Selected Sections of The Florida Public Assistance Manual. Here you will find the Department of Children and Families guide to the Florida laws on Medicaid and how they affect eligibilty for public benefits to pay for the costs of long term care. We have broken the selected sections into three part for ease in navigation. Those parts are: Sections 1600 to 1630 Sections 1630 to 1845 Sections 1845 to 1875 1630.00.00 TRANSFER OF ASSETS   At application and eligibility reviews, individuals must provide information regarding assets transferred prior to the application or eligibility review. The time periods for asset transfers and the specific policy for transfer of assets vary by program.   1630.20.00 TRANSFER OF ASSETS (MA-SSI)   (10-01-95) This policy applies only to ICP, institutionalized MEDS-AD and the Home and Community Based Services programs (HCBS). This policy applies to transfers made by SSI-DA recipients applying for these programs. (It does not apply to Hospice, ICF/DD, or state mental hospitals programs.)   Transfers do NOT affect other SSI-related programs.   A "transfer" occurs when an individual, his/her spouse, a legally authorized representative, or the joint owner of a jointly held asset:   - disposes of an asset (by selling it or giving it away) or decreases the extent of the individuals or spouses ownership interest in an asset   AND   - does not receive a fair amount of compensation in return.   Effective 10/l/93 transfer policies apply to transfers of income as well as transfers of resources.   When a resource or income is disposed of or transferred for less than fair market value within the transfer look-back period of the date of application, the individual may be ineligible for Medicaid nursing facility services and HCBS services for a specified period of time.   A transfer is presumed to be made for the purposes of obtaining Medicaid eligibility and a period of ineligibility will be imposed unless the individual presents convincing evidence of one of the following:   - the individual intended to dispose of the assets either at fair market value (FMV) or in exchange for other valuable compensation (for example, support and/or maintenance); OR   - the asset was transferred solely for reasons other than to become eligible for Medicaid; OR   - the transfer was considered allowable under policies in section 1630.20.10.05, 1630.20.10.10, 1630.20.15, 1630.20.16, or 1630.20.20; OR   - all of the assets transferred for less than fair market value have been returned to the individual (refer to section 1630.30.20); OR   - imposing the transfer penalty on the individual would place an undue hardship on the individual (see section 1630.20.25).   If a person is ineligible due to the uncompensated value (UV) of a transfer, he must be denied Medicaid nursing facility or HCBS services. However, he is entitled to regular Medicaid benefits if he meets all other factors of eligibility (including level of care). This coverage group is identified as "MI T" on the FLORIDA system.   Legal basis: 42 USC 1396p(c); HCFA State Medicaid Manual, Part 3, sections 3257 and 3258.   1630.20.01 How To Determine if a Transfer Penalty Applies (MA-SSI)   (01-01-96) If an individual, his or her spouse, a legal representative or the joint owner of a jointly owned resource disposes of a resource or income without receiving fair compensation, the individual may be ineligible for Medicaid nursing home care services or home and community based services for a period of time.   You need to identify when a transfer has occurred and when to apply a transfer penalty to a case. Answer the following questions and review the applicable manual material to determine if a penalty period applies to your case.   REFER TO SECTIONS FOR DETAILED INSTRUCTIONS ON TRANSFER POLICIES   STEP ACTION/DECISION REFER TO...   1 Has a resource or income been given away 1630.20.00 or sold for less than its fair market 1630.20.05 value within the look-back period or 1630.20.05.05 anytime thereafter? 1630.20.10   If Yes, go to step 2. If No, STOP. Do not apply penalty 1630.20.25 period.*   2 Is the individual applying for or 1630.20.00 receiving Medicaid nursing home services (ICP or institutional MEDS-AD) 1630.20.10 or home community-based services?     If Yes, go to step 3. If No, STOP. Do not apply penalty period.*   3 Was this an allowable transfer according 1630.20.10 to policy? 1630.20.10.04 1630.20.10.05 If Yes, STOP. Do not apply penalty 1630.20.10.10 period.* 1630.20.10.11 If No, go to step 4. 1630.20.10.12 1630.20.15 1630.20.16 1630.20.20 4 Determine the fair market value of the 1620.10.10 transferred resource or income. 1630.20.25   GO to step 5.   5 Determine the value of compensation 1630.20.30 received for the transferred resource or 1630.20.30.05 income after the transfer. 1630.20.30.10 1630.20.30.15 GO to step 6   6 Determine the uncompensated value (UV) of 1630.25.00 the transferred resource or income (fair market value minus compensation).   If there is no UV, STOP. Do not apply penalty period.*   If there is UV, GO to step 7.     7 Enter UV on AAAT screen so the system 1630.30.10 computes the tentative penalty period. 1630.30.15   GO to step 8.   8 Does the transfer penalty affect 1630.20.25 eligibility for the months of requested 1630.25.O0 assistance?   If Yes, you must presume the transfer was for the purpose of becoming Medicaid eligible and go to step 9. If No, STOP. Do not apply penalty period.*   9 Send the transfer notice to the client 1630.25.00 and/or his designated representative 1630.25.05 and offer the opportunity to rebut the 1630.30.00 presumption that the transfer was done to become Medicaid eligible.   GO to step 10.   10 Was the rebuttal successful? 1630.20.25 1630.25.05   If Yes, STOP. Do not apply penalty 1630.30.00 period.* 1630.30.05 If No, go to step 11.   11 Does the undue hardship provision apply 1630.20.00 to this case? 1630.20.25   If Yes, STOP. Do not apply penalty period.*   If No, go to step 12.   12 Check AAAT screen to assure correct FMV (VALUE field, line 3) and UV (AMOUNT field, line 4) are entered.   GO to step 13.   13 Enter explanation on CLRC. 1630.35.00   GO to step 14.     14 Process case with penalty period. Make 1630.20.00 sure the system assigns the correct 1630.30.10 penalty period. 1630.45.00   - If the transfer is the reason the client is ineligible for ICP or HCBS, approve the client for all other Medicaid benefits except institutional care services (MI T coverage).   - If the client is ineligible based on the transfer plus other factors, deny all Medicaid benefits unless the client qualifies under another coverage group (e.g., Medically Needy).   - If the transfer occurred prior to 10/l/93, the penalty period cannot be longer than 30 months. If the transfer occurred after 10/l/93, there is no limit on the penalty period months.   15 Send notice advising client/D.R. of the application decision and the period of ineligibility.     Refer to Section 1630.30.20 for adjustments to the penalty period when additional compensation is received or the transferred resource is returned to the individual.   Refer to section 1630.40.00 for transfers after approval or transfers of previously excluded resources.   Refer to section 1630.20.15 for transfers of the community spouse allocated resources.   Refer to section 1630.20.10.04 for transfers to retirement funds.   *If no penalty period applies to your case, return to the AAAT screen and enter the following on the screen:   - indicate the transfer was allowable by entering "Y" for YES in the "ADC/ICP/RAP: PROPER field; AND   - enter the value of compensation received in the "AMOUNT" field on line 4, after RELATION. (If no compensation is received, enter "O".)   Don't forget to enter VR source.   Remember to include a complete explanation of the transfer on the CLRC screen.   1630.20.05 Transfer Look-Back Period (MA-SSI)   (10-01-95) You must consider any transfer that occurred within the transfer "look-back" period prior to the date of application or anytime after applying. The look-back period begins with the month of application, counting backwards. The current look-back period is 30 months.   - For applications prior to 5-01-96: You must look back 30 months prior to the month of application to determine if a transfer of a resource or income occurred. Each transfer must be evaluated to determine if fair compensation was received and if not, to evaluate if a period of ineligibility must apply.   - For applications made on or after 5-01-96, the transfer look-back period will change to 36 months prior to the month of application (but no earlier than 10-01-93) and will be phased in as indicated by the following chart:   If app. is received: Then look-back period is:   prior to 05-01-96 30 months   05-01-96 31 mo. (10-1-93)   06-01-96 32 mo.   07-01-96 33 mo.   08-01-96 34 mo.   09-01-96 35 mo.   10-01-96 or later 36 mo.     - Trusts which are considered transfers of assets will follow the same look- back periods as above until 11-01-96 when they will begin to phase into the 60 month lookback period. The following chart explains this phase-in period:   If app. is received: Then look-back period is:   prior to 10-01-96 use chart above   10-01-96 36 mo. (10-01-93)   11-01-96 37 mo.   12-01-96 38 mo.   (etc.) (etc.)   10-01-98 60 months         1630.20.10 Criteria for Applying Asset transfer Policy (MA-SSI,SFP)   (01-01-96) You must ask all applicants if they or their spouses have transferred any assets within the "look-back period" preceding the month of application.   APPLY the transfer of asset policy to the following individuals:   - Transfers made by applicants/recipients for nursing home care (i.e., institutionalized) and HCBS programs. This includes recipients of ICP, institutionalized MEDS-AD, and Home and Community-Based Services (HCBS). This does not apply to Hospice, institutionalized Hospice, ICF/DDs, or state mental hospitals.   - Transfers made by the individual, his/her spouse, or legally authorized representative, such as a legal guardian, parent of minor child, or power of attorney;   - Transfers made by SSI recipients applying for nursing home care (ICP or MEDS-AD) or HCBS; Transfers by joint owners, for transfers on or after 10-01-93.   APPLY the transfer of asset policy to the following situations:   - Transfers of funds which were constructively received by the individual (e.g., refusing an inheritance or funds paid directly into a trust unless paid into a qualified trust in accordance with policies in 1625.85.15 et seg.);   - Transfers on or after April 1, 1995 to annuity funds or other retirement funds which fail to give the individual fair compensation in his lifetime;   - Transfers of homestead property, or property excluded due to a bona fide effort to sell, unless the property is transferred to an allowable relative according to criteria in Section 1630.20.10.05.   1630.20.10.04 Transfers to Retirement Funds (MA-SSI)   (10/01/95) Annuities are a type of retirement fund which provides a source of income after an individual retires. Most are set up in advance of retirement as part of the person's retirement plan. Others are set up shortly before application for Medicaid services and are a means to shelter the individuals resources to qualify for Medicaid assistance. To avoid penalizing annuities validly purchased as part of a retirement plan, but to capture those annuities which shelter assets, you must determine if the purchase of the annuity (or other retirement plan) constitutes a transfer of assets for less than fair market value for any plan purchased on or after 04/01/95.   If the average number of years of expected life remaining for the individual equal or exceed the life of the annuity (or other retirement fund), fair compensation is received. If the individual is not expected to live at least as long as the guarantee period of the annuity, then the individual may not receive fair market value for the annuity. In this case, a transfer of assets for less than fair market value may have taken place, subjecting the individual to a period of ineligibility.   The penalty must be assessed based on the uncompensated value of the transfer of assets that is considered to have occurred at the time the annuity (or other retirement fund) was purchased. Remember: you can only impose a penalty period if the annuity (or other retirement fund) was purchased by the individual on or after 04/01/95 and within the transfer of assets look-back period.   Example 1: Mr. Jones (age 65) purchases an annuity to be paid over the course of 10 years. According to the life expectancy tables, his life expectancy is 14.96 years. The annuity is considered actuarial sound and there is no uncompensated value.   Example 2: Mr. Smith (age 80) purchases the same annuity, also to be paid over 10 years. His life expectancy is only 6.98. Since Mr. Smith's life expectancy is less than the payout of the annuity, you must use the following instructions to determine if there will be any uncompensated value:   To determine if the individual will receive a fair market return in his lifetime on an annuity or other retirement fund purchased on or after 04/01/95, use the life expectancy tables in Appendix A, Attachments 13 and 14 and the following instructions:   Step 1: Calculate the compensation the individual is expected to receive in his lifetime by computing the individuals annual income from the annuity and multiplying by the individuals life expectancy. Use the life expectancy factor corresponding to the individuals age at the time the annuity (or retirement fund) was purchased (i.e., the time of the transfer). (If a couple is involved, use the life expectancy factor for the spouse who is receiving the retirement payments.)   Step 2: Determine the uncompensated value by subtracting the compensation the individual expects to receive in his lifetime from the annuity (the result of step 1) from the total amount put into the annuity. The result is the uncompensated portion of the annuity (or other retirement fund) which the individual cannot reasonably expect to receive in his lifetime.   Step 3: If there is no uncompensated value, the annuity is actuarial sound and no transfer of assets penalty applies. If there is uncompensated value, proceed by following all standard transfer of asset procedures, including the opportunity to rebut the reason for the transfer.   Legal Basis: HCFA State Medicaid Manual, Section 3258.9.   1630.20.10.05 Allowable Transfers-Homestead Property (MA-SSI)   (10-01-94) The transfer of a homestead is considered allowable if the individual transfers his home to his spouse or any of the following relatives:   - a child under 21;   - a blind or permanently disabled adult child (Receipt of SSI or Title II Social Security disability is acceptable proof of disability. Otherwise a disability decision must be obtained in all situations, including adult children over 65. These policies apply to all blind/disabled adult children.);   - a sibling of the individual who has an equity interest in the home and was residing in the home for at least one year immediately before the individual became institutionalized (the worker must accept the sibling's statement unless there is reason to question);   - an adult son or daughter of the individual who was residing in the home for at least two years before the individual became institutionalized and who provided care to the individual that delayed the individuals institutionalization (the worker must accept the son/daughter's statement unless there is reason to question).   If the home is transferred to any individual not listed above, the transfer of assets policy is developed. The individual must be given the opportunity to rebut and gather data on the compensation received from the transfer.   1630.20.10.10 Allowable Transfers (MA-SSI)   (04-01-96) The following transfers are considered "allowable" and no period of ineligibility will be imposed:   - Transfers by individuals who are not applying for or receiving ICP, institutionalized MEDS-AD or HCBS;   - Transfers of assets which are excluded because they are not marketable (for example, condemned property or interest in heir property);   - Transfers of life estates;   - Transfers where fair compensation is received. Examples would be resources used to make a purchase for a client or used to pay (or repay) a valid debt equal to the fair market value of the resource.   - In order for the debt to be considered a valid debt, it must be a legally collectible debt;   - An informal loan will be considered to be a valid debt provided it meets the criteria for a bona fide loan set forth in section 1625.70.15;   - A transaction in which an individual makes burial arrangements with a funeral director and places funds in a burial trust is considered a purchase;   - Transfers to the individuals child under 21;   - Transfers to the individuals blind/disabled child or to a trust described in sections 1625.85.15.31 established solely for the benefit of the individuals disabled adult child; Transfers to a trust (including a qualified trust for the disabled or qualified pooled trust, as described in section 1625.85.15.31) for the sole benefit of a disabled individual under age 65.   - Transfers of the individuals income to a qualified income trust (see 1805.15.20).   - Interspousal transfers made on or after October 1, 1989;   - Transfers of assets to a third party by the individual applying for nursing home care (ICP or institutionalized MEDS-AD) or HCBS programs or by the individuals spouse, if the third party intends to use the funds for the sole benefit of the individuals spouse (see 1630.20.10.12);   - Transfers of excluded resources other than homesteads or property excluded due to a bona fide effort to sell (for example, a car); - Transfers made by the spouse of a HCBS individual of any of the spouses individually owned assets.   1630.20.10.11 Definition of Disability (MA-SSI)   (10/01/95) When an allowable transfer is alleged to have been made to a disabled individual (per policy in 1630.20.10.10), you must determine if the individual meets the definition of disability used by the SSI program.   Disability must be determined according to regular policy; that is, the person must receive social security disability or SSI benefits or the DMRT must make an independent determination to evaluate if the individual meets the disability requirement.   1630.20.10.12 Definition of "For The Sole Benefit Of" (MA-SSI)   (10/01/95) In order for the transfer to be considered to be for the sole benefit of the spouse; the individuals blind or disabled child; or a disabled individual under age 65, the transfer instrument or document must provide that   - no individual or entity except the spouse, the individuals disabled child, or the disabled individual under age 65 can benefit from the resources or income transferred in any way either at the time of the transfer or at any time in the future; AND   - the spending of the funds involved for the benefit of the individual is actuarial sound based on the life expectancy of the individual involved; that is, the individual must be able to receive fair compensation or return of the benefit of the transferred asset during his lifetime. (Follow instructions in 1630.20.10.04 to use life expectancy tables on pages A-13 and A-14 of Appendix A to determine if the person will receive fair compensation in his lifetime.)   If the transfer instrument or document does not meet these requirements, it cannot be considered a transfer for the sole benefit of the spouse, the blind or disabled child, or disabled individual and any potential exemption from penalty or consideration for eligibility purposes is void. In this case, you need to compute the uncompensated value of the transferred funds, notify the client and give him the opportunity to rebut the presumption that the transfer was done to become Medicaid eligible.   Legal Basis: HCFA State Medicaid Manual, Part 3, Section 3257   1630.20.15 Interspousal Transfers After Approval (MA-SSI)   (04-01-96) This policy only applies to nursing home cases (ICP or institutional MEDS-AD). It does not apply to HCBS or Hospice.   In determining initial eligibility for an institutionalized individual with a community spouse, you must consider all countable resources of the institutionalized person and his legal spouse (refer to 1610.25.00; 1615.10.30). A portion of the couple's total countable resources is attributed to the community spouse and not counted when determining the institutionalized spouses eligibility for Medicaid nursing home services. This portion is known as the community spouses resource allowance, which are the resources the community spouse may keep to help meet his/her needs in the community. After the community spouses resource allowance is subtracted from the couple's total resources, any remaining resources are considered countable resources to the institutionalized individual. The institutionalized individuals eligibility depends on whether or not these remaining resources are within program standards.   After approval of Medicaid nursing home services, resources which are attributed to the community spouse but remain in the institutionalized spouses name are not considered available to the institutionalized spouse if they are transferred to the community spouse before the next scheduled complete redetermination. The FLORIDA system generates an alert for the worker to check on the transfer 90 days following approval.   At the time of approval, the couple and the designated representative must be advised of the need to transfer resources remaining in the institutionalized spouses name (which are part of the community spouses resource allowance) to the community spouse. Such transfers are allowed and no penalty can be imposed.   Partial reviews must be scheduled on a quarterly basis to check on the status of the transfers and to remind the couple/designated representative of the necessity to transfer excess resources (over the individuals program limits) to the community spouse. All necessary transfers should be completed as soon as possible after approval to assure such resources will not cause the individual to become ineligible for Medicaid assistance at the time of the annual review.   Failure to transfer resources to the community spouse before the next scheduled redetermination must not be reported as overpayment.   1630.20.16 Transfers by Community Spouse (MA-SSI)   (10-01-94) Transfer of resources between spouses do not affect eligibility. Transfer of resources to a third party by the spouse of the individual applying for nursing facility services prior to the approval of the institutional Spouses's eligibility are subject to the transfer of assets penalty. However, if the third party intends to use the funds for the sole benefit of the community spouse, it is not counted as a transfer.   After the individual has been determined eligible for Medicaid nursing facility services, transfers of resources owned by the community spouse will not affect eligibility of the institutionalized spouse provided included assets were within the applicable limit at the time of application disposition.   1630.20.20 Assets Transferred Due to Court-Ordered Support (MA-SSI)   (10-01-94) For ICP, institutionalized MEDS-AD or HCBS, when a court has entered an order against an institutional spouse for the support of the community spouse or family member, there will be no penalty imposed due to assets transferred to comply with the court order.   1630.20.25 Processing Transfer Cases (MA-SSI)   (10-01-95) You must evaluate all transfers of resources or income which occur in the look-back period to determine the following:     - if the transfer is legally binding; and   - if the client has any remaining ownership in the asset; and   - if the client received fair compensation.   When an asset is legally transferred, you must determine if the individual received fair compensation for it. If the individual received fair compensation, there is no need to develop transfer policy further. If the individual did not receive fair compensation, you must:   - presume the transfer was for the purpose of becoming Medicaid eligible, and   - determine the amount of the uncompensated value.   You must explain to the client the presumption that the transfer was for purposes of becoming Medicaid eligible and may result in a period of ineligibility. You must offer the client the opportunity to rebut the presumption by notifying him in writing (using HRS-ES 2264) and giving him the opportunity to present a written rebuttal (see 1630.25.05).   A period of ineligibility is not imposed if the individual successfully proves the following:   - the asset was transferred solely for reasons other than to become Medicaid eligible; or   - the individual intended to dispose of the assets either at fair market value or in exchange for other valuable compensation (for example, support and/or maintenance); or   - the transfers are considered allowable per policies in 1630.20.10.05, - .10, -.15, - .16, and 1630.20.20; or   - all transferred assets were returned to the individual (see 1630.30.20); or   - imposing the period of ineligibility would place an undue hardship on the individual.   Undue hardship exists when application of the provision would deprive an individual of food, clothing, shelter or medical care such that his life or health would be endangered. All efforts to reverse the transfer must be exhausted before this exception applies. All undue hardship decisions must be reviewed and approved by the district program specialist.           1630.20.30 Value of Compensation Received (MA-SSI)   A determination of the value of compensation received must be made based on the agreement and expectation of the parties at the time of transfer or sale, if earlier. The value of compensation is the gross amount paid or agreed to be paid by the purchaser. The value is not reduced by expenses attributed to the sale. Compensation may be received in one or more forms as described in Sections 1630.20.30.05 through 1630.20.30.15.   1630.20.30.05 Compensation in Cash (MA-SSI)   Compensation in the form of cash is the total amount paid or agreed to be paid, if greater, in exchange for the asset. The case manager must obtain documentary evidence when available (for example, bill of sale, contract, receipts, and the like) or statements from the eligible individual and the person(s) to whom the property was transferred to establish the amount of case compensation received.   1630-20.30.10 Compensation in Property (MA-SSI)   Compensation in the form of real or personal property is valued according to the FMV of that property at the time of asset transfer or sale, if earlier.   1630.20.30.15 Compensation in Support or Services (MA-SSI)   (04/01/95) Compensation in the form of support and/or maintenance, or services is based on:   - the FMV, - the support or services at the time of asset transfer, AND - the frequency/duration of the support or service.   In order for compensation to be considered, a statement and any related documentation must be obtained from the person(s) to whom the property was transferred to establish the FMV of the support and/or maintenance provided if:   - the intent is for a specified period, the actual length of time the support or service is provided is used;   - services are to be performed on an "as needed" basis, or for an interim period, the statement must include the individuals expectation as to the frequency of the services and the basis for that expectation; and   - the support or services are to be provided for the life of the individual, using the life expectancy tables in Appendix A, pages A-13 and 14 of the hard copy manual.   To establish the value of support and maintenance for the individuals life, use the following formula:     Multiply the yearly Fair Market Value (FMV) of the support and/or maintenance TIMES the life expectancy factor corresponding to the individuals age (as of the last birthday) at the time the asset was transferred.   Contact with an outside source in the same locality will usually be necessary to determine value. The case record must:   - state how the value was determined; and   - include a copy of the agreement or a statement from the person receiving the transferred asset showing the type, frequency, and duration of the support or services.   1630.25.00 UNCOMPENSATED VALUE/NOTIFYING THE CLIENT (MA-SSI)   (10-01-95) Whenever the individual disposes of income or resources within the transfer look-back period and does not receive fair compensation, he is potentially ineligible for Medicaid institutional care or HCBS for a period of time. The ineligibility period is dependent on the amount of the uncompensated value of the transferred funds.   The uncompensated value (UV) of the transferred funds is determined by subtracting the compensation received after the transfer from the fair market value of the transferred resource or income at the time of the transfer (less any outstanding loans, mortgages or other encumbrances on the asset).   Whenever the UV exceeds the average monthly private nursing home rate (see 1630.30.10), the individual is potentially ineligible for at least one month of nursing home care or HCBS. You must send HRS-ES Form 2264 to the individual to offer him the opportunity to dispute the presumption that the asset was transferred to establish eligibility.   Notification of uncompensated value due to transfers of income or resources is not required and the application may be processed immediately if   - the individual is ineligible for other reasons; or   - the total uncompensated value of the transferred assets is less than the private nursing home rate; or   - the period of ineligibility has elapsed; or   - the transfer was considered allowable.   When notification is required, you must allow the individual the full 15 days to respond to the rebuttal notice . if the individual does not respond within 15 days, the uncompensated value must be considered in determining eligibility.   You must record the individuals written statement or remarks on CLRC.     1630.25.05 Rebuttal of Presumption (MA-SSI)   The individual should be assisted in obtaining clear and convincing rebuttal evidence when necessary; however, the burden of proof rests with the individual.   The individual must provide a written statement of convincing evidence that the assets were transferred exclusively for some reason other than to establish eligibility. The statement should include:   - the purpose of the transfers; - attempts to dispose of the asset at FMV; - reasons for accepting less than FMV for the asset; - means of or plans for supporting himself after the transfer; - relationship, if any, to the persons to whom the asset was transferred; and - the individuals belief (considering age and-background) that FMV was received.   The individual must also submit pertinent documentation such as legal documents, realtor agreements, and relevant correspondence. Statements from other individuals may be obtained if needed.   1630.30.00 TRANSFER FOR OTHER PURPOSE (MA-SSI)   (10-01-95) To successfully rebut the presumption that the transfer was for the purpose of becoming Medicaid eligible, the individual must establish that the transfer was done exclusively for some other purpose than establishing eligibility. If the individual had some other purpose for transferring the asset but establishing eligibility seems to have been a factor in the decision to transfer the asset, the presumption is not successfully rebutted.   The presence of one or more of the following factors may indicate that assets were transferred exclusively for some purpose other than establishing eligibility.   1. The occurrence after the transfer of assets of:   - traumatic onset of disability or blindness;   - diagnosis of previously undetected disabling condition; o unexpected loss of other assets (including deemed assets) that would have precluded eligibility;   - unexpected loss of income (including deemed income) that would have precluded eligibility;   2. Total included assets were below the asset limit at all times from the month of transfer through the present month even if the transferred asset had been retained. 3. A court-ordered transfer; or   4. Exploitation (another person stole the funds of the individual).   This list is not all inclusive.   The rebuttal decision must be clearly recorded on CLRC. The determination is based only on whether the individual has presented convincing evidence that the transfer was exclusively for some purpose other than establishing eligibility.   1630.30.10 Period of Ineligibility (MA-SSI)   (04/01/95) When the presumption is not successfully rebutted, the worker must determine the period of ineligibility.   The penalty period depends on:   - the amount of the total UV, - when the transfer occurred, and - the average private nursing home cost at the time of application or discovery of the transfer.   The following basic formula is used to determine the period of ineligibility on all applicable cases:   Total UV (divided by) the average private nursing home rate = Number of months of ineligibility (rounded down to the nearest whole number).   Where assets have been transferred in amounts and/or frequency that would make the calculated penalty periods overlap, the value of all assets transferred are added together and divided by the average cost of private nursing home care.   Where multiple transfers are made in such a way that the penalty periods for each would not overlap, each transfer is treated as a separate event with its own penalty period.   If an institutionalized individual is ineligible for assistance due to a transfer of resources or income by the community spouse and the community spouse becomes eligible for ICP or HCBS, any remaining period of ineligibility must be apportioned between spouses. This will be done by dividing any new or remaining penalty periods by 2 and attribute to each spouse. Any odd months may be attributed to the spouse that caused the penalty or attribute according to the couple's (or their representatives) wishes.     The current average private nursing home rate ($3,300) is used for all transfers, regardless of when the transfer occurred. For transfers on or after 10-01-93, there is no limit in the number of months of ineligibility. For transfers prior to 10-01-93, the period of ineligibility cannot exceed 30 months.   1630.30.15 Uncompensated Value Months (MA-SSI)   (04/01/95) The period of ineligibility is calculated beginning with the month in which the transfer occurred. For example, if the individual transfers an asset in August and the period of ineligibility will be counted for five months, then the period of ineligibility would begin August 1 and end December 31.   If an applicant reapplies before the end of the period of ineligibility, the original penalty period must still be used even if the transfer occurred more than 30 months prior to this second application. However, the period of ineligibility may be adjusted if the transferred asset is returned or additional compensation is received (see 1630.30.20.)   1630.30.20 Adjustments to Penalty Period (MA-SSI)   (01-01-96) If the transferred resource (or income) is returned to the individual in whole, there is no penalty period. When all transferred resources or income are returned to the individual, the penalty period is eliminated, retroactive to the date of the transfer. Returned resources must be counted as available resources according to standard policy when determining eligibility for retroactive months.   If the transferred resource (or income) is returned to the individual in part, the worker must:   - reduce the uncompensated value accordingly,   - refigure the period of ineligibility, and   - evaluate the returned resource according to normal resource rules.   If the individual receives additional compensation from the person who received the transferred resource (or income), the worker must:   - document the compensation received,   - refigure the uncompensated value and the penalty period, and   - evaluate the compensation received according to normal resource rules.       1630.35.00 CASE RECORDING OF TRANSFERS (MA-SSI)   (01-01-96) The worker must record the following information on CLRC regarding exploration and development of transferred assets:   áwhat assets were transferred and their FMV;   ácompensation received, with a clear explanation of the determination;   áuncompensated value;   áthe date the transfer notice was sent (or given) to the individual;   áevaluation of the rebuttal, and if the rebuttal was successful, clear explanation as to basis for determination; and   áthe period of ineligibility (i.e., the penalty period), including basis for determination.     1630.40.00 COMPLETE ELIGIBILITY REVIEWS (MA-SSI)   (10-01-95) The transfer of resource provisions applies to reviews of currently eligible individuals. No special development is required in eligibility reviews unless you have reason to believe that the individual has transferred an asset. It is not necessary to redevelop transfers which occurred before the initial application or last eligibility reviews.   Transfer policies do apply to the following resources which were previously excluded as countable resources unless the property was transferred to an allowable relative according to 1630.20.10.05 or transferred for a reason other than to remain Medicaid eligible:   átransfers of homestead property or   átransfers of property excluded due to a bona fide effort to sell.     1630.45.00 DENIAL OF NURSING FACILITIES SERVICES (MA-SSI)   (10-01-94) Institutionalized individuals ineligible for ICP or institutionalized MEDS-AD solely due to a transferred asset must be approved for Medicaid only benefits if they meet all other factors of eligibility (including level of care). These individuals will be coded as "Ml I" on the FLORIDA system which indicates that they will not receive nursing home payment benefits but can receive other Medicaid services.     If the individual is ineligible for ICP or institutionalized MEDS-AD for any reason(s) other than the transferred asset, his case must be evaluated to see if he is eligible under any other Medicaid coverage groups.   1800.00.00 INCOME   This chapter discusses income policy for individuals whose income must be considered. Refer to Chapter-2200 to determine which SFU members must have their income considered.   - The specific income situations discussed in this chapter are: - Income Concepts (Section 1805), - Wages Included by All Programs (Section 1810), - Self-employment (Section 1815), - Wages Received from Training Programs (Section 1820), - Real Estate Income (Section 1825), - In-Kind Benefits (Section 1830), - Support (Section 1835), - Assistance From Government Agencies (Section 1840), - Benefits (Section 1845), - Dividends and Interest (Section 1850), - Reimbursements (Section 1855), - Student Loans, Grants, and Scholarships (Section 1860) - Personal Loans, Gifts, and Contributions (Section 1865), and - Trust Funds (Section 1870).   1800.05.00 DEFINITION OF INCOME   Income is cash received at regular intervals from any source such as wages, benefits, contributions, and rentals. Income means all income, earned as well as unearned from any source unless specifically excluded in this chapter.   1805.00.00 INCOME CONCEPTS   This section contains a discussion of the following income concepts;   á earned and unearned income, á infrequent or irregular income, á availability of income, á diversion of income, á third party payments, á deeming of income, and á verification of income.     1805.05.00 EARNED AND UNEARNED INCOME   Income is classified into two categories for budgeting purposes: earned income and unearned income.   Earned income is the receipt of wages, salary, commission, or profit from an individuals performance of work or services, or a self employment enterprise.   Unearned income is income for which there is no performance of work or services. unearned income may include:   á retirement, disability payments, unemployment/workman's compensation, etc.; á annuities, pensions, and other regular payments; á alimony and support payments; á dividends, interest, and royalties; á proceeds of life insurance policies; á prizes and awards; á gifts and inheritances; and á SSA, SSD, and SSI.     1805.05.05 Deductions from Gross Income   (10-01-95) Some deductions withheld from gross income must be included. Examples of these deductions include:   - premiums for Supplemental Medical insurance (SMI/Medicare) from a Title 11 (Social Security) benefit, - premiums for health insurance or hospitalization, premiums for life insurance, - federal and state income taxes, - social security taxes, - optional deductions, - a garnished or seized payment, and - guardianship fees.   Note: If the naming of a guardian is a requirement to receive the income, deductions for guardianship fees are disregarded, i.e., are not counted as income. This is the only exception.           1805.10.00 INFREQUENT OR IRREGULAR INCOME (FS,MA-SSI,SFP,EFAHP)   Sections 1805.10.05 through 1805.10.10 discuss situations where earned or unearned income is excluded because it is received on an irregular or infrequent basis.   1805.10.10 Infrequent or Irregular Income Excluded (MA-SSI,SFP) Infrequent or irregular income is excluded income. The total of infrequent and irregular earned income cannot exceed $10 per month. Irregular unearned income cannot exceed $20 per month. When infrequent or irregular income exceeds these limits, the total, not just the excess, is included. The excluded limits are not increased when both an eligible individual and spouse (either eligible or ineligible) have infrequent or irregular earned or unearned income. Payments less than the amount are included if received either frequently or regularly.   Income from work performed on an "as needed" basis rather than as regular part-time work, may meet the definition of irregular income.   Infrequent income is received only once in a calendar quarter from a single source. Irregular income is unpredictable and is not subject to being on schedule and the frequency of the receipt cannot be anticipated. The case manager must identify and categorize each receipt by amount, frequency, type, and source to determine if unearned income can be excluded as infrequent. Any unearned income of one type received once in a quarter from one source is considered infrequent; that is, an individual may receive the same type of income from two different sources or two different types from the same source if each is received only once during the quarter and still have the same amount excluded if no more than $20 is received in any given month.   1805.15.00 AVAILABILITY OF INCOME   Some types of income are readily available to the individual and must be included; however, the individual may have limited or no access to income in certain situations.   Some unavailable income may still be included as income. Sections 1805.15.05 through 1805.15.15 describe these situations and policy for determining income availability.   1805.15.10 Income Availability   (07-01-96) Income must be available to meet the SFU's needs to be considered, except in the case of lump sum income. Generally, income is considered available when it is actually available and/or when the individual has the legal ability to make the income available.   Exceptions to the policy above:   Occasionally, a regular monthly payment (e.g., Title II or VA) is received in a month other than the month of normal receipt. As long as there is no interruption in the regular payment schedule, consider the funds to be income in the normal month of receipt. Examples of this situation follow:   á Advance Dated Checks - When a payor advance dates a check because the regular payment date falls on a weekend or holiday, there is no intent to change the normal delivery date. Whenever such an advanced dated check goes to a bank by direct deposit, the funds may be posted to the account before or after the month they are payable.   á Electronic Funds Transfer - When an individuals money goes to a bank by direct deposit, the funds may be posted to the account before or after the month they are payable. Whenever this occurs, treat the electronically transferred funds as income in the month of normal receipt.   Florida State Retirement benefits are received the last workday of the month. The payment is considered income in the following month for SSI-related programs.   Income may be unavailable due to legal restrictions or factors beyond the control of the individual.   In both these situations, the case manager must request supporting evidence and make an independent assessment regarding availability based on the evidence presented. Additional guidance may be requested from the district program office, headquarters (through the district office), or legal counsel.   20CFR, Section 416.1123   1805.15.15 Availability of Income for Institutional Care (MA-SSI) (08-01-92) The following policy applies to: áICP, áMEDS-ICP, and áInstitutionalized Hospice.   The income owned solely by the community spouse is not considered when determining if the institutionalized individuals income is within program standards. once eligibility has been determined, the community spouses income is considered based on the following policy. á Income derived from jointly owned assets is considered available to whom it is paid unless the trust or nontrust instrument indicates otherwise. If the payment is made:   . solely to the community spouse, the income is available only to the community spouse; . to both spouses, half of the income is considered available to each spouse; . to the institutional spouse, the community spouse, and to others, income is considered available in proportion to each spouses interest in the asset.   á The institutionalized spouse may rebut the presumed ownership interest of non-trust assets. Trust assets are considered available according to the terms of the trust.   á Income from assets included in the community spouses asset allocation are considered available according to whom the income is paid until the asset is legally transferred to the community spouse. Once the asset is transferred to the community spouse, the income is not counted toward the institutional spouse.   1805.15.15.05 Determining Ownership of Income (MA-SSI,SFP)   The individual who has title to the proceeds of a payment or property is the individual who "owns" the income.   If the income is received by an individuals legal representative or guardian, the individual still owns the income.   When a legal representative receives the income, the case manager may verify ownership through the following documents:   áthe designation on the payment, check, award letter, or other document; or áthe title to the property.   1805.15.15.10 Joint Bank Account Transactions (MA-SSI,SFP)   When an eligible individual is a joint account holder, a deposit to the account specifically designated for any other account holder is not income to the individual.   Interest payments to the account are divided equally among the account holders. For example, if there are two owners, 50 percent of the interest paid is included income of the individual.   If an individual states that he does not own any portion of a joint bank account, he must rebut ownership of the bank account. Refer to Chapter 1600, Assets, Sections 1615.05.05.15 and 1615.05-05.20, Rebuttal of Ownership.   1805.15.15.15 Availability of an Inheritance (MA-SSI)   "Inheritance"is any person's rights to, or possession of, cash or property that are left to the individual at the person's death. An individuals inheritance becomes unearned income when it actually becomes available to the individual, but in no case later than when the estate is closed.   Usually the court issues an order specifying the distribution of an inheritance when closing out the estate. The individuals portion can be established by the court order.   If an inheritance is included as an asset as a result of deeming, and the individual later inherits the asset, the income from the inheritance is excluded at that time.   1805.15.20 Income Trusts (MA-SSI)   (10-01-95) The following policy applies only to the Institutionalized Care Program (ICP), institutionalized MEDS-AD and HCBS. It does NOT apply to institutionalized Hospice.   To qualify for ICP or HCBS, an individuals gross income cannot exceed 300 percent of the SSI federal benefit rate (refer to Appendix 8 for the current income standard). If an individual has income above the ICP income limit, he may become eligible for institutional care or HCBS if he sets up and funds a qualified income trust. A trust is considered a qualified income trust if:   á it is established on or after 10-01-93 for the benefit of the individual;   á it is irrevocable;   á it is composed only of the individuals income (Social Security, pensions, or other income sources); and   á the trust stipulates the State will receive the balance in the trust upon the death of the individual up to an amount equal to the total medical assistance paid on behalf of the individual.   You MUST forward all income trusts to your district program office for review and submission to the District Legal Counsel (DLC) for a decision on whether the trust meets the criteria to be a qualified   YOU MUST forward all income trusts to your district program office for review and submission to the District Legal Counsel (DLC) for a decision on whether the trust meets the criteria to be a qualified income trust. Use the designated income trust transmittal contained in the June 10, 1994 memo for this purpose. Follow the FLORIDA system work around instructions in the June 10, 1994 memo to enter the case into FLORIDA.   You must advise the individual (and/or his representative) that sufficient income must be deposited into the income trust account in the month in which the income is received to reduce the individuals countable income (the income outside the trust) to within the program income standard. The individual may continue to receive his income but must make the deposit within each month that eligibility is requested. You must also advise the individual that he cannot qualify for Medicaid for any month in which his income is not placed in an executed income trust in the same month in which the income is received. (This may require the individual to begin funding an executed income trust prior to its official approval by the district legal counsel if eligibility is needed for any of those interim months.)   Once the DLC returns the income trust transmittal to you through the district program office, you must promptly process the Medicaid application. Use the manual notice found in the June 29, 1994 memo.   If the district program office and DLC determine the trust is a qualified income trust:   ádo not consider the corpus of the trust a resource to the individual for any month the qualified income trust exists and eligibility is requested;   ádo not apply penalties for transfers of income placed in a qualified income trust provided the individual receives fair compensation;   ádo not count income deposited into the trust as income when determining if the applicant's income is less than the program income standard;   ádo not consider disbursements from the trust to third parties as income to the individual;   . do not count income generated by the trust which remains in the trust as income to the individual;   ácount any payments made directly to the client as income to the client;   ácount all income going into the trust (plus any not going into the trust) in determining patient responsibility, unless protection of income policies for the month of admission or discharge apply (refer to 2605.35.35).   The trustee of the qualified income trust must provide quarterly statements identifying the deposits made to the trust for each month. Any funds paid directly to the individual from the trust must be counted as income to the individual. Disbursements not paid to the individual are not counted as income to the individual.   If the individuals patient responsibility exceeds the cost of care, the department must examine the purpose of the trust, what disbursements are allowed under the trust, and determine if fair compensation is received for income transferred to the income trust to assure if the trust is a qualified income trust. The district program office must refer all cases to the headquarters program office for review and final clearance prior to approval.   If the individuals patient responsibility is less than the Medicaid rate, you do not need to look at the disbursements (unless funds are paid to the individual, in which case the funds must be counted as income to the individual).   You must verify all income at the source, including income placed into the trust.   Send a copy of the approved qualified income trust to the following address:   Estate Recovery Section Florida Medicaid P.O. Box 13825 Tallahassee, Florida 32317-3825   When you receive inquiries regarding the settlement of remaining funds in the trust after a client's death, tell them to make checks payable to Florida Medicaid and send to the above address. Advise them to clearly identify the client by including a note with the client's full name and Social Security number or Medicaid number.   Legal Basis: 42 United States Code 1396p(d)(4). 1805.15.25 Transfer of Income (MA-SSI) (10-01-94) The following policy applies to ICP and HCBS. Transfer policies apply to transfers of income as well as resources. For example, if an individual receives an inheritance on or after 10-0193, and transfers it in the month received, the transfer of asset provisions will apply and a possible period of ineligibility may be imposed. Refer to transfer of assets policy in Section 1630.   NOTE: Transfers of income into a qualified income trust are NOT considered transfers without fair compensation unless the trust document does not allow monthly disbursement of all funds.   1805.20.00 PAYMENTS TO JOINT OWNERS   Payment to joint owners is one payment made to two or more individuals.   A document -- such as a single or combined Social Security check for a couple or to a parent on behalf of two or more children -indicating the amount due each owner is generally sufficient verification of ownership.   In the absence of specific documentation, divide the income minus allowable expenses by the number of beneficiaries to determine the income amount for each individual.   1805.25.00 ALLOCATION OF INCOME (MA-SSI,SFP)   Allocation of income is a process allowing a portion of the individuals income to be set aside to meet the needs of the spouse and/or the dependents living in the community. Allocated income includes earned and unearned income.   1805.30.00 DEEMING OF INCOME   Deemed income refers to a special budgeting calculation in which a portion of an individuals income is considered available to another SFU member. Individuals whose income may be deemed differ by program. Deemed income is considered as unearned income in the budget.   For policy regarding deeming situations refer to SFU and deeming budgeting methods, refer to Chapter 2600.   1805.35.00 VENDOR PAYMENTS (FS,AFDC,RAP,CIC,MA-AFDC,MA-SSI,SFP)   (10-01-94) A vendor payment is a money payment made for SFU expenses by an individual or organization outside the SFU from funds not legally owed to the SFU. Vendor payments are excluded as income. Any expense which is entirely paid by a vendor payment (see examples in 1805.35.10), cannot be allowed as an expense under the income disregard policy (2415.00.00 and following).   NOTE: There is one exception to the above rule: For OSS, if the vendor payment to the facility is more than twice the recognized cost of care, the payment is included as income to the SFU.     1805.35.05 Vendor Payments (MA-SSI,SFP)   Direct payments to a creditor or vendor on behalf of an individual are vendor payments and are excluded as available income to the individual with one exception. When a vendor payment results in the individual directly receiving income, the income is included.   NOTE: Payments made by a third party to an OSS facility on behalf of the individual that are more than twice the recognized cost of care are included as income to the individual.   Payments by credit life or credit disability insurance policies are excluded. They are paid by insurance companies directly to loan companies and mortgage companies and are not available to the individual.   1805.35.10 Examples of Vendor Payments   Examples of vendor payments include, but are not limited to, the following:   árent payments made directly to the landlord by a third party;   árent or mortgage payments made to landlords or mortgagees by HRS, Housing and Urban Development (HUD), or by state or local housing authorities;     ápayments made directly to the utility or phone company by a third party;   ápayments by a government agency to a child care institution to provide day care for an assistance group individual;   ádisability insurance coverage makes payments on a car due to an accident or illness of an assistance group member. The payment is not voluntary but rather is a specified part of the issuance policy.   álegal agreement or court ordered payments that go directly to a third party rather than the assistance group; and   áexpense payments by an employer, agency, former spouse, or other person made to a third party from funds not legally owed to the assistance group.   Any payments to the SFU by non-SFU members made directly to a member of the SFU are not vendor payments regardless of the purpose or intent of the payment.   1805.35.10.05 Supplementary Medical insurance Premiums (MA-SSI,SFP)   Premium payments for supplementary medical insurance under Title XVIII (Medicare) are not included as income when the payment is made by a third party insurer.   1805.35.10.10 Representative Payee Income (MA-SSI,SFP)   When an individual acts as a legal representative (for example, representative payee, agent, guardian, conservator) to receive and spend money on behalf of another, the money received is not available income to the individual acting as legal representative. However, if the legal representative receives a fee, commission or contribution that amount must be considered as unearned income. The representative payee's income received from the individuals funds must be verified. 1805.35.10.15 OSS and HCE/DA Subsidies (MA-SSI,SFP)   (08-01-92) Optional State Supplementation (OSS) and Home Care for the Elderly and Disabled Adult (HCE/DA) program payments made to help cover the expenses of the individual that are recognized in the HRS subsidy payment are considered income based on need.   These payments are not to be considered as income to the individual receiving services or to the individual providing services when determining his or her eligibility for Medicaid- or state funded programs.   1805.45.00 VERIFICATION OF INCOME (MA-SSI,SFP)   Income must be verified and documented by the source.   A verbal statement from a suitable source as to the amount of income, amount and types of any deductions, frequency of receipt, and date of anticipated increases can be accepted when documentation is not available.   Examination of a check or bank deposit is not sufficient for verification, because these do not necessarily include deductions.   For SSI recipients, SDX serves as acceptable verification of both Title II and SSI benefit amounts.   Verification for the SSI recipient must still be obtained. Any loss or reduction of income must be properly verified or documented, and an adequate explanation concerning the loss or reduction recorded.   1810.00.00 WAGES INCLUDED BY ALL PROGRAMS   (11-01-92) Gross earned income includes all gross (before taxes or other deductions) wages and salaries from performance of work (including wages deferred that are beyond the individuals control). Wages are included as income at the time they are received rather than when earned.   Wages are considered earned income even when withheld at the request of the employee or provided as an income advance on income expected to be earned at a future date. Advances are different from loans since they are paid in exchange for anticipated services or labor.   An individual is considered employed when engaged in a business, occupation or service for cash paid by another person, group of persons or company. Wages or paid salaries received after employment has ended are considered earned income (except for severance pay, which is unearned income). An example of this type of wage is payment for accrued vacation time. Note: For MA-SSI and SFP severance pay is earned income.   Employer-provided sick pay is earned income as long as the individual plans to return to work after recovering and is still considered an employee. Sick pay is a continuation of salary with normal payroll deductions and is not to be confused with benefits, such as Worker's Compensation, that are considered unearned rather than earned income.   1810.10.00 OTHER TYPES OF EARNED INCOME   This section includes the following types of income that must be considered earned income:   ástriker income (Section 1810.10.05), ásale of blood or plasma (Section 1810.10.10), áBAQ and BAS payments (Section 1810.10.15), and átips (Section 1810.10.20).   Note: BAQ and BAS payments are not applicable for MA-SSI and SFP.   1810.10.10 Sale of Blood or Plasma   Income derived from the sale of blood or plasma is included as earned income.   1810.10.15.05 BAQ and BAS Payments (MA-SSI,SFP)   BAQ and BAS payments are included as unearned income except when the service member lives in free on-base housing and the allowance is both paid and deducted in the same pay period. In this instance, the allowance is not considered income. The leave and earnings statement (LES) is needed for verification.   1810.15.00 VERIFICATION OF EARNED INCOME   (1/l/92) All earned income must be verified by the employer. Information that must be verified includes:   áthe first and last dates of employment, áthe first and last day of pay, ágross income including overtime and tips, áfrequency of payment, áthe day of the week payment is received, and áthe number of hours and days employed.         Acceptable forms of verification include, but are not limited to, the following:   áW-2 forms and income tax returns for self-employed individuals,   .wage receipts,   áPEIR signed by the employer, bookkeeper, or other appropriate person,   .wage statements,   .pay stubs,   .employment verification form or written statements containing the required information,   ácollateral contact with employer, and   áwork calendar (for tips and daily cash payments).   Any document used to verify income must be copied and retained in the case record. All documents must be completed and signed by the appropriate individuals (for example, the employer, the client). Exceptions follow.   áThe individuals statement that his income exceeds the income standard is sufficient to deny or close FS, AFDC, and RAP benefits. However, medical assistance cannot be denied/closed without an ex parts determination of Medicaid eligibility. Verification of income must be pursued for these situations in which the individual/AG appears to be Medicaid eligible.   áWhen documentation/verification of income that makes the assistance group ineligible cannot be obtained prior to the advance notice deadline, the case manager must redetermine the assistance group's eligibility based on its statement to avoid overpayment for AFDC. In this situation, the cost of child care can be disregarded without verification.   1815.00.00 SELF-EMPLOYMENT   An individual who owns a business or otherwise engages in a private enterprise is considered self-employed. Income derived from self-employment is considered earned income.   This includes but is not limited to:   ábabysitting, ásales from a franchise company, ápicking up and selling cans, áfarm self-employment, and áselling newspapers.   Refer to Sections 1815.05.00 through 1815.30.00 to determine net income as well as verification required.     1815.25.00 SELF-EMPLOYMENT INCOME (MA-SSI,SFP)   Net earned income from self-employment is the total gross income derived from all trades and businesses as computed under the Internal Revenue Code, less deductions allowable under the code, attributable to such trades or businesses. It includes the individuals share of ordinary net income (or loss) from partnerships even though the partnership profits have not been distributed yet.   1815.25.05 Home Produce For Personal Consumption (MA-SSI,SFP)   Home produce is farm and garden produce (such as plants, animals or their by products) usually grown or raised by the family. Any gain made from-home produce is included income, unless it is traded for another home produce item.   Excess home produce is sometimes sold for profit even though there is no true commercial farming operation. If the income is being reported on tax returns then the reported net income must be considered the net income of the individual; otherwise accept the individuals estimate of earned income if it appears to be reasonable.   Farms operated for profit, or primarily to market produce, are commercial farming operations. For commercial farms:   .income is subject to self-employment income policies; and .the amount of income included can be based on the individuals estimate of the future value of the produce.   1815.30.00 VERIFICATION OF SELF-EMPLOYMENT INCOME   Self-employed individuals must verify earned income. In addition, these individuals must make all business records available to the case manager. Examples of business records include documentation on:   áincome tax records necessary to determine gross income and deductible expenses; ápurchases; ásales; ásalaries; ácapital improvements; and áutility, transportation, and other operating costs.   If the individual claims to have no business records, or that the records are inaccurate, the case manager must submit a request for a temporary exception to the verification requirements to DPOES/DPOAA. At the district's option, a temporary exception may be granted by the supervisor.   Exception: For FS, the case manager and supervisor may make the determination to use the best information available and record this in the case record.   1820.00.00 WAGES RECEIVED FROM TRAINING PROGRAMS   When the individual participates in a work or on-the-job-training program that involves work for payment, the payment is included as income. Training allowances from vocational and rehabilitative programs recognized by a government agency are also included income, unless excludable as a reimbursement. For example, Project Independence and Job Training Partnership Act (JTPA) program payments or allowances are included income unless provided as a reimbursement or otherwise identified as excluded income (see sections 1820.05.05, 1820.05.10, and 1820.05.15).   1820.05.00 JTPA   Sections 1820.05.05 and 18.05.10 describe exceptions to general JTPA income policy that apply to FS, AFDC, RAP, CIC, and MA-AFDC. Other programs have no additional written policy in this area.   1820.15.00 SHELTERED WORKSHOP EARNINGS (MA-SSI,SFP)   Any payments from a sheltered workshop are included as earned income. A sheltered workshop is any place where the individual receives experience or training as arranged by a state or vocational rehabilitation agency.   Note: Earned income disregards do not apply for ICP, HOSPICE, HCBS, or Institutional MEDS.   1820.20.00 THERAPEUTIC WAGES (MA-SSI)   Therapeutic wages are included as earned income. Earned income disregards do not apply if the individual is institutionalized.   1825.00.00 REAL ESTATE INCOME   Income from real estate includes any funds resulting from property ownership. This income can be earned or unearned.   Sections 1825.05.00 through 1825.10.00 describes income received from rental property, sales contracts on property, and room and board.   1825.05.00 RENTAL INCOME   Except for the Food Stamp Program as described in Section 1825.05.05, rental payments are unearned income if the individual does not actively manage the property as a business. Rental income is any payment for using real or personal property less allowable expenses. Examples of rent include payments for the use of:   .land; ábuildings; .an apartment, room, or house; or ámachinery or equipment.   1825.05.15 Rental Income (MA-SSI,SFP)   (07-01-93) Expenses recognized by the IRS and incurred during the taxable year can be deducted from unearned rental income. Allowable expenses include:   .real estate taxes, .utilities, .maintenance, .repairs, .the cost of advertising for renters, .lawn service, .interest and escrow, and áhomeowner's insurance   Unacceptable expenses include depreciation, depletion, and the principal portion of the mortgage payment.   1830.00.00 IN-KIND BENEFITS   Non-cash or in-kind benefits are excluded. This includes, but is not limited to:'   ámeals, áclothing, ápublic housing (HUD), áproduce from a garden, áWIC coupons, and áFood stamps.   Sections 1830.05.00 through 1830.15.00 describe general policy for in-kind benefits. Section 1830.20.00 describes policy for a specific program. There are no other written program specific policies for in-kind benefits.   1830.05.00 IN-KIND BENEFITS-MEALS/FOOD The following types of in-kind support are excluded: á free or reduced-price meals and food from government agencies or schools, service facilities and other institutions recognized under a USDA program, the Older Americans Act or HRS program; and   . the value of the food stamps and WIC coupon allotments.   1830.10.00 IN-KIND BENEFITS FOR DISABLED VETERANS   The clothing allowances for veteran's with prosthetic or orthopedic devices are excluded as an in-kind benefit.   1830.15.00 MEDICAL AND SOCIAL SERVICE PROGRAM   Medical and social service program payments or in-kind benefits are excluded.   Examples of in-kind benefits from-medical and social service programs include:   .child welfare services provided under Title IV-B of the social Security Act;   .Title XX services;   .services provided under Title III of the Older Americans Act;   .Title XIX medical assistance (Medicaid);   áTitle XVIII health insurance (Medicare);   áservices provided under the Rehabilitation Act of 1973;   ámental health services;   áVeterans Administration payments for aid, attendance and assistance group allowances; and   ámaternal and child health and crippled children's services provided under Title V of the Social Security Act.       1830.20.00 IN-KIND INCOME FOR SSI DIRECT ASSISTANCE (MA-SSI,SFP)   Income in-kind is unearned income for SSI direct assistance, but is not used to determine eligibility for HRS programs. It is classified either an in-kind support and maintenance (ISM) or "other" in-kind income.   ISM is food or shelter given to an individual. mother" in-kind income is any non-ISM item not otherwise excluded that can be sold or converted to cash.   In the OSS program, alternate living arrangements are considered as private non-medical institutions or as non-institutional care situations by SSI.   Individuals in OSS homes are not classified as living in the household of another by SSI, therefore, in-kind income is excluded by SSI.   1835.20.00 CHILD SUPPORT AND ALIMONY (MA-SSI,SFP)   Child support is payment from an absent parent to a child. one-third of the support payment is excluded; the remainder is unearned income.   Alimony is court ordered payment by a spouse or former spouse to an individual. An individuals countable income cannot be reduced because the court has ordered part of that income to be paid to a spouse. Court ordered support received by the spouse is unearned income. This applies even if the individual is institutionalized.   A legal agreement or court order alone does not constitute income, the payment must actually be received.   1840.00.00 ASSISTANCE FROM GOVERNMENT AGENCIES   (07-01-93) Assistance payments are benefits based on applicant/recipient need.   The following topics are discussed in this section.   áEnergy Assistance (Section 1840.05.00), áHUD Assistance Payments (for Public Housing and utility payments) (Section 1840.10.00), áVocational Rehabilitation Payments (Section 1840.15.00), áDisaster Assistance Payments (Section 1840.20.00), áRelocation Assistance (section 1840.25.00), áFoster Care for children or adults (Section 1840.30.00), áAssistance Programs Administered by HRS (Section 1840.35.00), áSupplemental Security Income (SSI) (Section 1840.40.00), áPolicy Regarding Assistance Based on Need (Section 1840.45.00), and áOverpayments While Receiving Assistance Payments (Section 1840.50.00). áDevelopmental Services Payments (for Independent Living) (Section 1840.35.00)   For AFDC, MA-AFDC income tax refunds are handled as follows:   áIncome tax refunds are not included as income because the amount previously withheld or paid was, or would have been, counted as income as part of gross earnings. The amount of refund remaining is counted as an asset the month following the month of receipt.   áFor treatment of earned income tax credit (EIC) - see manual section 1845.15.40.   For food stamps, income tax refunds are handled as follows:   áIncome tax refunds are not included as income because the amount previously withheld or paid was, or would have been, counted as income as part of gross earnings. The amount of the refund is counted as an asset in the month of receipt.   .For treatment of earned income tax credit (EIC) see manual section 1845.15.40.   For the MA-SSI and SFP programs, income tax refunds and earned income tax credits are handled as follows.   áIncome tax refunds are not included as income because the amount previously Withheld or paid was, or would have been, counted as income as part of gross earnings. The amount of refund remaining is counted as an asset the month following the month of receipt.   áEarned income tax credit or refunds are excluded income. These are payments from programs that are federally mandated or financed in any amount with federal funds. To qualify, the individual must receive the program payment the month before receiving the tax credit or refund. This policy also applies to individuals with income subject to deeming.   1840.O5.00 ENERGY ASSISTANCE   Sections 1840.05.05 through 1840.05.15 discuss energy assistance payments.   1840.05.10 LIHEAP Payments   Assistance payments received by households from the Low Income Home Energy Assistance Program (LIHEAP) administered by HRS are excluded income.   1840.05.10.05 HEA Payments (AFDC,RAP,CIC,MA-AFDC,MA-SSI,SFP)   Payments received in the form of home energy assistance (HEA) are excluded if they are based on need and certified by HRS.   Across-the-board rebates from utility companies to all customers are not considered to be based on need.   The source of HEA payment must be verified.   1840.05.15 Emergency Energy Conservation Services (MA-SSI,SFP)   The Public Services Administration furnishes financial and other assistance through nonprofit agencies for special projects that assist low income individuals in conserving energy. Income from this source is excluded, including the following benefits and services:   áwinterization (materials and labor), of old or substandard dwellings;   .third party vendor payments for winterization when they cannot be converted to cash and they do not result in the receipt of a basic need;   .emergency loans and grants for energy conservation devices or increased housing expenses due to an energy crisis;   .alternate fuel supplies and any fuel vouchers or stamps;   .alternate transportation activities designed to save fuel and assure continued access to training, education, and employment;   .assistance to prevent fuel cut offs including plans for crisis intervention to prevent fuel cut-offs;   .legal or technical assistance provided to represent the interests of the poor during an energy crisis; and   .energy related assistance to nutrition, health, and other supportive services in emergencies such as providing meals when utilities have been turned off.     Any of these types of assistance retained beyond the month of receipt must be kept separate from countable assets to be excluded.   1840.10.00 PROGRAMS ADMINISTERED BY HUD/FmHA   (07-01-95) (7 CFR 273.9; 45 CFR 233.20; 1OC-1.201; 1OC-1.512; 409.275, F.S., 409.185) Individuals generally can exclude the value of any assistance from the U. S. Department of Housing and Urban Development (HUD) and the Farmers Home Administration (FmHA) used to offset their rent or mortgage payments. These payments may be made to landlords or mortgagees.   Sections 1840.10.05 through 1840.10.15 discuss further policy for payments received for utilities and housing assistance from HUD/FmHA.   1840.10.05 HUD/FmHA Utility Payments   (08-01-94) (7 CFR 273.9; 1OC-1.201; 409.275, F.S.) When an assistance group lives in subsidized housing, all or a portion of its rent may be paid by HUD or the Farmers Home Administration (FmHA). In this situation, a rent deduction may be claimed for the amount the assistance group actually pays. The assistance group may also qualify for a HUD or FmHA utility payment.   HUD and FmHA utility payments are excluded as income due to these payments being made for the purpose of providing energy assistance. Additionally, when a HUD/FmHA utility allowance is used to reduce the amount of rent, this type of "utility allowance" is not to be considered income.   1840.10.15 Public Housing (MA-SSI,SFP)   The housing assistance provided by HUD that is excluded includes items such as:   árent subsidies;   áloans for housing renovations;   .mortgage insurance;   áloans to elderly individuals, farmers, and developers for the construction, improvement, or replacement of farm homes and other buildings;   águaranteed loans and mortgages; and   ápayments to mortgage holders on behalf of tenants. For the OSS program only, any funds received by the individual are included as income. 1840.20.00 DISASTER ASSISTANCE PAYMENTS   (07-01-95) (7 CFR 273.9; 45 CFR 233.20; 1OC-1.201; 1OC-1.512; 409.275; 409.185, F.S.) Sections 1840.20.01, and 1840.20.05 discuss program specific policies for the exclusion of disaster assistance payments.   1840.20.05 Disaster Assistance Exclusion Provision (MA-SSI,SFP)   The value of any other assistance, in cash or in-kind, may be excluded indefinitely if both of the following are met.   á The assistance is furnished under Federal statute (for example, the Disaster Relief Act of 1974, the Food Stamp Act of 1977).   á The assistance is furnished specifically in conjunction with a presidentially declared disaster.   Any interest on such assistance is excluded up to nine months after the date assistance was first received. This exclusion ends on the same day of the month as it begins.   1840.25.00 RELOCATION ASSISTANCE   Sections 1840.25.05 and 1840.25.10 discuss program specific policies for Federal laws pertaining to relocation assistance.   1840.25.10 Relocation Assistance (MA-SSI,SFP)   Payments from Federal or Federally assisted projects that acquire real property are excluded income.   The exclusion does not apply to fair market value (FMV) payments of the real property acquired by the project or agency. These funds are considered replacement of a non-liquid asset rather than income.   The relocation assistance includes payments or allowances for:   ámoving expenses;   álosses of tangible property;   áexpenses of looking for a business or farm;   ádisplacement allowances;   áreplacement of a dwelling over the original acquisition cost to the project or agency for the prior dwelling;   áincreased interest costs on a prior dwelling such as early pay-off penalties;   áexpenses (other than prepaid) for closing costs on a replacement dwelling;   árental expenses for displaced tenants;   ádown payments on replacement housing for tenants who decide to buy;   ámortgage insurance through Federal programs; and   ádirect provision of replacement housing provided as a last resort.   1840.30.00 FOSTER CARE PAYMENTS   Sections 1840.30.05 through 1840.30.15 describe program specific policy on Foster Care payments for children and adults received from any agency.   1840.30.15 Payments for Providing Foster Care (MA-SSI,SFP)   (10-01-94) Foster care payments for children who are not eligible for Medicaid are excluded when:   áthe child lives with the foster parent; and áthe child was placed by non-profit placement or child care agency.   If these criteria are not met, foster care payments for support of the child are counted as unearned income for the child when determining the child's eligibility. This applies even if the child is placed by one agency and payments are made by:   áa different agency; áby one relative to another relative; or áby a parent to another person.   The following must be verified in order to exclude foster care payments:   .the name(s) of the child(ren) receiving foster care from the individual;   áthe individuals relationship, if any, to the child;   áthe name, address, and telephone number of the agency that made the placements; áthe payment amount, frequency, and source; and   áthe child's residence in the foster parent's household.   1840.40.00 SUPPLEMENTAL SECURITY INCOME   Sections 1840.40.05 through 1840.40.20 discuss program specific policy on the inclusion or exclusion of income received from the Supplemental Security Income (SSI) program. SSI payments are administered by the Social Security Administration.   1840.40.15 Supplemental Security Income (MA-SSI,SFP)   (04-01-96) SSI payments are included as unearned income.   Exception: If the individual is admitted to a nursing facility and is applying for institutional care services, do not consider SSI payments as income to the individual the month after admission to the facility. The SSI benefits may also be excluded the month of admission if protection of income policies apply (2605.35.35) or the stay is expected to be temporary (1450.10.10 and 2605.35.40). Refer to 1450.10.05 for additional information regarding SSI recipients in nursing facilities.   1840.45.00 ASSISTANCE PAYMENTS BASED ON NEED   Sections 1840.45.05 and 1840.45.25 discuss policy on treatment of assistance payments. Income based on need is included as unearned income unless specifically excluded in Sections 1845.05.00 through 1845.45.25.   1840-45.25 Assistance Based on Need (MA-SSI,SFP)   (08-01-92) In order to be excluded, assistance based on need must be:     .provided by a public program that uses income or assets as criteria to determine assistance eligibility and amount; and   áwholly funded by a state or political subdivision of a state, including an Indian tribe.   Assistance based on need is not deemed from an ineligible spouse to an eligible spouse for SSI cash assistance or Medicaid eligibility determination. However, if one member of the couple is Medicaid eligible (from any source) or enrolled in Medically Needy, the assistance based on need income (and any income used in that determination) is deemed to the other member of the couple when determining that person's eligibility for Medicaid.   1845.00.00 BENEFITS   The benefits discussed in Section 1845 (inclusive) discusses types of benefits payable to individuals and their treatment as unearned income, including benefits such as:   ásocial security payments; áprivate benefit income such as annuities, pensions, retirement, or disability (other than SSA); áveterans payments; áAgent Orange benefits; áworker's compensation; árailroad retirement; áunemployment benefits; ástriker support; áseverance pay; or ádeath benefits.   1845.05.00 VERIFICATION OF UNEARNED INCOME   (10-01-95) All unearned income must be verified. The following sources maybe used to verify unearned income:   áBendex or SDX tapes, áSSA award letters, áVA award letter, ápension or award letter, áUnemployment Compensation award letter, áchild support court statement and/or current statement from absent parent, and áinterest on bank account statements.   1845.05.05 Verification of Unearned Income (MA-SSI,SFP)   (08-01-92) All unearned income must be verified from the source. Bank statements are not acceptable verification for any unearned income except the interest on the bank account as they reflect the amount of benefits received after deductions; not necessarily the amount of income which must be counted. (Data exchange is an acceptable source of unearned income verification.)   1845.10.00 GROSS BENEFITS   The gross benefit amount received or anticipated to be received is considered unearned income. Benefits are owned by the individual for whom they are intended unless the individual is not in the home and the benefits are not redirected. Deductions for optional items such as health insurance and Medicare premiums continue to count as income.   1845.10.05 SSA Income   (07-01-95) Benefits that are paid by SSA are unearned income for all programs. These type of benefits include Title II Social Security benefits, SSI, special age 72 payments (PROUTY), and black lung benefits.   For all programs, the gross entitlement amount (prior to any deduction) is entered into the FLORIDA System on AFMI. The cents should not be dropped. (The system automatically drops the cents when calculating the budget for Food Stamps and SSI-related programs.)   For Food Stamps, AFDC, RAP, CIC, MA-AFDC, and EFAHP: Social Security benefits recouped by SSA that are not received by the household are excluded unearned income.   For MA-SSI and SFP: Social Security benefits recouped by SSA are addressed in 2415.95.00.   For treatment of lump sum payments for SSA income refer to Section 2620.10.20and (for SSI-related) 2620.15.20.   1845.10.10 Private Benefit Income   Annuities, pensions, retirement or disability payments are all included as unearned income. These payments are the result of purchase of an annuity, retirement from employment, survivor benefits for a former employee's dependents, or injury or disability, and may be made by an employer, an insurance company, or public or private fund.   1845.10.15 Veterans Payments   (10-01-95) Veterans' compensation and pensions are based primarily on service in the armed forces and may also be made to the veterans' dependents or survivors.   These payments are counted as unearned income. Exceptions are Aid and Attendance, housebound allowance, and unreimbursed medical expenses, which are not counted as income for MA-SSI and HCE/DA.   1845.10.15.05 Veterans Payments - Compensation (MA-SSI,SFP)   Compensation payments are included as unearned income. Compensation benefits generally are not based on need and a $20 general exclusion is applied.   Compensations are paid to a veteran because of a service-connected disability and are paid to a widow, widower, child, or parent of a veteran because of the service-connected death of the veteran. Death compensation and dependency and indemnity compensation (DIS) do not generate the $20 general exclusion because they are based on need. These payments are made to parents and based on the parents' income.   All applicants who appear potentially eligible for compensation payments must apply.   1845.10.15.10 Veterans Payments - Pensions (MA-SSI,SFP)   VA pensions are included as unearned income, excluding the amount of aid and attendance, housebound allowance, and unreimbursed medical expenses. Except in OSS, refer to Section 1845.10.15.45 for OSS information. VA pensions generally are based on need and, therefore, do not receive the $20 general exclusion.   Pensions are paid to veterans based on a combination of services and age (65 or older), or a non-service connected disability. Pensions are paid to a widow, widower, or child of a veteran because of the non-service connected death of a veteran.   Three types of pensions are not based on need and do receive the $20 general exclusion. These are pensions passed as a special act of Congress, service in the Spanish-American War (April 21, 1890 - July 3, 1902), and service in the Indian Wars (January 1, 1817 - December 31, 1898).   All applicants who appear potentially eligible for a pension must apply.   1845.10.15.15 VA Increments for Dependents (MA-SSI,SFP)   Increments included in the VA check designated for a dependent are only counted as income to the dependent.   The case manager must ask the individual if an increment is included for a dependent. If the individual states no, further action is not required. If the individual states he does receive for a dependent or that he does not know, verification of whether or not he receives an augment for a dependent and the amount of the increment must be verified with VA. Any increment for a dependent is deducted from the individuals VA income.   1845.10.15.20 Veterans Administration Improved Pension (VAIP) (MA-SSI,SFP)   (04/01/95) The Veterans and Survivors Pension Improvement Act changed the method of determining the pension payable and pension rates effective January 1979, but the new rates of payment are not automatic. Since the new rates are not automatic, the veteran or survivor who was receiving benefits prior to January 1979 must apply to VA to establish entitlement under the Act. All individuals who apply for or receive Medicaid benefits must apply for the Veterans Administration Improved Pension Program (VAIP). An individual who receives a VA pension under the old law must apply for improved pension under the new law unless the individuals VA benefit would be lowered under the improved pension. If an individuals pension would be lower under the improved pension, he may continue to receive the pension under the old law. VAIP includes allowances for aid and attendance, housebound, and unreimbursed medical expenses.   Section 8003 of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) provides for a reduction in Veterans Administration improved pensions (VAIP) for single veterans and surviving spouses residing in Title XIX nursing facilities who have no dependents and who are Medicaid eligible. The pension will be reduced to $90 or less per month, which is all considered Aid and Attendance and is not counted as income for the eligibility determination. Also, it's not added back into the patient responsibility.   However, if the veteran is enrolled in the Medically Needy program in the nursing home and Medicaid is not paying for nursing home care, the veteran is entitled to the FULL VA benefit, and must apply to receive it.   1845.10.15.25 VA Aid and Attendance (MA-SSI,SFP)   The policy does not apply to OSS.   The VA provides additional compensation when the individual needs routine aid and attendance by another. This compensation may be paid to disabled veterans and to spouses, widows, widowers, and parents of veterans. Aid and attendance payments provided to an eligible individual and paid by the individual to his/her ineligible spouse, parent, or child living in the same household in return for taking care of him are excluded from income for deeming purposes. A&A payments made directly to the ineligible spouse, parent or child on behalf of the eligible individual are also excluded as income for deeming purposes.   NOTE: If an ineligible spouse or parent receives payments for services provided to anyone other than his/her eligible spouse or child, the payments are included as earned income subject to deeming to the eligible individual.   VA considers an individual in need of regular aid and attendance if the individual is categorized as one of the following:   áblind or nearly blind, áa nursing home patient due to mental or physical incapacity, áunable to keep clean and presentable without assistance, áunable to dress or undress without assistance, or áhas frequent need of adjustment of any prosthetic or orthopedic device and the adjustment cannot be made without assistance. 1845.10.15.30 VA Housebound Allowance (MA-SSI,SFP)   This policy does not apply to OSS.   VA pays a housebound allowance to eligible individuals who do not qualify for regular aid and attendance payments. This allowance can be paid to a veteran or widow or a widower who receives dependency or indemnity compensation. It is excluded income.   1845.10.15.35 VA Unreimbursed Medical Expenses (MA-SSI,SFP)   This policy does not apply to OSS.   VA provides an allowance for unreimbursed medical expenses (UME) incurred by the veteran that exceed five percent of an individuals annual income. UME is excluded income.   1845.10.15.40 VA Lump Sum Payments (MA-SSI,SFP)   Lump sum payments, minus A&A, housebound, and UME, are included as unearned income in the month received. Any balance, including A&A, housebound, and UME, left as of the next month is counted as an asset.   1845.10.20 Agent Orange Benefits (FS,MA-SSI,SFP)   Agent Orange Settlement Program is excluded as income to the veteran receiving the benefit as well as the veteran's survivors. The veteran receives a payment once per year while he is disabled for the life of the program. Survivors of the deceased veteran receive a one-time lump sum payment.   1845.10.25 Workers' Compensation Payments   Workers' Compensation is included as unearned income.   Workers' Compensation payments are awarded to an injured employee or to the employee's survivors. Any portion of the payment designated for medical expenses paid or deducted at the source and not controlled by the individual is excluded from the income amount.   For MA-SSI only, legal or related expenses pertaining to workers compensation are also deducted from the income amount.   1845.10.30 Railroad Retirement Payments   (11-01-92) Retirement, survivor, unemployment, sickness and strike benefits from railroad payments are included as unearned income. Premiums for medical insurance under Medicare that may have been deducted must be added to the payment amount in determining the amount of unearned income, except in EFAHP. Entitlement or potential entitlement for railroad benefits should be suspected if the individuals SSN begins with the number " 7."   The following are three different railroad retirement benefits.   áThe retirement benefit is payable only to the railroad employee or the employee's spouse. Benefits may be increased because of dependent children; however, the amount of the increase is considered income to the individual rather than the child(ren).   áThe survivor benefit is payable to widows/widowers and children or to dependent parents if no widow or child qualifies.   áChecks for unemployment, sickness, and strike benefits cover a period up to two weeks.   Retirement and survivor benefits are paid monthly. Payment received in the current month is the amount due the individual for the prior month.   Railroad retirement benefits are adjusted for cost of living at the same time as SSA. However, differences in amounts may exist due to individual case circumstances. verification of differences should be made by reviewing an award notice. When contact with the railroad board (RRB) is necessary, contact the local RRB district office, not the RRB in Chicago.   1845.10.35 Unemployment Compensation   Payments received pursuant to a state or federal unemployment law, or paid by a union or employer are included as unearned income.   1845.10.50 Life insurance Policy/Death Benefits (MA-SSI,SFP)   (04/01/95) Proceeds of life insurance policies and other death benefits include lump-sum death payments from SSA, the Railroad Retirement Board, and VA burial benefits.   Proceeds from such payments are counted as unearned income in the month received, after deducting any expenses paid from the proceeds for the deceased person's last illness and burial.   Last illness expenses include related hospital, medical, and nonmedical expenses. Burial expenses include the funeral, burial plot, interment expenses, and related costs.   The only exception is when the beneficiary of a life insurance policy is also the owner. In this situation the proceeds are considered to result from converting an asset and are not included as income.   1845.15.00 BENEFITS RECEIVED DUE TO FEDERAL LAW   (10-01-94) Benefits may be received due to Federal statute from the following sources (refer to Chapter 1600 for applicable asset exclusions):   áDomestic Volunteer Services Act, áolder Americans Act, áIndian Tribe/Alaskan Natives laws, áGerman Reparation or Japanese/Aleutian Restitution payments, áAgent Orange Payments áCrisis Intervention program, áExperimental Housing Allowance, áEarned Income Credit, áRadiation Exposure Compensation Act, áPlan for Achieving Self-Support, áMaine Indian Claims Settlement Act, áChild Nutrition Act áVeterans' Benefits Improvement and Health-Care Act, ."At-Risk" (of Welfare Dependency) Block Grant Child Care Payments. (These payments are vendor paid to the provider through the Children and Families Program Office's Subsidized Child Care Program.), and .National and Community Services Act, Title I.   Sections 1845.15.05 through 1845.15.70 discuss these benefits.   1845.15.05 Domestic Volunteer Service Act   Sections 1845.15.05.05 through 1845.15.05.25 discuss benefits received due to Federal laws pertaining to the Domestic Volunteer Service Act.   1845.15.05.05 Domestic Volunteer Services Act (FS,MA-SSI,SFP)   The following payments to volunteers under Title II, the Domestic Volunteer Services Act of 1973 (Public Law 93-113), as amended, are excluded as income.   áPayments under Title I of the act (including payments from such Title I programs as VISTA, University Year for Action, and Urban Crime Prevention Program) to volunteers are excluded for those households receiving food stamps or public assistance at the time they joined the Title I program. Ver