PM 15-06-01-f

Use Form 2383A to compare the client's monthly income to the income standard:

  • at the first application for medical assistance if the Automated Intake System (AIS) is down or inaccessible;
  • at each reapplication for medical assistance;
  • at REDE;
  • any time there is a change affecting the amount of income or size of the family unit; and
  • to figure eligibility for benefits for special circumstances (see PM 15-07-02).
  1. Determine Assist eligibility (Family Assist and All Kids/FamilyCare Assist) for each person requesting assistance. Consider the income of all persons included in the standard. Include in the standard the following persons who live in the home:
    • the persons requesting assistance,
    • persons who are responsible for the persons requesting assistance,
    • children under age 18 of the responsible relative, and
    • unborn children of those included in the standard. 
  2. revised textIf total family income is less than 133% of the FPL, set up one case for the family. 

    Example 1:
    Ms. A and Mr. B have a child, Beth, and are not married. They are requesting medical benefits for all 3 family members. The family's total countable income is $2,000. The All Kids/FamilyCare Assist standard for 3 is $2,116. Set up one case for the family.

    Note:
    When determining a person's eligibility, only request proof of income of a non-responsible relative if the non-responsible relative is also requesting benefits, or the applicant requests to include the non-responsible relative in the standard.

    Example 2:
    Ms. C and Mr. D have a child, Joey, and are not married. Because Mr. D and Joey are insured, they are only requesting benefits for Ms. C. Use a standard of 2 (Ms. C and Joey) to determine eligibility for Ms. C. Do not include Mr. D in the standard because he is not responsible for Ms. C, is not requesting assistance for himself or Joey, and is not requested to be in the standard.
     
    Example 3: Mr. and Mrs. E live with her child, Mary. Mr. E is Mary's stepfather. Mrs. E is requesting medical benefits for Mary only. Since benefits are not requested for Mr. E, and they have not asked to include him in the standard, determine eligibility for Mary using a standard of 2 (Mrs. E and Mary). 
  3. revised textIf total family income is over 133% of the FPL, and it is not due to the income of a child, stepparent or unmarried parent, set up one case for the family.

    Example 4:
    Mr. and Mrs. G have 2 children. The children do not have income. Mr. and Mrs. G's combined countable income of $2,600 is over the All Kids/FamilyCare Assist standard for 4 of $2,555. Since countable income is less than the All Kids/FamilyCare Share standard of $2,881, set up a Share case for the family. (Determine eligibility for All Kids/FamilyCare Rebate if family requests it.)
  4. revised textIf total family income is over 133% of the FPL, and a child, stepparent or unmarried parent has income, further separate the cases according to PM 15-06-01-g or PM 15-06-01-h.

    Example 5:
    Ms. H and Mr. J are the parents of Sandy, and are not married. They apply for benefits for all 3 family members. Ms. H and Sandy have no income. Mr. J has countable income of $2,800.The All Kids/FamilyCare Assist standard for 3 is $2,116. Since the total family income of $2,800 is over the Assist income limit, separate the cases. Determine Ms. H's eligibility using a standard of 2 (Ms. H and Sandy). Determine Sandy's eligibility using a standard of 3 (Sandy, Mom and Dad). Determine Mr. J's eligibility using a standard of 2 (Mr. J and Sandy).
  5. A 3rd All Kids/FamilyCare determination is completed for remaining family members whose countable income is over 133% of FPL. In the above example, Ms. H is Assist eligible (countable income is 0). Since Mr. J and Sandy are not Assist eligible, determine their eligibility for Share, Premium or Rebate again using a standard of 3 and total family income according to PM 06-08-02-d.