2010 1619(b) ND Medicaid Threshold for 2010

State 1619(b) Medicaid threshold amounts for calendar year 2010 our out.

"North Dakota Threshold for 2010 is $36,082"

1619(b) provides that if your earned income (after the applicable exclusions) is too high to permit a SSI cash benefit, you will still be eligible for Medicaid.

Any questions may be directed to: rsi5@srt.com

H1N1 and the Unique Needs of Children with Special Needs/High Risk Medical Conditions

The Swine Flu is here. Get the vaccine or don't? What can I do to help prevent contraction? Is my child with special needs at higher risk - or should we be taking different precautions? All valid questions for parents to ask and to research. Below you will find 2 resources specifically addressing these issues. I hope you find them informative. H1N1 Fact Sheet for Children With Special Needs

A new brochure from the CDC that addresses seasonal and 2009 H1N1 flu for parents who have children or adolescents with high risk medical conditions is also available and can be found HERE.

Any questions may be directed to: rsi5@srt.com

Hearing on Backlog Slated

"Congressman John S. Tanner (D-TN), Chairman, Subcommittee on Social Security of the Committee on Ways and Means, today announced a hearing on Clearing the Disability Claims Backlogs: The Social Security Administration’s Progress and New Challenges Arising From the Recession. The hearing will take place on Thursday, November 19, 2009 in Room B-318, Rayburn House Office Building, beginning at 1:30 p.m. "

Full Press Release

Any questions may be directed to: rsi5@srt.com

Does Income from Participation in a Clinical Trial Count as Income?

September 16, 2009 "Last night, the Senate followed the House’s lead in introducing legislation to allow patients with rare diseases to participate in clinical studies without losing their eligibility for government healthcare benefits. “The CF Foundation applauds the Senate co-sponsors for introducing this vital bill to allow more people with rare diseases — including cystic fibrosis — to participate in clinical trials," said Robert J. Beall, Ph.D., president and CEO of the Cystic Fibrosis Foundation. “If successful, this legislation will help ensure swift advancement of life-lengthening and potentially lifesaving drugs from the research phase to the people who need them.” Currently, Supplemental Security Income (SSI) rules require that compensation provided for participation in a clinical trial be counted as income when determining benefits. Because Medicaid benefits are tied to SSI eligibility, patients who take part in clinical trials may be disqualified from receiving the government healthcare coverage. This penalty prevents many people with rare diseases from participating in clinical studies. Researchers developing drugs to treat rare diseases like cystic fibrosis struggle to recruit participants for clinical trials because of limited patient populations. More than 30 promising CF drugs are in development, and about 30,000 people in the United States have the disease. The bill is co-sponsored by Sens. James Inhofe (R-OK), Richard Durbin (D-IL), Richard Shelby (R-AL), Ron Wyden (D-OR), and Chris Dodd (D-CT). Source: Cystic Fibrosis Foundation, www.cff.org.

Any questions may be directed to: rsi5@srt.com

Is Rental Income Earned Income?

Received this info from our WIPA National Training Center at Virginia Commonwealth University.
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I have had this question posed numerous times and the answer is (as it always seems to be) – Well…..it depends.

In most cases the question relates to a beneficiary who owns a house that he/she rents out, or when a beneficiary lives in a house and rents out a room or owns a duplex that he/she lives in and rents out the other unit. That is the situation I will address in this correspondence.

The basic rule of thumb in cases like these is that net rental income counts as unearned income (meaning not subject to FICA per POMS Section RS 02505.240) unless it is earned income from self-employment (e.g., someone who is in the business of renting properties). This is actually stated very clearly for SSI recipients in the POMS at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0500830505!opendocument

Of course, for SSI recipients, unearned income is treated less favorably than earned income since only the $20 General Income Exclusion is applied to unearned income. In addition, if the SSI recipient owns a home which he/she does not live in because it is rented out, then the property would be a countable resource.

If the SSI recipient is actually self-employed and in the business of renting property, then any Net Earnings from Self-Employment (NESE) the business generates would be decreased by any applicable work incentives when SSA is determining countable NESE. The countable NESE would affect the SSI cash payment in the usual manner. For a review of how the SSI program treats NESE, refer to the 2009 WIPA Training Manual - Module 3, Unit 6.

On the title II side, things are a little bit more complicated. There is no specific citation in the DI section of the POMS saying that rental income is not counted as earned unless the beneficiary is self-employed in the business of renting properties. This is implied when SSA defines what to count by describing earnings or self-employment income as income a person receives in exchange for his/her work activity – it is remuneration for work performed. In most cases, simply renting out one’s home or a portion of one’s home would not constitute work activity – it is too passive and is not subject to FICA. Unless a beneficiary is engaged in the business of renting property, the money received from renting a single house would typically NOT be considered to be earned income. If the rental income is not considered to be earned, then it would not be considered when SSA makes TWP or SGA determinations.

Of course, there are all sorts of situations in which things can get pretty murky. What if the person rents out multiple pieces of property – does that mean the person is in the rental business? SSA has to sort these situations out one-by-one. The first thing they do is look to see if the beneficiary is engaged in “trade or business”. To make this determination, the SSA asks the following questions:

· Is there a good faith intention of making a profit or producing income?
· Is there continuity of operations, repetition of transactions, or regularity of activities?
· Are the functions being performed a regular occupation or profession?
· Is the beneficiary holding himself out to others as being engaged in the selling of goods or services?

(From POMS Section RS 01802.002)

With these questions, the SSA is looking for an overall pattern. One ‘yes’ answer to these questions is insufficient to make a determination of self-employment, but they need not all be answered with “yes” for self-employment to be determined to exist. If SSA determines that the beneficiary is self-employed, any countable NESE from the business will be considered during TWP and SGA determinations.

REMEMBER – Determinations of what is or is NOT earned income can only be made by SSA. If there is any doubt, refer the beneficiary to the local Social Security Field Office for clarification. If the beneficiary does not agree with the determination rendered by SSA, he/she may request reconsideration as part of the standard appeals process.


Any questions may be directed to: rsi5@srt.com

Increase in the Medically Needy Income Level

Certain people who are blind, disabled, or aged may qualify for Medicaid as part of the medically needy group. However, unlike individuals who are categorically eligible for Medicaid (such as SSI recipients), persons within the medically needy group can incur recipient liability.

Recipient liability is the amount the eligible persons are responsible to pay toward their medical expenses for the month. Recipient liability is based on the monthly income of the members of the Medicaid unit, and it is similar to the deductible amount in an insurance policy.

The Medically Needy Income Level establishes the amount of income that individuals, couples, and families may keep to meet their maintenance needs without having recipient liability. Before July 1, 2009, the Medically Needy Income Level was $500 per month for a one-person household and $516 per month for a household of two persons.

As of July 1, 2009, this income level is $750 per month for a one-person household and $1,008 per month for a two-person household. See the following chart for the income levels for households consisting of more than two persons.

Number of Persons	Monthly Income Level
1	$750
2	1008
3	1267
4	1526
5	1784
6	2043
7	2302
8	2560
Effective July 1, 2009

For each person in the medically needy unit above eight, add $259 to the monthly amount.

This information was obtained from section 510-05-85-40(2) of the Medicaid Program Policy Manual.

Any questions may be directed to: rsi5@srt.com