TN 5 (04-97)

Citations:

Sections 1614(f)(2) and 1611(e)(1)(B) of the Act Social Security Act

A. Policy — deeming waiver

1. Deeming Waiver Criteria

Effective June 1, 1990, do not deem parental income and resources to any child under age 18 who:

• is disabled; and

• received one or more months of SSI benefits limited to the $30 reduced benefit rate (plus any federally-administered optional State supplementary (OSS) payment) while in a medical treatment facility; and

• is eligible for Medicaid under a State home care plan; and

• would be ineligible for SSI benefits because of deemed parental income or resources, or would be eligible for less SSI than he/she would receive (usually $30 plus any applicable OSS payment) under this provision.

The SSI benefits referenced in the second bullet are also known as the “personal needs allowance.”

2. Payment Amount

When a child is eligible under this deeming waiver provision, payment will be based on the Federal reduced benefit rate ($30 payment limit), plus any applicable federally-administered OSS payment. See SI 01310.203 for more information on deeming waiver cases and optional State supplementation.

B. Policy — how waiver relates to other rules

1. Eligible Child's Own Income and Resources

The eligible child's own income and resources affect SSI eligibility and payment in the usual manner. For example, if the child's countable income (excluding deemed income) exceeds the Federal $30 payment limit (plus any applicable OSS payment), the child's eligibility is suspended for excess income.

2. When Eligibility Requirements Must be Met

The eligibility requirements for SSI benefits under the waiver of parental deeming provision must be met in the computation month, but no earlier than June 1990.

EXCEPTION: The requirement that the disabled child received an SSI benefit that was limited to $30 (plus any federally-administered OSS payment) while in a medical treatment facility may be met at any time prior to the computation month.

3. Federal SSI Benefits Limited to $30

One of the deeming waiver criteria is that the child must have received SSI benefits (for one or more months) limited to $30 (plus any federally-administered OSS payment) while in a medical treatment facility.

Effective beginning with SSI benefits payable for December 1996, the $30 payment limit applies to children under 18 not only when Medicaid pays over 50 percent of the cost of their care, but also when private health insurance (or a combination of Medicaid and private health insurance) pays over 50 percent of the cost of care.

(Policy instructions regarding the applicability of the $30 payment limit are contained in SI 00520.011.)

4. Multiple Children Ineligible Under Parental Deeming Rules

When there is more than one child claimant/recipient in the household and parental deeming applies, follow the usual rules in SI 01320.500 ff. and SI 01330.200 ff. to determine each child's eligibility under the deeming rules. If ineligible due to parental deemed income or resources, any child who could qualify under the waiver of parental deeming provision should have his/her eligibility redetermined following the policy in A. above.

5. Multiple Children Eligible Under Parental Deeming Rules

When multiple children are eligible for SSI under the usual parental deeming rules, we pay each eligible child the benefits computed under the usual rules.

EXCEPTION:

If any child who could otherwise qualify under the waiver of parental deeming provision would receive a higher benefit under that provision, we redetermine his/her eligibility following the policy in A. above.

For example, if the amount the child is due under the usual deeming rules is $24, but the child could receive $30 under the waiver of parental deeming provision, we pay the $30. In such a case, we do not redetermine the other child(ren)'s eligibility—that is, we do not “reallocate” the waived portion of parental deemed income to the other eligible children.

6. Living Arrangements and In-Kind Support and Maintenance

Determine changes in living arrangements and the value of in-kind support and maintenance for “parental deeming waiver” children as if the usual deeming rules applied. For example, the value of the one-third reduction (VTR) cannot apply if the child lives with his/her parent who is the householder (see SI 00835.210).

7. Overpayment Recovery Policy

Apply the same overpayment recovery policies to children paid under the parental deeming waiver provision as apply to other individuals subject to the $30 payment limit (for example, the same policies that would apply to an aged individual who was subject to the $30 payment limit and was overpaid).

C. Definitions

1. “Disabled”

Any child determined to be disabled and/or blind by the State Disability Determinations Service (DDS) for the purpose of SSI eligibility is disabled for the purpose of this provision. (See SI 01310.206A.1.)

2. “Medical Treatment Facility”

For purposes of the parental deeming waiver provision, a “medical treatment facility” is a hospital, extended care facility, nursing home, or intermediate care facility that is a certified inpatient provider under a Medicaid State plan.

3. “State Home Care Plan”

A State home care plan is a means of providing medical assistance (Medicaid) to individuals (including children) or groups of individuals (see SI 01310.207). For purposes of this provision, State home care plans are those:

• approved by the Secretary of Health and Human Services under the provisions of section 1915(c) of the Act relating to waivers; or

• authorized under section 1902(e)(3) of the Act.

The purpose of plans under each of these provisions is to provide Medicaid coverage at home for disabled individuals who have been (or could be) institutionalized, but who are able to be cared for at home without a decrease in the quality of care, and at a cost no greater than the cost of care in the institution.

NOTE: Some States may provide home health services as part of regular Medicaid eligibility. However, unless home care is provided under the authority of one of the above provisions, receipt of such services does not qualify as Medicaid under a State home care plan. Also, if the child is on a waiting list for services but not actually receiving Medicaid services, the child is not considered eligible for Medicaid.