See policy memorandum dated 12/11/13 Family Health Spenddown Ending for Non-Pregnant Adults.
3-Generation Family Units
Example 1: Ms. T, her 17 year old daughter, 14 year old son and daughter's 2 year old child apply for medical. Mom's monthly countable income is $2,700. First determine eligibility for All Kids/FamilyCare Assist including all 4 persons in the standard:
|Ms. T's earned income
||$2,700 ($2,790 - $90 disregard)
|All Kids/FamilyCare Assist standard for 4
Since the total family countable income is over 133% of FPL, a 2nd All Kids/FamilyCare Assist determination is completed for each family member:
- For Mom, family size = 3 (self, daughter and son). Consider Ms. T's countable income of $2,700. Mom is not eligible for Assist.
- For teen daughter, family size = 4 (mom, teen, sibling and baby). Consider Ms. T's countable income of $2,700. Teen mom is not eligible for Assist.
- For son, family size = 3 (self, mom and sister). Consider Ms. T's countable income of $2,700. Son is not eligible for Assist.
- For baby, family size = 2 (self and teen mom). Consider countable income of $0. The All Kids Assist standard for 2 is $1,677. Baby gets All Kids Assist.
A 3rd All Kids determination is completed for the children whose countable income is over 133% of FPL:
- Determine mom's eligibility for Family Health Spenddown.
- Determine teen mom's and son's eligibility for Share, Premium and Rebate using total family size and income per PM 06-08-02-d. The All KidsShare standard for 4 is $2,944. Teen mom and son are eligible for Share, and both of them would be included in one case.
Non-Responsible Caretaker Relatives
When assistance is requested for a caretaker relative who is not legally responsible for the children who live with them, determine eligibility for the caretaker relative separately from that of the children for whom they are not responsible. Do not consider the income of the caretaker relative when determining the child's eligibility. Do not consider the income of the child when determining the caretaker relative's eligibility.
Example 2: Mr. and Mrs. V are requesting medical benefits for themselves and their 2 grandchildren, Lisa and Lexi (ages 2 and 3) who are siblings. Mr. and Mrs. V do not have a disability and are not elderly. Mr. V has monthly countable income of $1,800. Lisa and Lexi get social security benefits of $200 each.
- Determine eligibility for Mr. and Mrs. V.
|Mr. V's earned income
||$1,800 ($1,890 - $90 disregard)
|FamilyCare Assist standard for 2
Mr. and Mrs. V's income exceeds for Assist, review eligibility for spenddown.
- Determine eligibility for Lisa and Lexi.
|Lisa's SSA income
|Lexi's SSA income
|total family income
|All Kids Assist standard for 2
Lisa and Lexi get All Kids Assist.
If a child's income causes total family income to be over 133% of the FPL, further separate the cases according to PM 15-06-01-g.
If assistance is requested for the non-responsible caretaker relative, their own minor children and the child for whom they are not the parent, set up a separate case for the caretaker relative and their own child.
Example 3: Ms. W requests medical benefits for herself, her child, and her 10 year old nephew who lives with her. Ms. W gets monthly UIB of $800. The family receives no other income. Set up one All Kids/FamilyCare Assist case for Ms. W and her child, and a separate All Kids Assist case for her nephew.