PM 15-06-01-f

New InformationSee policy memorandum dated 12/11/13 Family Health Spenddown Ending for Non-Pregnant Adults.

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. If 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 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 and are not married. Because Mr. D and their child are insured, they are only requesting benefits for Ms. C. Use a standard of 2 (Ms. C and their child) 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 their child and is not requested to be in the standard.
     
    Example 3: Mr. and Mrs. E live with her child. Mr. E is the child's stepfather. Mrs. E is requesting medical benefits for the child only. Since benefits are not requested for Mr. E, and they have not asked to include him in the standard, determine eligibility for the child using a standard of 2 (Mrs. E and her child). 
  3. If 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/Share standard of $2,881, set up a Share case for the family.
  4. If 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 have a child and are not married. They apply for benefits for all 3 family members. Ms. H and their child 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 child). Determine the child's eligibility using a standard of 3 (child, Mom and Dad). Determine Mr. J's eligibility using a standard of 2 (Mr. J and child).
  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 child 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.