PM 15-06-01-g: Whose Income to Count in the FHP or ACA Adult EDG

WAG 15-06-01-g

For each EDG, IES will use the total countable income of each person included in the EDG, except that there are special rules about:

  • Family Health Spenddown
  • income of a child/stepchild of another person in the EDG or a tax dependent,
    • See PM 15-06-01-h for policy about whether to count the income of a child/stepchild (of any age) of another person in the EDG and for policy about whether to count income of a tax dependent

New TextNote: For the Family Planning program the EDG always equals 1 (the applicant) and only the applying individual's income is counted.

Special Policy for Family Health Spenddown

Federal guidelines allow states to use MAGI budgeting for Family Health spenddown EDGs with the following budgeting difference: if the EDG goes into spenddown, we could only use the income of responsible relatives to determine the spenddown obligation amount.

For purposes of this rule, a responsible relative is defined as:

  • a spouse, or
  • a biological or adoptive parent of a child under age 19.

If the only income is that of a non-responsible relative (such as a stepparent or sibling), the result is a spenddown case with a zero spenddown amount. With a '0' SPD obligation, the family does not need to submit any medical expenses. In this situation, spenddown is met.