PM 15-06-01-g

new textIncome Counting Examples

Example 1: Omar applies for himself, his wife, Leila, their daughter, Jade, age 8, and Leila's nephew Tony, age 20. Omar and Leila expect to file jointly and plan to claim Jade and Tony as dependents.

Person/Income Tax filer or Relationship Rule? Who's Income to count? Total countable income EDG Size Income Standard Income eligible?
Omar - Earned Income $1250/month Tax filer Omar, Leila

$2498

(1250 + 1248)

4

$2,708

(FamilyCare, 138%)

pass
Leila - Unemployment $1248/month Tax filer Omar, Leila

$2498

(1250 + 1248)

4

$2,708

(FamilyCare, 138%)

pass
Jade - none Tax filer Omar, Leila

$2498

(1250 + 1248)

4

$2,885

(All Kids Assist, 147%)

pass
Tony - SSA $450/month (not expected to be required to file) Relationship Tony $450 1

$1,321

(ACA Adult, 138%)

pass

Results: Tax filer status is used for Omar, Leila and Jade, so their EDGs include the tax payers and all their dependents. Since Tony is a dependent who is not expected to be required to file, his income is not counted in the EDGs that include the tax payers.

Tony is a dependent who is not being claimed by a parent or spouse, so relationship rules apply for him. He is in a separate EDG from the tax payer, so his income is counted in his own EDG.

Example 2: Katla applies for herself, her spouse, Joe, Katla's son, Sam, age 18, and their adopted daughter, Vera, age 15. Katla and Joe file jointly and claim both children as dependents. Sam is attending college out-of-state. He meets 'living with' requirements per PM 03-05-05 and Illinois residency requirements per PM 03-02-01. Sam is employed part-time.

Person/Income Tax filer or Relationship Rule? Who's Income to count? Total countable income EDG Size Income Standard Income eligible?
Katla - Earned Income $2,500/month Tax filer Katla, Joe

$5,000

(2,500 + 2,500)

4

$2,708

(FamilyCare, 138%)

fail
Joe - Earned Income $2,500/month Tax filer Katla, Joe

$5,000

(2,500 + 2,500)

4

$2,708

(FamilyCare, 138%)

fail

Sam - Earned Income $200/month

(not expected to be required to file)

Tax filer Katla, Joe

$5,000

(2,500 + 2,500)

4

$6,241

(All Kids Prem Level 2, 318%)

pass
Vera - none Tax filer Katla, Joe

$5,000

(2,500 + 2,500)

4

$6,241

(All Kids Prem Level 2, 318%)

pass

Example 3: Jerry, a 20 year old college student who is an Illinois resident applies for himself. He has earned income of $200 per month and does not expect to be required to file. His parents, Jim and Dora, live in another state, file taxes jointly and claim Jerry as their dependent. They also claim their 5 year old niece, Flora. They receive child support for Flora of $300 per month.

Person/Income Tax filer or Relationship Rule? Who's Income to count? Total countable income EDG Size Income Standard Income eligible?

Jerry - Earned Income $200

(not expected to be required to file)

Tax filer Jim, Dora $4,000 4

$2,708

(ACA Adult, 138%)

fail
Jim - SSA $1,000/month N/A - not an applicant N/A N/A N/A N/A N/A
Dora - Earned Income $3,000/month N/A - not an applicant N/A N/A N/A N/A N/A
Flora - Child Support $300/month N/A - not an applicant N/A N/A N/A N/A N/A

Results: Since Joe is a dependent who does not meet any of the exceptions in Step #2, tax filer rules apply. His EDG includes the tax payers and all their dependents. Since Joe is not expected to be required to file, and he is the child of another person in his EDG (Jim and Dora), his income is not counted.

Example 4: Aman applies for himself, his wife, Helen, and their 2 year old daughter, Isabel. Aman is an ineligible non-citizen (a legal permanent resident who has not met the 5 year bar). Helen is an eligible non-citizen and Isabel is a U.S. citizen. Aman has earned income of $2,000 per month, Helen receives $500 a month in unemployment benefits, and the couple will file a joint tax return claiming Isabel as their dependent. Helen is pregnant, expecting one child.

Person/Income Tax filer or Relationship Rule? Who's Income to count? Total countable income EDG Size Income Standard Income eligible?
Aman N/A N/A N/A N/A N/A N/A
Helen Tax filer Aman, Helen

$2,500

($2,000 + $500)

4

$4,102

(Moms & Babies, 209%)

pass
Isabel Tax filer Aman, Helen

$2,500

($2,000 + $500)

4 $2,885 (All Kids Assist, 147%) pass

Results: Aman fails for a non-financial reason due to not meeting the citizen/immigration criteria. However, he is included in the EDGs of the other household members.

Family Health Spenddown

Example 1: On March 1st, Joyce applies for herself, her husband, Fred, and her 10 year old daughter, Maria. Fred is Maria's stepfather. Joyce and Fred file taxes jointly and claim Maria as a dependent.

Joyce provides a $5,000 hospital bill for Maria that was incurred on February 10th, the month before her application date, and requests medical backdating.

Person/Income Tax filer or Relationship Rule? Who's Income to count? Total countable income EDG Size Income Standard Income eligible?
Joyce - Earned Income $800/month Tax Filer Joyce, Fred

$3,800

($800 + $3,000)

3

$2,246

(FamilyCare, 138%)

fail
Fred - Earned Income $3,000/month Tax Filer Joyce, Fred

$3,800

($800 + $3,000)

3

$2,246

(FamilyCare, 138%)

fail
Maria Tax Filer Joyce, Fred

$3,800

($800 + $3,000)

3

$3,401

(All Kids Prem Level 1, 209%)

pass

The worker completes a spenddown calculation in IES for Maria for the month of February.

Person Who's Income to count? Family Health Income Standard Spenddown Amount
Maria Joyce - $800 $508 for EDG size of 3 $292 ($800 - 508 = $292)

Results: Eligibility determination is made on March 20th for the regular roll month of May. Maria qualifies for All Kids Premium Level 1 effective May. She qualifies for Family Health Spenddown from February through April, and spenddown is met with a split bill on February 10th.

Example 2: Household consists of Tammi, her husband Don, and Tammi's son Brandon. Don is not the father of Brandon. Tammi and Don are filing taxes jointly, and they claim Brandon as a tax dependent. Don has earned income of $3314/mo. In January they apply for medical benefits for Tammi and Brandon only.

Person/Income Tax filer or Relationship Rule? Who's Income to count Total Countable Income EDG Size Income Standard Income eligible?
Tammi Tax filer Tammi, Don $3,314 3

$2,246

(FamilyCare, 138%)

fail
Don N/A - not an applicant N/A N/A N/A N/A N/A
Brandon Tax filer Tammi, Don $3,314 3

$3,401

(All Kids Prem Level 1, 209%)

pass

On February 25th, Brandon is approved for Premium Level 1 effective for April. A Family Health Spenddown calculation is done for the months of January through March.

Person Who's Income to count? Family Health Income Standard Spenddown Amount
Brandon Tammi $508 for EDG size of 3 $0

Results: Tammi's medical is denied. Brandon's is approved for premium effective April, and for spenddown for Jan, Feb, and March. IES does not count any income for those three months.

With a '0' SPD obligation, the family doesn't need to submit any medical expenses.