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Medi-CalMedi-Cal 15. MAGI MC Income
15. MAGI MC Income
15.1 Reported Income
Both the Single Streamline Application (SSApp/CCFRM604) and the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) allow clients to provide their Current Monthly Income (CMI) and Projected Annual Income (PAI).
Single Streamline Application
In Step 2 of the SSApp, the application has the following questions which relate to CMI:
The SSApp also has the following question which relates to PAI:
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Floating View and Summary View
In Floating View and Summary View, PAI income is displayed separately from CMI (Earned/Self-Employed Income and Unearned Income). If the PAI fields are blank (as in the example below), the client has not attested to PAI in CalHEERS.
15.2 .Income Verification
15.2.1 Earned Income
Earned income can be verified using:
• E-Verification from the federal hub
• One pay stub (most current pay stub available to the client; not required to have been issued within the last 30 days but must accurately reflect the amount reported on the application).
• Copy of federal tax return that accurately reflects current income. For self employment, last years tax documents are sufficient. For all other income, the tax documents must have been filed within 90 days to be used as verification
• Signed letter from employer showing the gross amount and date of paycheck
• Receipts showing gross earnings and expenses
• Business records (Profit and Loss Statements)
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Medi-CalMedi-Cal 15. MAGI MC Income
Earned income must be verified prior to approval and at redetermination, restoration or reapplication. If there is a discrepancy between the pay stub submitted and the amount reported on the application, the EW may request additional pay stubs to determine the correct monthly income.
If the client receives income and items listed above are not available, EW must obtain a “Sworn Statement” as a last resort. Any statement signed and dated under penalty of perjury is acceptable (e.g. SCD 101, Attestation of Income form from Covered CA, etc.).
Individuals Paid in Cash
Individuals who are paid in cash often cannot provide proof of income. If all other options are exhausted (i.e. attempt to get employer statement, verification through the Federal Hub, etc.), the signature on an application is sufficient verification of income for clients paid in cash. Additionally, clients can complete a Sworn Statement as verification.
The Work Number
The Work Number is not to be utilized to obtain verification of income for MC only cases. It may however be used for combo MC cases. Additionally, if an individual is on CalFresh in one case, and Medi-Cal in another, the Work Number may be used to verify income for the Medi-Cal only case.
Example:
Daisy is on a CalFresh only case, because her and her roommate purchase and prepare food together, however, they file taxes separately, so Daisy is on her own Medi-Cal case. Because Daisy is active on both CalFresh and Medi-Cal (despite the fact that it is on two different cases) the Work Number can be used as verification on the Medi-Cal only case. Document the circumstances thoroughly in the Maintain Case Comment window.
15.2.2 Unearned Income
Unearned income can be verified using:
• Award letter or most recent cost-of-living increase notice
• IEVS/PVS abstract or printout
• Current bank statement if the applicant has direct deposit or copy of the applicants current benefit check
Note:Note:The deposit or check may not reflect gross income if Medicare premiums are being deducted or an overpayment is being collected from the client’s check.
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page 15-4Medi-Cal 15. MAGI MC Income
• Signed statement from the person or organization providing the income.
If the client receives income and items listed above are not available, EW must obtain a “Sworn Statement” (SCD 101) from the individual (as a last resort).
Unearned income must be verified prior to approval, and at each reapplication, restoration, or redetermination.
15.2.3 Using the Federal Hub to Verify Income
When EDBC is run for a MAGI case, information from CalWIN is sent to CalHEERS and matched against the Federal Data Services Hub (Federal Hub). Reported income that matches the federal hub within the allowable threshold will be “e-verified”. E-verification is only valid for MAGI MC and APTC and must not be used as verification for Non-MAGI or other programs. In a combo case (i.e. CalFresh/MC) other verification must be requested.
There are two E-Verification categories on the Manual Verification page in CalHEERS: Household Current Monthly Income (CMI) and Household Income Subsidy. For MAGI individuals, the Household CMI must be e-verified or paper verification is required. For APTC individuals, the Household Income Subsidy must be e-verified or paper verification is required.
E-Verification is at an individual level. The same amount of income may be E-Verified for one person, and not E-Verified for another.
Example:
A mom is applying for her child and not requesting aid. The EW enters her income information into CalWIN and marks it Not Received. After running EDBC, mom’s manual verification page shows the income of $1000 is not E-Verified, however on the child’s manual verification page, the income of $1,000 is E-Verified. This is sufficient verification of income for the child. If the mom were requesting aid, paper verification would be required to establish eligibility.
DIVS Verification
CalHEERS has added a new DIVS verification for APTC, CSR, and QHP. Anything that is only DIVS verified is not sufficient verification for Medi-Cal household members. Other verification must be received.
15.3 Current Monthly Income
Current Monthly Income (CMI) should be entered for every individual who reports income, regardless of whether or not they report Projected Annual Income (PAI).
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Medi-CalMedi-Cal 15. MAGI MC Income
15.4 Projected Annual Income
For income that fluctuates month to month, the SSApp specifically asks for the PAI. CalHEERS also asks for PAI information and e-verifies PAI and CMI separately.
PAI is not required for a MC eligibility determination and benefits should never be denied or discontinued for failure to provide PAI verification.
Note:
PAI will not be counted in the CalWIN budget for Non-MAGI MC or any other program.
15.4.1 How CalHEERS E-Verifies PAI and CMI
CalHEERS calculates a monthly income amount from the PAI for comparison purposes. CalHEERS will always use the lower of the two monthly amounts to determine eligibility when both have been e-verified. If the lower amount is e-verified, it will e-verify the higher amount as well.
Table 15-1: CalHEERS eVerification of PAI and CMI
If... Then...
Both amounts are e-verified, CalHEERS will use the lower amount for eligibility.
The lower amount is e-verified, CalHEERS will use the lower amount for eligibility and automatically e-verify the higher amount so eligibility does not pend.
The higher amount is e-verified, CalHEERS may not e-verify the lower amount and verification may need to be requested. [Refer to Chapter 15, Section 15.4.3 "When to Request Verification,” page-6]
15.4.2 When to Enter PAI in CalWIN
PAI is only entered in the Display Projected Annual Income Detail window for individuals who attest to PAI that is more beneficial than their CMI. [Refer to Chapter 15, Section 15.5 "Income Flowchart,” page-10]
Examples of when PAI is used:
• When PAI is below the MAGI limit and CMI is above the MAGI limit.
• When both PAI and CMI are under the MAGI limit, but the CMI makes a child eligible to a premium aid code and the PAI makes the child eligible to a non-premium aid code.
• When PAI and CMI are both above the MAGI limit, and PAI is lower than CMI.
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page 15-6Medi-Cal 15. MAGI MC Income
CMI must continue to be entered in the appropriate income-related windows, even when PAI is entered in CalWIN. Because PAI is used as a last resort, it should not be entered until it has been verified.
15.4.3 When to Request Verification
When a client reports PAI and CMI, verification is not necessarily required for both. Follow the table below for requesting verification.
Table 15-2: Requesting Verification
If... And... Then... Exception
Both amounts are within the MAGI limit,
One or both are e-verified, No further verification is required. If the unverified amount would qualify a child for a non-premium aid code and the e-verified amount qualifies a child for a premium aid code, request verification of the lower amount.
Neither is e-verified, Request verification of CMI.
One amount is over MAGI, one amount is below,
Only the amount above MAGI is e-verified,
Request verification of the amount below MAGI to see if the client is MAGI eligible.
Only the amount below MAGI is e-verified,
No further verification is required.
Both amounts are over MAGI (mixed households),
One or both are e-verified, No further verification is required.
Neither is e-verified, Request verification of the lower amount.
15.4.4 Display Projected Annual Income Detail window
The table below lists the CalWIN field in the Display Projected Annual Income Detail window, the CalHEERS field where the information can be found, and what to enter in CalWIN.
Table 15-3: Display Projected Annual Income Detail Window
CalWIN Field CalHEERS Field What to Enter in CalWIN
Effective Begin Date N/A The date PAI was reported
Calendar Year For Year Year the PAI record was created
PAI Begin Date Record Created Date the PAI record was created.
Projected Annual Income
You Expect PAI amount.
PAI End Date Record Superceded Date the PAI ended.
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Guidelines for Entering PAI in CalWIN
• Never enter $0 PAI when the client has not attested to any PAI.
• Never enter PAI for dependents or other household members when they do not have their own annual income. PAI is individual-based; adding incorrect PAI will cause the household income to increase.
• When a PAI record is open and a client reports new CMI, but does not report PAI, the PAI should be end dated. A new record should only be opened when the client reports new PAI that is more beneficial to the client than CMI.
End Dating PAI
PAI should be end dated when an income change is reported.
• If no PAI is reported, end date the entry in the Display Projected Annual Income Detail window and update the CMI.
• If a new PAI amount is reported, determine whether the new PAI is more beneficial to the client. If it is, end date the existing PAI entry and create a new entry. If the PAI is not more beneficial, end date the existing PAI entry and update the CMI.
The Effective Begin Date in the Display Projected Annual Income Detail window should not be updated on an existing row unless it was entered in error at initial entry. To update or end PAI, enter an end date in PAI End Date and create a new row when applicable.
There can only be one PAI amount that covers the same PAI Begin and End Date range. An error message will display in the following scenarios:
• When an existing PAI record is not end dated and an EW tries to add a new PAI entry with the same calendar year.
Effective End Date N/A Not a fillable field. PAI is ended by PAI End Date, not Effective End Date.
Admin Verification N/A How it was verified in CalWIN.
State Verification N/A Verification from CalHEERS.
Table 15-3: Display Projected Annual Income Detail Window
CalWIN Field CalHEERS Field What to Enter in CalWIN
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• When the new PAI Begin Date overlaps with the PAI Date Range (PAI Begin Date to PAI End Date) on an existing PAI entry.
15.4.5 Individuals With No PAI Who Are Pending Eligibility for PAI Verification
Individuals who have no PAI, but have household members that do, may pend for not having PAI verification. To grant those individuals eligibility, complete the following steps:
1. Log in to CalHEERS.
2. Enter the CalHEERS Case ID.
3. Select any individual from the appropriate case and click [Manual Verification].
4. Select the individual who is pending in CalWIN to open the Personal Verification page.
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Medi-CalMedi-Cal 15. MAGI MC Income
5. On the Personal Verification page, scroll down to “MAGI Medi-Cal Projected Annual Income”. The drop-down in the Verification Status column should say Pending.
6. Select Pass from the drop-down in the Verification Status column.
7. Click [Save].
8. Repeat Step 1 through 7 for any other household members who are pending for PAI but have no attested PAI.
9. On the Household Verifications page, click [Redetermine Eligibility]. This will send a CEW Through Portal Change DER to CalWIN. Process the Change DER. [Refer to “CEW Through Portal Change DERs,” page 18-38]
10. Once EDBC is run, the individual(s) should no longer be pending.
Note:
THIS SHOULD NOT BE USED FOR ANY OTHER SCENARIO. If individuals do have PAI and are pending for PAI, the verification must be requested and processed as usual.
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15.5 Income Flowchart
Follow the flowchart below to determine which income type should be used:
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Medi-CalMedi-Cal 15. MAGI MC Income
Example 1
Maria files taxes as Head of Household and claims one child as a dependent. She reports PAI of $24,240 and CMI of $1,900 for a HH of 2. The PAI works out to $2,020 monthly which is e-verified and qualifies the child for T1. The CMI is not e-verified, but would qualify the child for T2. Both are under MAGI limits, but CMI qualifies the child for a non-premium aid code. A request is sent for CMI verification and Maria provides verification. Only CMI will be entered in CalWIN and used to determine eligibility.
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page 15-12Medi-Cal 15. MAGI MC Income
Flowchart for Example 1
Example 2
Michael files taxes as Single. He reports PAI of $12,000 and CMI of $1,800. The PAI works out to $1,000 monthly. PAI and CMI are both e-verified. PAI and CMI will be entered in CalWIN and PAI will be used to determine eligibility.
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Flowchart for Example 2
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page 15-14Medi-Cal 15. MAGI MC Income
Example 3
Darius files taxes as Single. He reports PAI of $12,000 and CMI of $1,900. The PAI works out to $1,000 monthly. CMI is e-verified and above MAGI. PAI is not e-verified and is below MAGI. PAI verification is requested and Darius does not provide any verification. CMI should be entered in CalWIN and will be used to determine eligibility.
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Medi-CalMedi-Cal 15. MAGI MC Income
Flowchart for Example 3
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15.6 Income of a Tax Dependent
The income of a tax dependent (qualifying child or qualifying relative) or child who is not expected to be required to file taxes is excluded from the tax household’s MAGI income calculation. Income of children and tax dependent is counted in determining MAGI household income when a child or tax dependent is expected to be required to file a tax return.
The EW can accept the tax filing requirement as reported by the client for the benefit year that they are applying for.
Note:
Supplemental Security Income (SSI) and Social Security benefits (i.e. Retirement, Survivor’s, Disability Insurance) are not counted for the purposes of determining whether a tax dependent will be required to file a tax return. However, if the tax dependent does have a tax filing requirement then the dependent’s Social Security benefits will be counted toward the household’s MAGI income.
If the Expected to be Required to File Taxes this Year [Y/N] field in Display Tax Filer Detail is marked No the income will not count in the MAGI MC budget.
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Medi-CalMedi-Cal 15. MAGI MC Income
15.7 Self-Employment Income
The amount the client enters or provides on the application should be the net taxable income from self-employment activities, which is the amount after applying expenses and deductions permitted by the IRS. IRS rules for determining taxable net profit income from self-employment may result in a negative number (a net income loss). The negative number may be used to offset other income the household reports on their application and, may result in zero countable income for MAGI MC. If the self-employed expenses exceed the self-employment income, CalWIN will send a negative number to CalHEERS.
The amount that is entered on the SSApp is the amount that should be transmitted to CalHEERS the Federal Hub will determine whether that amount is reasonably compatible. If it is not determined to be reasonably compatible, paper verifications of income must be provided (i.e. IRS Form 1040, Schedules C, E, K-1, etc.)
The IRS rules are different from the rules for determining net income from self-employment for Non-MAGI eligibility. The IRS deductions for MAGI MC are broader than those allowed for Non-MAGI MC net income from self-employment and rental property calculations.
Self-employment income is typically verified using the prior year’s tax documents, however, if the client is unable to provide the tax documents or states that the tax documents from last year do not accurately reflect the current year’s income, they must provide verification of their income and expenses from the last three months. The Eligibility Worker must average the three months of income and expenses and use the resulting amount as the monthly income/expenses in CalWIN.
15.7.1 Combo Cases
When an individual on a combo case is self-employed, the rules of the other programs must be used, rather than the information outlined above.
Note:
For instructions on how to enter self employment income on a MC/CF case please see SA 331.
15.8 Individuals Paid in Cash
Individuals who are paid in cash often cannot provide proof of income. If all other options are exhausted (i.e. attempt to get employer statement, verification through the Federal Hub, etc.), the signature on an application is sufficient verification of income for clients paid in cash. Additionally, clients can complete an SCD 101 as verification.
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Medi-
15.9
When a e sworn statement on the Applicat
ExEx
idual, the EW must request
15.10
Uncond pt it. This includes but is not limited to:
• Di• Ve• Re• Un
Individu they are not required to provide verificat criteria are met.
15.11
The Pub dentifies discrepancies in unrepor irectly from the U.S. Department of
Page 15-18
Cal 15. MAGI MC Income
Verification of Zero Income
client reports zero income at Application or Redetermination and the income is not E-Verified, thion/Redetermination forms is sufficient verification of income.
ception:ception:
If the client reports zero income, but there is an open employment record in CalWIN for that indivverification that the job has ended.
Unconditionally Available Income
itionally available income is income that is potentially available to the client if they claim and acce
sability Insurance Benefitsterans benefitstirement, Survivors, Disability Insurance (RSDI)employment Insurance Benefits
als applying for MAGI MC are required to apply for all unconditionally available income, however,ion that they applied, and eligibility can be granted in the meantime as long as all other eligibility
PARIS Federal Match
lic Assistance Reporting Information System (PARIS) Federal Match is a quarterly report which ited income. Information from the report is to be treated as verified federal income as it is taken d
Update #20-02
Medi-
Defense rted by income amount, eligibility status, a d and record the findings on the spreads evaluated and appropriate NOA(s) should b
15.12
Income di-Cal (MC) and Advanced Premium when the income type is selected from the the income is counted or not counted or are not) counted for both MAGI MC and
The inco Income,” page 20-1] for Non-MAGI MC inco
Page 15-19
Cal 15. MAGI MC Income
(DOD) and the U.S. Office of Personnel Management (OPM). DHCS will send a quarterly list sond aid code. The EW will compare the federal income on the list to the income the client reporteheet provided with the listing. If the income information does not match then eligibility must be ree sent. [Refer to MC HB 7.2.4 for PARIS Interstate Match].
CalWIN Income and Deduction Types
and deductions may be counted differently between Modified Adjusted Gross Income (MAGI) Me Tax Credit (APTC). CalWIN has a feature that indicates if the income is counted or not counted
CalWIN drop-down menu. (CalWIN displays the CalHEERS income type which shows whether ). The tables in this chapter provide information of how various income and deduction types are ( APTC and which are the corresponding CalWIN types.
me and deduction tables in this chapter do not apply to Non-MAGI MC. [Refer to “Non-MAGI MCme information.
Update #20-02
Medi-
15.13
The follo ne on the IRS Form 1040. It also shows i Revenue Service (IRS) Form 1040 can be e alWIN and CalHEERS only partial informa and/or CalHEERS provide addition
Other Inco CalWIN Window
$25 weeklycompensatAmerican R
Acceleratedthe insuredlong term cin excess o
Page 15-20
Cal 15. MAGI MC Income
Income Types
wing table provides various income types for MAGI MC and APTC, including its corresponding lif the income is counted in the MC eligibility determination. Income from CalHEERS and/or Internalntered into several CalWIN windows. Due to the current mapping between the various types in C
tion, related to income, deductions and expenses, may be available in this chapter. Once CalWINal information, this chapter will be updated accordingly.
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
supplement to unemployment ion payment authorized by the ecovery
N/A Not Counted
Not Counted
death benefits/viatical settlements if is chronically ill for costs of qualified are or if the insured is terminally ill not f limit
N/A Not Counted
Not Counted
Update #20-02
Medi-
Acceleratedpaid to persinsured’s b
ox
Activity not
Adoption as Collect Unearned Income Detail
Alaska Natdistribution
Alaska Per
Alimony recseparation 12/31/18. Not countaseparation 01/01/2019
t • Collect Child/Spousal Detail
• Collect Unearned Income Detail
AmeriCorpsAward
AmeriCorpsStipend and
AmeriCorps ts Collect Unearned Income Detail
Austrian ge
Other Inco CalWIN Window
Page 15-21
Cal 15. MAGI MC Income
death benefits/viatical settlements ons with a financial interest in the
usiness
21 Counted Counted Choose “Other” and enterIncome Type in the Text B
for profit, Pub.535 21 Counted Counted
sistance payments N/A Not Counted
Not Counted
ive corporations and settlement trust s
N/A Not Counted
Count taxable portion only
manent Fund dividends 21 Counted Counted
eived: Income only if the divorce or instrument is executed on or before
ble income for any divorce or instrument modified on or after
11 Counted on or before 12/31/18
Counted on or before 12/31/18
AR - Alimony Received
Alimony - Spousal Suppor
State/National Stipend and Education 21 Not Counted
Counted
National Civilian Community Corps Education Award
21 Not Counted
Counted
Vista Stipend and Educational Award 21 Not Counted
Counted MS - Miscellaneous
AmeriCorps Vista Paymen
neral social insurance payments N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Ball v. Swo Collect Unearned Income Detail
Bartering, 1
Black Lung Collect Unearned Income Detail
Bribes
Blood, plascompensat
Business (o
rts
nts
rly
e
tem
• Collect Rental Income Detail
• Collect Room & Board Detail
• Collect Unearned income Detail
Other Inco CalWIN Window
Page 15-22
Cal 15. MAGI MC Income
ap payment N/A Not Counted
Not Counted
099-B, Pub. 525 21 Counted Counted
benefit payments
21 Counted Counted
ma, sperm, egg, embryo, or ion received for other body parts
21 Counted Counted
r loss), Schedule C or C-EZ 12 Counted Counted SE - Self-Employment
• Lump sum from trade/business of self-employed person
• Lump sum not from trade/business of self-employed person non-recurring
• R & B/Room rent: has business license or repoincome for taxes
• R & B/Room rent: no business lic regularly reto non-family member
• R & B/Room rent: no business license regularents to family member
• Self Employment incom
• Third Party payment to vendor for a non-need i
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
CalFresh b
Cancellatio• intended• amounts• amounts• with rega
excess oplus imp
Cancellatiointended asinsolvency with regardthe cost of improveme
Collect Unearned Income Detail
Capital gain Collect Unearned Income Detail
Carpool pa
Child Supp Collect Child/Spousal Detail
Clergy houof market ra
Clergy houmarket rate
Clinical traiexpenses in
Other Inco CalWIN Window
Page 15-23
Cal 15. MAGI MC Income
enefits N/A Not Counted
Not Counted
n of non-business debt as a gift not in excess of insolvency discharged in bankruptcyrd to mortgage cancellation, not in f the cost of the principal residence rovements, 1099-C
N/A Not Counted
Not Counted
n of non-business debt, unless a gift, that is in excess of • amounts of • amounts discharged in bankruptcy • to mortgage cancellation, in excess of your principal residence plus nts, 1099-C
21 Counted Counted CD - Cancelled Debts
Cancelled Debts
(or loss), Schedule E 13 Counted Counted CG - Capital gains
Capital Gains
yments N/A Not Counted
Not Counted
ort N/A Not Counted
Not Counted
sing and utility allowance not in excess te and actual cost respectively
N/A Not Counted
Not Counted
sing and utility allowance in excess of and actual cost respectively
21 Counted Counted
ls participation to the extent of curred plus $2,000
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Clinical triaamounts in1099-Misc
County Gen
Coverdale
Court awarcompensatcontract, pepatent or codamages
Collect Unearned Income Detail
Court awarinjury or siccompensatinclude combreach of cawards, papunitive da
Credit Card ce Collect Unearned Income Detail
Disability Ininsurance p525 and 90
its Collect Unearned Income Detail
Disability Indisability inemployer) P
Other Inco CalWIN Window
Page 15-24
Cal 15. MAGI MC Income
l participation remuneration and excess of expenses minus $2,000, and 42 U.S.C. Section 1396a(e)(14)
21 Counted Counted
eral Assistance cash grant N/A Not Counted
Not Counted
education savings account 21 Counted Counted
ds/judgments/settlements for ion for lost wages/profits, breach of nsion rights, interest on awards, pyright infringement and punitive
21 Counted Counted CA- Court Awards
Court Awards
ds/judgments/settlements for personal kness/emotional distress and other ory property damages. This does not pensation for lost wages/profits,
ontract, pension rights, interest on tent or copyright infringement and mages
N/A Not Counted
Not Counted
Insurance or Disability Payment 21 Counted Counted MS - Misc. • Credit disability insuranpayments
• Credit life insurance payments
come -taxed (taxed private disability remiums paid for by employer) Pubs 7, 1099 and 1099-A
21 Counted Counted MS - Misc. Disability Insurance Beneffrom private company
come- untaxed (untaxed private come insurance-premiums not paid by ubs 525 and 907
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
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Disability pdirectly fromincluding tr
Collect Unearned Income Detail
Other Inco CalWIN Window
Page 15-25
Cal 15. MAGI MC Income
ayments received for injuries resulting a terrorist or military action, not
aining exercises
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
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Disaster re
• From chasponsoreemergen
• From insareas. Note: Insnon-fedecount unon wheth
• From fedbased on
• For qualilocal govdefined b• Result• Result
comm• Is a Pr• Is an e
determ• From qu
source fo• Reaso
living, result
• Reasoincurrepersondisastea rente
• Reasoincurrecontenqualifie
Other Inco CalWIN Window
Page 15-26
Cal 15. MAGI MC Income
lief payments (qualified payments)
ritable organizations (not employer d) as a result of a disaster or cy hardships are considered gifts.urance in federally declared disaster
urance payments for losses in rally declared disaster areas may der certain circumstances, depending er they are taxable.eral or state government that are need,fied disasters from federal, state or ernment. A qualified disaster is y federal tax law as a disaster that:s from terrorist or military actions,s from an accident involving a on carrier,esidentially declared disaster, orvent that the Secretary of the Treasury ines is catastrophic.
alified disasters regardless of the r the following expense:nable and necessary personal, family, or funeral expenses incurred as a of a qualified disaster.nable and necessary expenses d for the repair or rehabilitation of a al residence due to a qualified r (a personal residence can be either d residence or owned).nable and necessary expenses d for the repair or replacement of the ts of a personal residence due to a d disaster.
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
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Diversion c
Down paym
Earned inco
Economic s
Employer cfunded by areduction, saccount
Other Inco CalWIN Window
Page 15-27
Cal 15. MAGI MC Income
ash assistance N/A Not Counted
Not Counted
ent assistance N/A Not Counted
Not Counted
me tax credit N/A Not Counted
Not Counted
timulus payments (federal) N/A Not Counted
Not Counted
ontributions to certain pretax benefits n employee’s elective salary uch as amounts for flexible spending
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Employmendifferential cost-of-livincompensatseverance and paid hocash paymallowancestransportaticommissionbonuses; aon a pre-tameals and under a plaguaranteedunemploymagreement,unemploymfinanced fuperformed,
es,
se
s &
Collect Earned Income Detail
Energy Con
Endowmendeath, not ito a benefic
Endowmendeath in exveteran’s e
Farm incom Collect Unearned Income Detail
Other Inco CalWIN Window
Page 15-28
Cal 15. MAGI MC Income
t (Wages; salary; back pay; wage payments; Government g allowances; Non-qualified deferred ion; notes received for services; pay; sick pay; vacation, annual leave, lidays; strike and lockout benefits,
ents for stock appreciation rights; and reimbursements for travel, on, or other business expenses; s; advance commissions; tips;
wards; and fringe benefits not provided x basis (including non-clergy housing, transportation), disability pension n that is paid for by your employer, annual wages paid during period of ent by employer under a union employer paid supplemental ent benefits from an employer
nd, fees received by clergy for services and other, W-2
7 Counted Counted • Census Income
• Earnings, wages, salaribonuses, commissions,military pay
• Excess income of spou
• Pre-strike - Earnings, wages, salaries, bonusecommissions
• Reimbursements or advances which exceedexpenses
• Sick Pay
• Striker Picket Pay
• Therapeutic wages
• Tips
servation Subsidy
t Contracts paid as a lump sum before n excess of costs or paid upon death iary
t Contracts paid as a lump sum before cess of costs (not applicable a ndowment contract)
21 Counted Counted
e (or loss), Schedule F 18 Counted Counted FF - farming or fishing income
Income from Fishing and Farming
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Federal Inc
Foreign Eanon-taxable ,
Collect Earned Income Detail
Foster care
Foster caretransitional
Gambling wForm W2-G
, Collect Unearned Income Detail
Gifts/Cash Collect Unearned Income Detail
Health savi
Hobby incoexpect to s
Holocaust vPersecution
Collect Unearned Income Detail
Host or hos
Other Inco CalWIN Window
Page 15-29
Cal 15. MAGI MC Income
ome Tax Return N/A Not Counted
Not Counted
rned Income (taxable and ), Form 2555
21 Count Gross
Count Gross
FI - Foreign Earned Income (taxable and non-taxable) Form 2555
Foreign Earned Income (taxable and non-taxable)Form 2555
, maintaining a space in your home 21 Counted Counted
or other Title IV-E payments and housing
N/A Not Counted
Not Counted
innings: gambling, lottery, raffles, 21 Counted Counted MS - Misc. • Winnings (bingo, lotterygambling, etc)
Contributions N/A Not Counted
Not Counted
ngs account 21 Counted Counted
me, or from an activity you did not ee a profit
21 Counted Counted
ictims restitution/Victims of Nazi /German Reparation Payment
N/A Not Counted
Not Counted
tess gift or gratuity 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Income fromSources• Indian fin
Indian Fiprofit-maenterpris
• Student fof Indian
ian Collect Unearned Income Detail
Income fromSchedule-C
Income frombusiness in
l • Collect Rental Income Detail
• Collect Room & Board Detail
Income In-K525
Collect inkind Income Detail
Income Taxdeducted o
Indian finanFinancing AIndian-ownreservation
Individual R1099-R
Inheritanceinherited pe
Other Inco CalWIN Window
Page 15-30
Cal 15. MAGI MC Income
American Indian or Alaska Native
ancing grants under title IV of the nancing Act of 1974 to expand king Indian-owned economic es on or near reservationsinancial aid provided under the Bureau Affairs education programs
Not Counted
Not Counted
AA - American Indian or Alaskan Native
Income from American Indor Alaska Native Sources
illegal activities (Schedule C or -EZ)
21 Counted Counted
the rental of personal property (not come)
21 Counted Counted Rent from real or personaproperty not a business
ind (non-taxable fringe benefits) Pub N/A Not Counted
Not Counted
Refund (Federal and State, if not n Federal Income Tax)
N/A Not Counted
Not Counted
cing grants under title IV of the Indian ct of 1974 to expand profit-making
ed economic enterprises on or near s
N/A Not Counted
Not Counted
etirement Account (IRA) distributions, 15b Counted Counted RP - Retirement/ pension
IRA Distributions
or taxable portion of inherited IRA or nsion
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Interest inc1099-INT
r
Interest inccharged wa
In-Home Suwages paidregardless beneficiary• In-Home• Nursing • Persona• IHSS Plu• Commun• IHSS- Re
In-Home Su• Restaura• Advance
Other Inco CalWIN Window
Page 15-31
Cal 15. MAGI MC Income
ome (taxable and non-taxable), 8a & 8b
Counted Counted IN - Interest income (taxable and non-taxable) 1099-INT
• Interest Income
• Contract of sale of OtheProperty/Interest
• Interest on payment to replace an excluded resource
• Interest portion of Retirement refund
• Loan interest paymentsreceived by client
• Interest on CalWORKs Restricted Account
• Trust Fund Interest Distributed
ome not received because the interest s below the applicable federal rate
21 Counted Counted
pportive Services (IHSS) caregiver to an enrolled provider who, of relationship, resides with the MC who receives those services from the: Operations WaiverFacility/Acute Hospital Waiverl care Services Programs Optionity first Choice Optionsidual Program
N/A Not Counted
Not Counted
N/A
pportive Servicesnt Meals Allowance Payments for Caregiver
N/A Not Counted
Not Counted
N/A
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Japanese ofrom the Un
Collect Unearned Income Detail
Job Corps
Jury duty p Collect Earned Income Detail
Kickbacks
KinGAP pa
Life insuransurrender in
Life insurannon-taxable
Loan proce Collect Unearned Income Detail
Long-term 1099 LTC
Long-term LTC
Lost, stolen
Manufactur
Medical Sa969
Military allo
Other Inco CalWIN Window
Page 15-32
Cal 15. MAGI MC Income
r Aleutian reparation payment whether ited States or Canada
N/A Not Counted
Not Counted
N/A
earnings/stipend 21 Counted Counted
ay in excess of costs 21 Counted Counted JD - Jury Duty Pay
Jury Duty/Court
21 Counted Counted
yments N/A Not Counted
Not Counted
N/A
ce proceeds turned over for price, e.g. excess of the cost of the insurance
21 Counted Counted
ce proceeds upon death, including annuity payments/proceeds
N/A Not Counted
Not Counted
N/A
eds N/A Not Counted
Not Counted
care benefits – non-taxable amount – N/A Not Counted
Not Counted
care benefits – taxable amount – 1099 21 Counted Counted
, or damaged property payments N/A Not Counted
Not Counted
er incentive payments 21 Counted Counted
vings Account (Archer-Medicare), Pub. 21 Counted Counted
wances N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Mortgage aof the Natio
Needs-bas
Netherland
Net Operatother line 2
Nutrition beAssistanceElderly or D
Ordinary/qu Collect Unearned Income Detail
Other gains m Collect Unearned Income Detail
Paid Family
Other Inco CalWIN Window
Page 15-33
Cal 15. MAGI MC Income
ssistance payments under section 235 nal Housing Act
N/A Not Counted
Not Counted
ed assistance N/A Not Counted
Not Counted
s WUV victims of persecution N/A Not Counted
Not Counted
ing Loss Carryover, Subtract from 1 income, Pub. 536
21 Subtract Losses
Subtract Losses
nefits (Supplemental Nutrition Program, Nutrition Programs for the isabled.
N/A Not Counted
Not Counted
alified dividends, 1099-DIV 9a Counted Counted OQ - Ordinary/qualified dividends, 1099-DIV
• Dividends
• Dividends and interest: Irregular/infrequent
• Dividends and interest: Regular
(or losses), Form 4797 14 Counted Counted OG - Other gains (or losses), Form 4797
Other gains (or losses), fro4797
Leave, 1099-G 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Pensions, DBoard militapaid as ann
Collect Unearned Income Detail
ent
Pension paemployee (were previo
Per-Capita Indian or Al
Collect Unearned Income Detail
Physical injpayments
Principal pa
Prizes and rds Collect Unearned Income Detail
Public assisBureau of I
Pulitzer, No
Qualified Tu
Other Inco CalWIN Window
Page 15-34
Cal 15. MAGI MC Income
epartment of Defense Retirement ry retirement, endowment contracts uities and taxable annuities, 1099-R
16b Counted Counted RP - Retirement/ pension
• Annuities/Insurance Company
• Civil Service Annuities
• Foreign Pension
• Pension/Retirement payments
• Public Employees Retirement
• State Teachers Retirem
• Military benefits
yments that were paid by the such as premiums of contributions that usly subject to tax
N/A Not Counted
Not Counted
Gaming Distributions to American askan Natives
21 Counted Counted PC - PCGD • Native American gaming/other proceeds
ury, illness, or emotional distress N/A Not Counted
Not Counted
yments on loans N/A Not Counted
Not Counted
awards 21 Counted Counted Winnings, prizes and awa
tance payments, general assistance, ndian Affairs general assistance
N/A Not Counted
Not Counted
ble or similar prize 21 Counted Counted
ition Program, Pub. 970 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Qualified respending a
Radiation e
Railroad renon-taxable
al
Collect Unearned Income Detail
Recoveriescredit was tRefunds/redeductions
Reemploympayments m
Refugee ca
Refugee reone-time paDepartmen(VOLAG) p
Reimburse
Reimburse
Other Inco CalWIN Window
Page 15-35
Cal 15. MAGI MC Income
servist distribution from health flexible ccount, W-2, Pub 525
21 Counted Counted
xposure compensation payment N/A Not Counted
Not Counted
tirement benefits (taxable and ), RRB1099
20a & 20b
Counted Counted RB - Railroad retirement benefits (taxable and non- taxable), RRB-1099
• Railroad Retirement
• Railroad Retirement Occupational Disability Benefit
• Railroad Retirement Tot& Permanent Disability Benefit
of amounts deducted or for which a aken an earlier year. imbursements/rebates of itemized
21 Counted Counted
ent Trade Adjustment Assistance ade by a state agency, 1099-G
21 Counted Counted
sh assistance N/A Not Counted
Not Counted
ception and replacement program yments by the Department of State or
t of Justice such as Voluntary Agency ayments
N/A Not Counted
Not Counted
ments not in excess of costs incurred N/A Not Counted
Not Counted
ment for Employment Agency Fee 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Relocation Collect Unearned Income Detail
Relocation floods undeDevelopme
Rental of pe nal
nit on
al ek
al
• Collect Unearned Income Detail
• Collect Earned Income Detail
Rental realS-Corporat
nal
e
f
• Collect Earned Income Detail
• Collect Unearned Income Detail
Renter’s ta
Repaymenoriginal loa
Other Inco CalWIN Window
Page 15-36
Cal 15. MAGI MC Income
assistance payments N/A Not Counted
Not Counted
and Rehabilitation payments due to r the Housing and Community nt Act
N/A Not Counted
Not Counted
rsonal property – not self-employment 21 Counted Counted MS-Misc. • Rent from real or persoproperty not a business
• Rent from unit of mult udwelling/other dwelling prop exmt as PR
• Rental other real/personproperty < 20 hours we
• Rental other real/personproperty > or = 20 hoursweek
estate, royalties, partnerships, ions, Trusts, etc. (or loss), Schedule E
17 Counted Counted RR - Rental or royalty income
• Rent from real or persoproperty business or appreciable effort
• Royalties as part of trador business or from publication of work
• Royalties paid for use oproperty
x credit (California) N/A Not Counted
Not Counted
t of bona fide loan not in excess of n
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Reverse An
Rewards
Ricky Ray h
Roth IRA, 4Distribution
Salary or w(received b
Scholarshipfor living ex
Scholarshipliving expen
SDI, not trebenefits
Other Inco CalWIN Window
Page 15-37
Cal 15. MAGI MC Income
nuity Mortgage N/A Not Counted
Not Counted
21 Counted Counted
emophilia relief fund N/A Not Counted
Not Counted
01K, 403(b), or 457(b) Qualified N/A Not Counted
Not Counted
ages from a decedents’ employer y a surviving spouse)
N/A Not Counted
Not Counted
s, awards, fellowship grants not used penses, Pub. 970
21 Not Counted
Counted
s, awards, fellowship grants used for ses, Pub, 970
21 Counted Counted
ated as unemployment insurance N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Self-employSchedule K
rts
e
nts
rly
tem
• Collect Earned Income Detail
• Collect Rental Income Detail
• Collect Room & Board Detail
• Collect Unearned Income Detail
Other Inco CalWIN Window
Page 15-38
Cal 15. MAGI MC Income
ment (in excess of expenses), -1, Schedule SE
21 Counted Counted SE • Lump sum from trade/business of self-employed person
• R & B/Room rent: has business license or repoincome for taxes
• Self Employment incom
• Lump sum not from trade/business of self-employed person non-recurring
• R & B/Room rent: no business lic regularly reto non-family member
• R & B/Room rent: no business license regularents to family member
• Third Party payment to vendor for a non-need i
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Social secuSSA-1099
led
ult
ed ild
Collect Unearned Income Detail
Collect Unearned Income Detail
Collect Unearned Income Detail
Sponsor’s i
State tax rededucted
Other Inco CalWIN Window
Page 15-39
Cal 15. MAGI MC Income
rity benefits (taxable and non-taxable), 20a & 20b
Counted Counted SD - Social Security Disability
• SSA/RSDI - Blind
• SSA/RSDI: Blind DisabAdult Child (DAC)
• SSA/RSDI: Disability benefits
• SSA/RSDI: Disabled AdChild (DAC)
• SSA/RSDI: income bason parent, spouse, or chdisability
SR - Social Security Retirement
• SSA/RSDI: Retirement benefits
SO - Social Security Survivors
• SSA/RSDI: Survivors benefits
• SSA/RSDI: Widower's benefits
ncome given to a sponsored immigrant N/A Not Counted
Not Counted
fund in excess of prior year state tax 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
State or Fe1099-G Statreated as uRailroad UnReadjustmeUnemploymRelief and E1099-G UnAirline Dere
oss
Collect Unearned Income Detail
Stolen prop
Strike and l d Collect Unearned Income Detail
SupplemenSupplemen
Collect Unearned Income Detail
Surrogacy Collect Unearned Income Detail
Taxable refincome tax
Unearned iby another,
Collect Inkind Income Detail
Unemploym
Utility rebat
Other Inco CalWIN Window
Page 15-40
Cal 15. MAGI MC Income
deral unemployment compensation, te Disability Insurance (SDI), when nemployment compensation, 1099-G employment benefits, 1099-G Trade nt allowances, 1099-G ent assistance under the Disaster mergency Assistance Act of 1974,
employment assistance under the gulation Act of 1974 Program, 1099-G
19 Counted Counted UE - Unemployment
• UIB: Disaster
• UIB: lump sum gross
• UIB: regular payment gr
erty received 21 Counted Counted
ockout benefits 21 Counted Counted UE - Unemployment
• Strike Benefits Unearne
tal Security Income/State tary Payment (SSI/SSP) benefits
N/A Not Counted
Not Counted
N/A Counted Counted ? Other unearned
unds, credits, or offsets of state/local es
10 Counted Counted TR - Taxable refunds, credits, or offsets of state/local income taxes
• CA FTB Senior CitizensTax Postponement
• Income tax Refund
• Property tax refunds
ncome in-kind/personal expenses paid including a corporation
21 Counted Counted
ent benefits paid by a union 21 Counted Counted
es 21 Counted Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Veteran’s Abenefits pa
VA agent o
VA children
VA compenpayments
VA death gof the Arme10, 2001
VA depend
VA disabilitveteran or t
VA educatio
VA grants fliving
VA grants fotheir sight o
VA insurancto veteransproceeds obefore deat
VA insuranc
Other Inco CalWIN Window
Page 15-41
Cal 15. MAGI MC Income
dministration (VA) aid and attendance id to the veteran or their families
N/A Not Counted
Not Counted
range benefits N/A Not Counted
Not Counted
with certain birth defects N/A Not Counted
Not Counted
sated work-therapy program N/A Not Counted
Not Counted
ratuity paid to a survivor of a member d Forces who died after September
N/A Not Counted
Not Counted
ent-care assistance program benefits N/A Not Counted
Not Counted
y compensation paid either to the heir families
N/A Not Counted
Not Counted
n, training or subsistence allowances N/A Not Counted
Not Counted
or homes designed for wheelchair N/A Not Counted
Not Counted
r motor vehicles for veterans who lost r the use of their limbs
N/A Not Counted
Not Counted
e proceeds and dividends paid either or their beneficiaries, including the f a veteran’s endowment policy paid h
N/A Not Counted
Not Counted
e interest left on deposit with the VA N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Veteran’s FTrust
Veteran’s N
VA pensionfamilies
Veteran’s bpolitical subcombat zon
Victims of c
Vocational received, nand rehabil
Volunteer W• Peace C
utilities, h• National
services expenseProgramProgram
• Service Camountsout-of-po
• Volunteetransporthave in tcounselin
Other Inco CalWIN Window
Page 15-42
Cal 15. MAGI MC Income
ilipino Veterans Equity Compensation N/A Not Counted
Not Counted
orth Vietnam POW/MIA N/A Not Counted
Not Counted
benefits paid to the veteran or their N/A Not Counted
Not Counted
onus payment paid by any state or division because of service in a e
N/A Not Counted
Not Counted
rimes payments N/A Not Counted
Not Counted
rehabilitation goods, services and cash ot in return for services, but for training itation due to disability
N/A Not Counted
Not Counted
ork amounts:orps living allowances for housing, ousehold supplies, food, and clothingSenior Service Corps supportive or reimbursements for out-of-pocket s from the Retired Senior Volunteer (RSVP), Foster Grandparent , or Senior Companion Programorps of Retired Executives (SCORE)
for supportive services or cket expensesr tax counseling reimbursements for ation, meals, and other expenses you raining for, or actually providing tax g for the elderly
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
Walker v. B
Weatherizaemergencyheating/coo
Whistleblow
Withholdingoverpayme
Work traininpaid by a swhat wouldbenefits
Worker’s cosurvivors
Workforce
Work traininwelfare agewould have
Other Inco CalWIN Window
Page 15-43
Cal 15. MAGI MC Income
ayer payment N/A Not Counted
Not Counted
tion, home energy assistance, repair, or replacement of ling devices
er’s award 21 Counted Counted
from a benefit to repay an nt from the same income source
N/A Not Counted
Not Counted
g program payments – entire amount tate welfare agency if greater than otherwise be paid for public welfare
21 Counted Counted
mpensation paid to the worker or their N/A Not Counted
Not Counted
Investment Act payments N/A Not Counted
Not Counted
g program payments made by a state ncy if the total does not exceed what been paid in public welfare benefits
N/A Not Counted
Not Counted
Table 15-4: Income Types (or Losses) from IRS Form 1040
me Types or Losses 1040 Line #
MAGI MC APTC
CalHEERS Income Type
CalWIN Income Type
Update #20-02
Medi-
15.13.1
The follo g line on the IRS Form 1040.
Income De pe CalWIN Window
Alimony padivorce or sexecuted oNot a deduseparation or after 01
Collect Other Expense Detail
Business eperforming rtists
Collect Other Expense Detail
Child Care
Deductible tax
Collect Other Expense Detail
Educator e Collect Other Expense Detail
Health Sav t Collect Other Expense Detail
Hobby incoexpenses fnot expect
tivity Collect Other Expense Detail
IRA deduct Collect Other Expense Detail
Moving expduty militarpermanent
Collect Other Expense Detail
Page 15-44
Cal 15. MAGI MC Income
Deductions and Expenses
wing table provides various deduction types for MAGI MC and APTC, including its correspondin
Table 15-5: Income Deduction Types from IRS Form 1040
duction Types 1040 Line #
MAGI MC APTC CalHEERS Deduction
Type CalWIN Deduction Ty
id: Deduction only if the eparation instrument is n or before 12/31/18. ction for any divorce or instrument modified on /01/2019
31a Deducted on or before 12/31/18
Deducted on or before 12/31/18
AL- Alimony Alimony Paid
xpenses of reservists, artists, etc.
24 Deducted Deducted BE -Business expenses of reservists, performing artists, etc.
Business expenses of reservists performing a
Not Deducted
Not Deducted
part of self-employment 27 Deducted Deducted DS- Deductible part of self-employment tax
Deductible part of self-employment tax
xpenses 23 Deducted Deducted EE- Educator expenses Educator expenses
ings Account 25 Deducted Deducted HS- Health Savings Account
Health Savings Accoun
me expenses, or rom an activity you did to see a profit
Deducted Deducted HE- Hobby income expenses, or expenses from an activity you did not expect to see a profit
Hobby or non-profit acexpenses
ion 32 Deducted Deducted ID- IRA deduction IRA Deduction
enses: Only if active y and moved due to change of station
26 Deducted Deducted ME- Moving Expenses Moving Expenses
Update #20-02
Medi-
Penalty on savings
rawal Collect Other Expense Detail
Rental of pexpenses
perty Collect Other Expense Detail
Self-employdeduction
Collect Other Expense Detail
Income De pe CalWIN Window
Page 15-45
Cal 15. MAGI MC Income
early withdrawal of 30 Deducted Deducted EW- Penalty on early withdrawal of savings
Penalty on early withdof savings
ersonal property Deducted Deducted PP- Rental of personal property expenses
Rental of personal proexpenses
ed health insurance 29 Deducted Deducted SH- Self-employed health insurance deduction
Self-employed health insurance deduction
Table 15-5: Income Deduction Types from IRS Form 1040
duction Types 1040 Line #
MAGI MC APTC CalHEERS Deduction
Type CalWIN Deduction Ty
page 15-46Medi-Cal 15. MAGI MC Income
bor
ope
sine
om
rmin
her s
w
pe
Self-Employment Pension (SEP), Simple, and qualified deduction
28 Deducted Deducted QD - Self-employed SEP, Simple, and qualified deduction
• Self-Employment Depreciation
• Self-Employment Employee Salaries
• Self-Employment Entertainment
• Self-Employment LaCosts
• Self-Employment PrInsurance Premiums
• Self Employment BuLicense
• Self-Employment RoBoard Expenses
• Self-Employment Fa& Fishing Losses
• Self-Employment OtNecessary Expense
• Self-Employment RaMaterial & Goods
• Self Employment Transportation
Student loan interest 33 Deducted Deducted SL- Student loan interest Student loan interest
Table 15-5: Income Deduction Types from IRS Form 1040
Income Deduction Types 1040 Line #
MAGI MC APTC CalHEERS Deduction
Type CalWIN Deduction Ty
Update #20-02Page 15-46
Medi-CalMedi-Cal 15. MAGI MC Income
15.14 CalWIN Income and Expenses NOT Mapped to CalHEERS
The following tables contain CalWIN Income and Expense Types that are not mapped to any value in CalHEERS and therefore will not count for MAGI MC or APTC/CSR. Ensure countable income is included in the final eligibility determination. [Refer to “Budgeting,” page 9-1]
Example:
Income Type: Net Countable Income for Medi-Cal is entered in order to count the income for MC but not for another program. This Income Type will NOT count for MAGI MC or APTC/CSR.
15.14.1 Income
Table 15-6: CalWIN Income Types NOT Mapped to CalHEERS
CalWIN Income Type Window in CalWIN
Adoption Assistance Program Income Collect Unearned Income Detail
Ball v. Swoap payments Collect Unearned Income Detail
Basic Education Oppt Grant-BEOG • Collect Unearned Income Detail
• Display Student Financial Aid Detail
BIA • Collect Unearned Income Detail
• Display Student Financial Aid Detail
BIA Educational Grants/Loans • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Black Lung Collect Unearned Income Detail
BOGG • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Bureau of Indian Affairs general assistance payments (BIAGA) Collect Unearned Income Detail
CA Franchise Tax Board Renter's Credit Collect Unearned Income Detail
Cal Grant A • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Cal Grant B • Collect Unearned Income Detail
• Display Student Financial Aid Detail
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Cal Grant C • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Cal-learn Bonus • Collect Unearned Income Detail
• Display Student Financial Aid Detail
CalWORKs Collect Unearned Income Detail
CalWORKs Diversion (Diversion period is greater than 4 months) Collect Unearned Income Detail
CalWORKs Diversion (Diversion period is less than 4 months) Collect Unearned Income Detail
CalWORKs Homeless Assistance Collect Unearned Income Detail
CAPI Collect Unearned Income Detail
CAPI ISM Collect Unearned Income Detail
Carl D Perkins Loan • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Cash Contributions Private Non Profit Collect Unearned Income Detail
Cash Contributions Public Non Profit Collect Unearned Income Detail
CGSL: California Guaranteed Student Loan • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Child/Spousal Support DA-Current Disregard • Collect Child/Spousal Detail
• Collect Unearned Income Detail
Child/Spousal Support DA-Excess Collect Child/Spousal Detail
Child/Spousal Support DA-Pass-On Paid to Client Collect Child/Spousal Detail
Child/Spousal Support DA-Prior Disregard Collect Child/Spousal Detail
Child/Spousal Support DA-Prior Retained Collect Child/Spousal Detail
Child/Spousal Support Direct From A/P or DA Collect Child/Spousal Detail
College Assistant Migrant Program Display Student Financial Aid Detail
CW/FS Non-MFG Direct Child Support EXEMPT for Food Stamps Collect Child/Spousal Detail
Disaster Relief and Disaster Emergency Assistance payments Collect Unearned Income Detail
Education Awards/Scholarships for Teens Display Student Financial Aid Detail
Energy Crisis Assistance-Energy Conserv. Prog./Low Inc. Energy Assist. Collect Unearned Income Detail
Executive Volunteer Program Payment for supportive services • Collect Earned Income Detail
• Collect Unearned Income Detail
Table 15-6: CalWIN Income Types NOT Mapped to CalHEERS
CalWIN Income Type Window in CalWIN
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Medi-CalMedi-Cal 15. MAGI MC Income
FFEL: Federal Family Education Loan • Collect Unearned Income Detail
• Display Student Financial Aid Detail
FISL: Federally Insured Student Loans Display Student Financial Aid Detail
Foster Care Collect Unearned Income Detail
GA/GR Collect Unearned Income Detail
GA/GR Grant Amount Prior to CW eligibility Collect Unearned Income Detail
GA/GR Other Exempt Collect Unearned Income Detail
GA/GR Other Non-exempt Collect Unearned Income Detail
Gifts: Cash Collect Unearned Income Detail
Holocaust Restitution Payment Collect Unearned Income Detail
Holocaust Restitution Payment: interest on retained funds Collect Unearned Income Detail
In kind for CAAP - Other Collect Inkind Income Detail
In kind for CAAP - Stabilization Collect Inkind Income Detail
In kind for CAAP GA Collect Inkind Income Detail
In kind for CAAP SSIP, CALM, PAES Collect Inkind Income Detail
In Kind Housing-shared w/1 GA Collect Inkind Income Detail
In Kind Housing-shared w/2 GA Collect Inkind Income Detail
In Kind Housing-shared w/3 GA Collect Inkind Income Detail
In-Kind Clothing Collect Inkind Income Detail
In-Kind Food Collect Inkind Income Detail
In-Kind Housing Collect Inkind Income Detail
In-Kind Utilities Collect Inkind Income Detail
Japanese-American/Aleutians Restitution Payment Collect Unearned Income Detail
KinGAP Collect Unearned Income Detail
Life ins/death benefits: individual beneficiary not owner of policy Collect Unearned Income Detail
Life ins/death benefits: individual is beneficiary and owner of policy Collect Unearned Income Detail
Loan principal payments received by client Collect Unearned Income Detail
Manual Cash Grant Collect Unearned Income Detail
MFG - Child Support • Collect Unearned Income Detail
• Collect Child/Spousal Detail
Table 15-6: CalWIN Income Types NOT Mapped to CalHEERS
CalWIN Income Type Window in CalWIN
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MFG - SSA Disability from Absent Parent • Collect Unearned Income Detail
• Collect Child/Spousal Detail
National Science Scholars Program • Collect Unearned Income Detail
• Display Student Financial Aid Detail
NDSL: National Direct Student Loan • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Net Countable Income for CalWORKs Collect Unearned Income Detail
Net Countable Income for CAPI Collect Unearned Income Detail
Net Countable Income for Food Stamps Collect Unearned Income Detail
Net Countable Income for Foster Care Collect Unearned Income Detail
Net Countable Income for General Assistance Collect Unearned Income Detail
Net Countable Income for IHSS Collect Unearned Income Detail
Net Countable Income for KinGAP Collect Unearned Income Detail
Net Countable Income for Medi-Cal Collect Unearned Income Detail
Net Countable Income for Medi-Cal-CMSP Collect Unearned Income Detail
Net Countable Income for RCA Collect Unearned Income Detail
Other Government disability Collect Unearned Income Detail
Paul Douglas Teacher Scholarship Program • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Pell Grant • Collect Unearned Income Detail
• Display Student Financial Aid Detail
PLUS: Parent Loan Student Program • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Radiation Exposure Compensation Collect Unearned Income Detail
RCA: Refugee Cash Assistance Collect Unearned Income Detail
Reimbursements or Advances that do not exceed Expenses • Collect Earned Income Detail
• Collect Unearned Income Detail
Relocation Assistance Payments Collect Unearned Income Detail
Retroactive SSI/SSP, including lump sums Collect Unearned Income Detail
Ricky Ray Hemophilia Relief Fund Act Payments Collect Unearned Income Detail
SDI/DIB/FMLA Gross Collect Unearned Income Detail
Table 15-6: CalWIN Income Types NOT Mapped to CalHEERS
CalWIN Income Type Window in CalWIN
Update #20-02Page 15-50
Medi-CalMedi-Cal 15. MAGI MC Income
SEOG: Supplemental Educational Opportunity Grant Pgm • Collect Unearned Income Detail
• Display Student Financial Aid Detail
SLS: Supplemental Loans For Students • Collect Unearned Income Detail
• Display Student Financial Aid Detail
SSI Only - Aged Collect Unearned Income Detail
SSI Only - Blind Collect Unearned Income Detail
SSI Only - Disabled Collect Unearned Income Detail
SSI/SSP or SSP only - Aged Collect Unearned Income Detail
SSI/SSP or SSP only - Blind Collect Unearned Income Detail
SSI/SSP or SSP only - Disabled Collect Unearned Income Detail
SSIG: State Student Incentive Grants • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Stafford Loan Subsidized/Unsubsidized • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Susan Walker v Bayer Corp payments Collect Unearned Income Detail
TANF Out Of State Collect Unearned Income Detail
Title IV Educational Grant/Loan • Collect Unearned Income Detail
• Display Student Financial Aid Detail
Training Allowance from Ancillary Payment Collect Unearned Income Detail
Training incentive payments/work allowances under Manpower programs Collect Earned Income Detail
Tribal TANF funds - CE Collect Unearned Income Detail
Tribal TANF funds - not CE Collect Unearned Income Detail
Victims of Crime Program Collect Unearned Income Detail
Work Incentive Collect Earned Income Detail
Work Study CalWORKs • Collect Earned Income Detail
• Display Student Financial Aid Detail
Work Study State/Federal • Collect Earned Income Detail
• Display Student Financial Aid Detail
Worker's Compensation - Permanent Collect Unearned Income Detail
Worker's Compensation - Temporary Collect Unearned Income Detail
Worker's Compensation - Vocational Rehab Collect Unearned Income Detail
Table 15-6: CalWIN Income Types NOT Mapped to CalHEERS
CalWIN Income Type Window in CalWIN
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15.14.2 Expenses
Table 15-7: CalWIN Expenses NOT Mapped to CalHEERS
CalWIN Expense Type Window in CalWIN
Apartment/House/Condo/Trailer,etc. Rent
Blind Work Expenses • Collect Income Expense Detail
• Collect Other Expense Detail
Board and Care • Collect Medical Expense Detail
Car Pool • Collect Income Expense Detail
• Collect Income Expense Detail (student)
Child/Dependent Care Collect Income Expense Detail
Child/Spousal Support paid • Collect Income Expense Detail
• Collect Other Expense Detail
Coal Display Shelter/Food Expense Detail
Coal Oil Display Shelter/Food Expense Detail
Condominium Fees
Conservator/Guardian fees • Collect Income Expense Detail
• Collect Other Expense Detail
Education Books and Supplies Collect Income Expense Detail (student)
Education Dependent/Child Care Collect Income Expense Detail (student)
Education Equipment and Supplies Collect Income Expense Detail (student)
Education Food & Housing Collect Income Expense Detail (student)
Education Loan Origination Fees Collect Income Expense Detail (student)
Education Special Clothing Collect Income Expense Detail (student)
Education Transportation Collect Income Expense Detail (student)
Electricity Display Shelter/Food Expense Detail
Energy Assistance Display Shelter/Food Expense Detail
Equipment and Property Rental • Collect Income Expense Detail
• Collect Other Expense Detail
Federal/State Tax • Collect Income Expense Detail
• Collect Other Expense Detail
Fees necessary to obtain income • Collect Income Expense Detail
• Collect Other Expense Detail
Update #20-02Page 15-52
Medi-CalMedi-Cal 15. MAGI MC Income
FICA • Collect Income Expense Detail
• Collect Other Expense Detail
Firewood Display Shelter/Food Expense Detail
Food
Food and Shelter
Funeral/Cremation/Burial Collect Other Expense Detail
Garbage Display Shelter/Food Expense Detail
Gas Display Shelter/Food Expense Detail
IHSS SOC pd to provider: family member in the home • Collect Income Expense Detail
• Collect Medical Expense Detail
IHSS SOC pd to provider: not family member in home • Collect Income Expense Detail
• Collect Medical Expense Detail
Impairment Related Work Expenses • Collect Income Expense Detail
• Collect Other Expense Detail
Interest on Loans for Capital Assets or Goods • Collect Income Expense Detail
• Collect Other Expense Detail
Interest on real property loan • Collect Income Expense Detail
• Collect Other Expense Detail
Legal Fees • Collect Income Expense Detail
• Collect Other Expense Detail
Mandatory Homeowners Assoc. Fees
Mandatory Payroll Deductions • Collect Income Expense Detail
• Collect Other Expense Detail
Meals • Collect Income Expense Detail
• Collect Other Expense Detail
Medical Expenses not Covered by Insurance • Collect Income Expense Detail
• Collect Medical Expense Detail
Medical Insurance - Involuntary • Collect Income Expense Detail
• Collect Medical Expense Detail
Medical Premiums • Collect Income Expense Detail
• Collect Medical Expense Detail
Table 15-7: CalWIN Expenses NOT Mapped to CalHEERS
CalWIN Expense Type Window in CalWIN
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Medicare Premiums - Part A
Medicare Premiums - Part B
Mortgage
Natural Gas Display Shelter/Food Expense Detail
Other Benefit Overpayment Adjustment
Other Tax deductions Collect Other Expense Detail
Other Utilities Display Shelter/Food Expense Detail
Phone/Internet/Other Communication-Standard • Collect Income Expense Detail
• Display Shelter/Food Expense Detail
Propane/Butane Display Shelter/Food Expense Detail
Property Taxes and Assessments • Collect Income Expense Detail
• Collect Other Expense Detail
Public Transportation - Bus • Collect Income Expense Detail
• Collect Other Expense Detail
Public Transportation - Train • Collect Income Expense Detail
• Collect Other Expense Detail
Real Property Insurance Premiums • Collect Income Expense Detail
• Collect Other Expense Detail
Real/Rental Property Upkeep & Repairs • Collect Income Expense Detail
• Collect Other Expense Detail
SDI/DIB Overpayment Adjustment Client Caused • Collect Income Expense Detail
• Collect Other Expense Detail
SDI/DIB Overpayment Adjustment not Client Caused • Collect Income Expense Detail
• Collect Other Expense Detail
Septic Tank Display Shelter/Food Expense Detail
Sewer Display Shelter/Food Expense Detail
Space Rent
Sponsor's Rental Expenses Collect Other Expense Detail
SSA/RSDI Insurance Overpayment Adjustment Collect Other Expense Detail
Support for a Disabled Relative • Collect Income Expense Detail
• Collect Other Expense Detail
Table 15-7: CalWIN Expenses NOT Mapped to CalHEERS
CalWIN Expense Type Window in CalWIN
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Medi-CalMedi-Cal 15. MAGI MC Income
Tips Allocated but Not Received • Collect Income Expense Detail
• Collect Other Expense Detail
UIB Overpayment Adjustment Client Caused Collect Other Expense Detail
UIB Overpayment Adjustment not Client Caused Collect Other Expense Detail
Unreimbursed Cost of Home Repair Due to Disaster Collect Other Expense Detail
Utility
Water Display Shelter/Food Expense Detail
Wood Pellets Display Shelter/Food Expense Detail
Table 15-7: CalWIN Expenses NOT Mapped to CalHEERS
CalWIN Expense Type Window in CalWIN
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page 15-56Medi-Cal 15. MAGI MC Income
Not found in IRS Form 1040 or in CALWIN income windows
Table 15-8: Income Types NOT Counted
Non-Income Types Also Known As
$25 weekly supplement to unemployment compensation payment authorized by the American Recovery and reinvestment Act of 2009
Accelerated death benefits/viatical settlements if the insured is chronically ill for costs of qualified long-term care or if the insured is terminally ill not in excess of limit
Austrian general social insurance payments
CalFresh benefits
Cancellation of non-business debt: intended as a gift, amounts not in excess of insolvency, or amounts discharged in bankruptcy or,with regard to mortgage cancellation, not in excess of the cost of your principal residence plus improvements, 1099-C
Carpool payments
Clergy housing and utility allowance not in excess of market rate and actual cost respectively
Clinical trials participation to the extent of expenses incurred plus $2,000
Court awards/judgments/settlements for personal injury or sickness/emotional distress and other compensatory property damages. This does not include compensation for lost wages/profits, breach of contract, pension rights, interest on awards, patent or copyright infringement, or punitive damages.
Disability Income -untaxed (untaxed private disability income insurance -premiums not paid by employer) Pubs 525 and 907
Disability payments received for injuries resulting directly from a terrorist or military action, not including training exercises
Diversion cash assistance
Down payment assistance
Earned income tax credit • Earned Income Tax Credit: actual...
• Earned Income Tax Credit: received...
Economic stimulus payments (federal)
Employer contributions to certain pretax benefits funded by an employee’s elective salary reduction,
Contributions earmarked
Endowment Contracts paid as a lump sum before death not in excess of costs, or paid upon death to a beneficiary
Federal Income Tax Return Income Tax refund
Update #20-02Page 15-56
Medi-CalMedi-Cal 15. MAGI MC Income
Fringe benefits provided on a pre-tax basis by an employer, such as transportation benefits, parking, or moving expenses
Home and Community Based Waiver Caregiver Wages
Housing and Urban Development Section 8 Rental Vouchers or Benefits Federal Housing Assistance
In-Home Supportive Services • Restaurant Meals Allowance • Advance Payments for Caregiver
• IHSS Advance pay to IPW recipient-New Affid
• IHSS Advance pay to IPW recipient-Old/No Affid
• IHSS Advance pay to Residual recipient-New Affid
• IHSS Advance pay to Residual recipient-Old/No Affid
Income Tax Refund – Federal Income Tax Refund – State – if not deducted on Federal Income Tax in which case it would be income
Income Tax refund
Indian financing grants under title IV of the Indian Financing Act of 1974 to expand profit-making Indian-owned economic enterprises on or near reservations
Inheritance or taxable portion of inherited IRA or inherited pension Inheritance in form of cash, securities or other liquid assets
Loan proceeds
Long-Term Care benefits (LTC) – non-taxable amount 1099-LTC
Lost, stolen or damaged property payments
Military allowances (BAH, BAS) Military Benefits
Military hostile fire/imminent danger pay
Mortgage assistance payments under section 235 of the National Housing Act
Needs-based assistance
Netherlands WUV victims of persecution
Nutrition benefits (Supplemental Nutrition Assistance Program, Nutrition Programs for the Elderly or Disabled)
Pension payments that were paid by the employee (such as premiums or contributions) that were previously subject to tax
Physical injury, illness or emotional distress payments
Refugee reception and replacement program one-time payments by the Dept. of State or Dept. of Justice, such as Voluntary Agency (VOLAG) payments
VOLAG Resettlement Income
Renter’s tax credit (California)
Repayment of bona fide loan not in excess of original loan
Table 15-8: Income Types NOT Counted
Non-Income Types Also Known As
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page 15-58Medi-Cal 15. MAGI MC Income
Reverse Annuity Mortgage
Roth IRA, 401K, 403(b), or 457(b) Qualified Distribution • IRA Distribution
• 401K Interest Income
• 401k Principal Income
Sponsor’s income given to a sponsored immigrant
Veteran’s Administration (VA) aid and attendance benefits paid to the veteran or their families
• Vet A&A Paymt recvd by non Pickle person for care of Pickle fam mem
• Vet A&A Paymt recvd for care of one who is not a Pickle-elig fam mem
• Veteran's A&A Payments received by the surviving spouse of a veteran
• Veteran's A&A Payments received by the veteran
Veteran’s Administration agent orange benefits Agent Orange Settlements
Veteran’s Administration children with certain birth defects
Veteran’s Administration compensated work-therapy program payments
Veteran’s Administration death gratuity paid to a survivor of a member of the Armed Forces who died after September 10, 2001.
Veteran’s Administration dependent-care assistance program benefits
Veteran’s Administration disability compensation paid either to the veteran or their families
Veteran's Benefits-Disability
Veteran’s Administration education, training or subsistence allowances and allowances
• Veterans Education Assistance Program (VEAP)
• Veterans Education GI Bill
• Veterans Student Service Program
Veteran’s Administration grants for homes designed for wheelchair living
Veteran’s Administration grants for motor vehicles for veterans who lost their sight or the use of their limbs.
Veteran’s Administration insurance interest left on deposit with the VA
Veteran’s Administration insurance proceeds and dividends paid either to veterans or their beneficiaries, including the proceeds of a veteran’s endowment policy paid before death
Veteran’s Administration pension benefits paid to the veteran or their families Veterans Benefits/Pensions
Veteran’s bonus payment paid by any state or political subdivision because of service in a combat zone
Increase due to deployment to combat zone
Table 15-8: Income Types NOT Counted
Non-Income Types Also Known As
Update #20-02Page 15-58
Medi-CalMedi-Cal 15. MAGI MC Income
Veteran’s Filipino Veterans Equity Compensation Trust
Veteran’s North Vietnam POW/MIA Compensation (FED) to persons captured/interned by North Vietnam
Vocational rehabilitation goods, services and cash received, not in return for services, but for training and rehabilitation due to disability
Volunteer Work Amounts: Peace Corps living allowances for housing, utilities, household supplies, food and clothingNat’l Senior Service Corps supportive services or reimbursements for out-of-pocket expenses from the Retired Senior Volunteer Program (RSVP); Foster Grandparent Program; or Senior Companion Program.Service Corps of Retired Executives (SCORE) amounts for supportive services or out-of-pockets expensesVolunteer tax counseling reimbursements for transportation, meals, and other expenses you have in training for, or actually providing tax counseling for the elderly.
Weatherization, home energy assistance, emergency repair or replacement of heating/cooling devices
Withholding from a benefit to repay an overpayment from the same income source
Workforce Investment Act payments
Table 15-8: Income Types NOT Counted
Non-Income Types Also Known As
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Update #20-02Page 15-60