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, and
  • 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.

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.