See policy memorandum dated 12/11/13 Family Health Spenddown Ending for Non-Pregnant Adults.
This policy applies to FCRC determinations only. The All Kids Unit always considers total family income to determine eligibility for all Family Health Plans (see PM 17-01-02-a).
To determine eligibility for FHPs, a determination for Assist (Family Assist and All Kids/FamilyCare Assist) for all family members requesting benefits is done first using total family size and income. In certain situations, a 2nd Assist determination is done by splitting the family into different groups. If only some family members are Assist eligible in the 2nd calculation, a 3rd determination for All Kids Share, Premium and Rebate is completed for remaining family members who are not Assist eligible, again using total family size and income per PM 06-08-02-d.
See the note below regarding undocumented noncitizen children.
First Determine Eligibility for Assist Using Total Family Income
For each person requesting assistance, include in the standard, if living in the home:
- their parents, if under age 18; and
- their spouse, if married; and
- any other children under age 18, of the parents, even if they are not requesting assistance; and
- unborn children of anyone included in the standard.
When the standard includes a spouse or dependent child with earned income and the spouse or child is included in another medical assistance case, use the earned income disregards and exemption (AABD, TANF, or Family Health Plans) that applies to the type of benefits received by the spouse or child.
Include the income of all of the family members included in the standard to determine eligibility for Family Assist, All Kids Assist and FamilyCare Assist.
Families Who are Assist Ineligible Due to Income of a Child, Stepparent, or Unmarried Parent
A 2nd eligibility calculation with different persons included in the standard is required when due to any of the following situations, the family is caused to be ineligible for All Kids/FamilyCare Assist or have a spenddown:
- a child in the unit has countable income, or
- there is a stepparent* with income in the family, or
- the parents are unmarried and one of them has income.
In this situation, follow the policy in PM 15-06-01-g and PM 15-06-01-h.
*Note About Undocumented Children: Always consider the income of a stepparent when determining the eligibility of an undocumented noncitizen child. Do not do a 2nd Assist eligibility calculation when the income of a stepparent results in the child's ineligibility for Assist. Determine eligibility for All Kids Share, Premium or Rebate.