifiability – Some resources must be identifiable to be excluded and, as such must be distinguishable from other resources. A resource is identifiable if:
d. The excluded funds remaining in the account can only be increased by deposits of subsequently received excluded funds and excluded interest. If interest on the excluded funds is excluded, the percent of an interest payment to be excluded is the same as the percent of funds in the account that is excluded at the time the interest is posted. The excluded interest is then added to the excluded funds in the account.
A. Resource exclusions may be mandated under the SSI methodology or by Federal laws other than the Social Security Act, 42 U.S.C. Chapter 7, as well as by the State and various other program requirements.
2. Required by State law or Regulation – Rhode Islanders are permitted a State tax deduction for funds committed to the State-administered 529 education account. Funds contributed to such an account are excluded, except for the amount of the Rhode Island tax deduction, as long as they are set aside for qualified educational expenses.
A. There are a number of special and time-limited exclusions that apply across the IHCC groups as well. Applicable general time-limited exclusions are as follows:
10. ABLE accounts – The federal Achieving a Better Life Experience Act (ABLE) of 2014, 26 U.S.C. § 529A, amended § 529 of the IRS code to permit States to create tax-advantaged savings accounts for persons who have proof of a documented disability or blindness, the onset of which occurred before age twenty-six (26). In accordance with R.I. Gen. Laws § 42-7.2-20.1 et seq., balances held in an ABLE account are excluded when determining financial eligibility for non-LTSS Medicaid under this Part and Medicaid LTSS pursuant to Part 50-00-6 of this Title. For persons eligible for Medicaid based on receipt of Supplemental Security Income (SSI), as described in Part 05-1 of this Chapter, balances of up to one hundred thousand dollars ($100,000.00) are excluded in the determination of financial eligibility. An SSI recipient with an ABLE account in excess of this balance loses SSI cash benefits until the balance is below this limit but is deemed eligible for the purposes of maintaining Medicaid eligibility. The resource exclusion for Medicaid eligibility continues to apply unless or until the contributions for the person benefiting from the ABLE account exceeds the annual limit of fifteen thousand dollars ($15,000.00) or the maximum life-time limit of three hundred ninety-five thousand dollars ($395,000.00). ABLE accounts are managed by the State and funds must be used only for the Qualified Disability Expenses established in Federal and State laws. Additional information on ABLE accounts is located at the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) website at: https://bhddh.ri.gov/developmental-disabilities-services/services-adults/able-saving-plan.
A. The following is a list of federally mandated exclusions based on whether or not they are identifiable:
| Federally Mandated Resource Exclusions |
| Identifiable and Excluded Indefinitely (unless otherwise indicated) |
| Agent Orange Settlement Fund payments |
| Blood Product Settlement payments |
| Corporation for National and Community Service (CNCS) payments. Payments to volunteers, including the following payments authorized under the Domestic Volunteer Services Act, Pub. Law 93-113, are excluded:AmeriCorpsUrban Crime Prevention ProgramSpecial Volunteer Programs under Title IDemonstration Programs under Title IISenior Corp:Retired Senior Volunteer Program (RSVP)Foster Grandparent ProgramSenior Companions |
| Individual Development Accounts (IDA) |
| Japanese and Aleutian Restitution payments |
| Jensen Settlement Agreement payments. Payments received by class members are excluded. Funds received under this agreement from countable resources at the time of application and at each renewal are deducted. |
| Low Income Home Energy Assistance Program (LIHEAP) payments |
| Nazi Persecution payments |
| Radiation Exposure Compensation Trust Fund (RECTF) payments |
| Real estate taxes, homeowner’s insurance and funds set aside for upkeep expenses of the property. Up to one (1) year’s expenses are excluded. Funds must be kept in a separate account. |
| Relocation Assistance payments, Federal |
| Ricky Ray Hemophilia Relief Fund payments |
| Student financial aid received under Title IV of the Higher Education Act (HEA) Pub. Law 89-329, or Student financial aid received from the Bureau of Indian Affairs (BIA)Non-Title IV and non-BIA grants, scholarships, fellowships and other non-loan financial aid, if used or set aside to pay educational expenses until the month following the last month the student is enrolled in classesDistributions from a Coverdell Educational Savings Accounts (ESA) if the funds are used for educational expensesExcluded for the designated beneficiary of the account for nine (9) months following the month of receipt of a distributionExcluded for anyone who is not a beneficiary who contributes money to the account beginning the month after the month the funds are transferred into the accountExcluded, due to being a conversion of a resource, for a contributor who is the designated beneficiary beginning with the month after the month the cash is transferred into the accountVeteran’s Affairs (VA) benefits designated as educational assistance both undergraduate and graduate students until the month following the last month the student is enrolled in classesPlan to Achieve Self Support (PASS) student financial aidTraining expenses paid by the Trade Act of 1974, Pub. Law 93-618Qualified Tuition Programs (QTP), also known as a 529 Plans, for the designated beneficiary (the student or future student) who is not the owner of the account and does not have any rights to the funds in the account |
| Tribal payments and interests. The following tribal resources are excluded:Tribal trust or restricted lands, individual interestTribal per capita payments from a tribal trustTribal land settlements and judgments |
| Uniform Gift to Minors Act/Uniform Transfers to Minors Act, Pub. Law 107-210, (UGMA/UTMA)The full value of resources established under the UGMA/UTMA is excluded.An adult designated to receive, maintain and manage custodial property on behalf of a minor beneficiary is not the owner of UGMA/UTMA resources because the adult cannot legally use any of the funds for their support and maintenance.When the UGMA/UTMA property is transferred to a beneficiary at the end of the custodianship (usually at the age of eighteen (18) or twenty-one (21) depending on State law) the property becomes available to the beneficiary. It is counted as income in the month of transfer and as a resource in the following month. |
| Veterans’ Children with Certain Birth Defects payments |
| Vietnamese Commando Compensation Act, Pub. Law 104-210, payments |
| Excluded Resources Regardless of Identifiability (unless otherwise noted) |
| Adoption Assistance payments are excluded in the month of receipt and thereafter. |
| Accrued Interest on resources is excluded if any excess is properly reduced at eligibility redetermination. |
| Alaska Native Claims Settlement Act (43 U.S.C. §§ 1601 – 1624) (ANCSA) payments |
| Appeal Payments are excluded as resources in the month received and for three (3) months after the month of receipt. |
| Clinical trial participation payments excluded by SSI. The first two thousand dollars ($2,000.00) a person receives during a calendar year is excluded. |
| Cobell Settlement for American Indians for a period of twelve (12) months beginning with the month of receipt. This exclusion applies to all household members. |
| Crime victim payments |
| Disaster assistance, Federal payments |
| Disaster assistance, State payments |
| Filipino Veterans Equity Compensation (FVEC) payments |
| Foster Care payments |
| Gifts to Children with Life Threatening Conditions from 501(c)(3) tax-exempt corporation. These are not considered resources of a parent and apply only to children who are under age eighteen (18).Cash gifts up to two thousand dollars ($2,000.00) in any calendar year are excluded. The amount of total cash payments that exceed two thousand dollars ($2,000.00) each year are counted as a resource.Multiple cash gifts in the same calendar year are added together and up to two thousand dollars ($2,000.00) of the total is excluded, even if none of the cash gifts exceeds two thousand dollars ($2,000.00) individually. |
| Homestead real property |
| Household goods and personal effects |
| James Zadroga 9/11 Health and Compensation Act of 2010, Pub. Law 111-347 |
| Kinship payments |
| Proceeds from the sale of a homestead are excluded if a person:Plans to use the proceeds to buy another homestead, andDoes so within three (3) full calendar months of receiving the funds |
| Reimbursements for replacement of lost, damaged or stolen excluded resources are excluded for the month of receipt and nine (9) months thereafter. The funds are excluded for up to nine (9) more months if the person tries to replace the resources during that time but cannot do so for good reason. |
| Representative Payee Misuse payments. If a person’s Supplemental Security Income (SSI), Retirement, Survivors and Disability Insurance (RSDI) benefits, or Veterans Benefits for the Elderly are reissued because an individual representative payee misuses benefits, the reissuance is excluded as a resource for nine (9) months if retained after the month of receipt. |
| Retroactive RSDI and SSI benefits are excluded for the nine (9) calendar months following the month in which the person receives the benefits. Any accrued interest on that account is counted as income in the month received and as a resource in the following months. |
| State Annuities for Certain Veterans |
| Relocation payments, State and local |
| Tax credits, rebates, and refunds are excluded for twelve (12) months after the month of receipt |
| Term life insurance |