Purpose: This section contains the rules and procedures regarding the establishment of medical assistance units (MAU), for one or more family members whose eligibility for medical care is determined separately or together based on type of medical program, relationship, and financial responsibility.
One or more medical assistance units (MAU) is established for individuals living in the same household based on the type of medical program, each individual's relationship to other family members, and the individual's financial responsibility for the other family members.
Financial responsibility applies only to spouses and to parents, as follows:
Married persons, living together are financially responsible for each other; and
Persons who meet the definition of a natural, adoptive, or step-parent described in WAC 388-454-0010 are financially responsible for their unmarried, minor children living in the same household.
Minor children are not financially responsible for their parents or for their siblings.
When determining eligibility for family, pregnancy, or children's medical programs, follow the income rules as described in WAC 388-450-0106(1) through (7).Only one MAU is required when all family members are eligible for categorically needy (CN) medical coverage.
If a family is not eligible as one MAU for a CN program, separate MAUs are required for family members living in the same household in the following situations:
A pregnant minor, regardless of whether she lives with her parent(s);
A child with earned or unearned income;
A child with resources which make another family member ineligible for medical assistance;
A child of unmarried parents when both parents reside with the child;
Each unmarried parent of a child in common, plus any of their children who are not in separate MAUs;
A caretaker relative that is not financially responsible for the support of the child;
For a family with multiple MAUs established based on the criteria described in subsection (5) of this section, a parent's:
Income up to one hundred percent of the Federal Poverty Level (FPL) is allocated to the parent and other members of the parent's MAU. The excess is allocated to their children in separate MAUs.
Resources are allocated equally to the parent and all persons in the parent's household for whom the parent is financially responsible. This includes family members in separate MAUs.
The exceptions to the income allocations described in subsection (6) of this section are as follows:
Only the parent's income actually contributed to a pregnant minor is considered income to the minor.
A parent's financial responsibility is limited when the minor child is receiving inpatient chemical dependency or mental health treatment. Only the income a parent chooses to contribute to the child is considered available when:
The treatment is expected to last ninety days or more;
The child is in court-ordered, out-of-home care in accordance with chapter 13.34 RCW; or
The department determines the parents are not exercising responsibility for the care and control of the child.
When determining eligibility for an SSI-related medical program, a separate MAU is required for:
SSI recipients;
An SSI-related person who has not been found eligible for family medical under this chapter; or
The purpose of applying medical income standards for an:
SSI-related applicant whose spouse is not relatable to SSI or is not applying for SSI-related medical; and
Ineligible spouse of an SSI recipient.
For a person in a separate MAU, based on the criteria described in subsection (8) of this section, the income and resource allocations described in subsection (6) of this section are not used. The SSI-related individual's eligibility is determined using the allocations or deeming rules in chapter 388-475 WAC.
Countable income for medical programs:
For SSI individuals is described in chapter 388-475 WAC; or
For family medical, pregnancy medical, and children's medical is described in WAC 388-450-0210.
The process of establishing separate MAUs for children and other family members because of financial responsibility rules is often referred to as Sneede/Kizer. Sneede v. Kizer is the name of a Ninth Circuit Court of Appeals class action settlement, which specifies how the separate income or resources of family members affects eligibility for medical assistance.
Determine eligibility as separate MAU's when the household meets one of the criteria in WAC 388-408-0055 (5) and:
The family is not eligible for family medical (F04) as a single MAU; or
All of the children are not eligible for a non-premium based (CN) program as a single MAU.
A separate MAU is established for a caretaker relative of a minor child when the caretaker relative is not the parent and is applying for medical assistance. Additionally, none of the caretaker relative's income is considered available to their minor relatives; (e.g. grandmother's income is not available to her grandchildren).
Determine eligiblity for P02 as a separate MAU for pregnant unmarried minors, if the parent's total income causes the pregnant minor to be ineligible for CN medical. Only the income actually contributed by her parents is considered available to the pregnant minor when on pregnancy medical programs. This applies whether or not the pregnant minor is living in the parent’s home. The parents of the pregnant minor are not financially responsible for the minor’s unborn child.
A family member who is SSI-related is established as a separate MAU from other members of the family, unless the family member is determined eligible for F04 or F06 as described in 2 above. When a person’s eligibility is determined for the SSI-related medical program, use the income allocation rules described in WAC 388-475. The income allocation rules described in this chapter are not used when determining eligibility for the SSI-related medical program (S02).
If the resources of a child, or other non-financially responsible family member, when included with the family's total resources, make another family member ineligible, the person with the resources is established as their own MAU.
Eighteen year olds and emancipated children living in the parents' home cannot be considered as their own MAU unless one of the conditions described above apply. Otherwise, the parents' income must be considered. Neither reaching the age of majority (18) nor state legal emancipation alters the parental financial responsibility for Medicaid benefits.
EXAMPLE
Gene, an 18 year old high school graduate, applies for Medicaid benefits. He lives with his parents while looking for a job. His parents' income will be used to determine his eligibility even though he is considered an adult.
WORKER RESPONSIBILITIES
Determining the Family as a Single Medical Assistance Unit
Determine a family's eligibility for CN medical as one MAU for family, pregnancy and children's health programs (F04, P02, F06, F07 and F08). When the family consists of one MAU, consider the entire family's income and resources together. Count all family members who live together to determine the appropriate family size standards to be used. Count each verified unborn as an additional family member. If the family is eligible as a unit, process the medical application as one MAU.
Determining Separate Medical Assistance Units
If the family is not eligible for CN medical as a single MAU, and a member of the family meets the criteria in WAC 388-408-0055 (5),establish separate MAUs. The balance of the family members not meeting criteria in WAC 388-408-0055 and not eligible for CN medical together are established as another MAU.
Determine eligibility for members of each of the MAUs individually.
EXAMPLE
A single pregnant mother with two children; one of the children gets child support. Total household income is over the standard for family and pregnancy medical due to the additional child’s income. The children are not financially responsible for their mother or each other. In this case establish 3 MAU’s:
MAU 1: Mom on pregnancy medical
MAU 2: Child with income
MAU 3: Child without income
If allocated income from mom along with child’s income is under 200% FPL for the two children, establish one MAU for F06 medical.
EXAMPLE
A single mother and two children, one of the children gets child support. The mother is financially responsible for herself and both children. The children are not responsible for their mother or each other. Establish 2 MAUs:
MAU 1: The mother and the child with no income
MAU 2: The child with income
EXAMPLE
Unmarried parents who have a common child and each has a separate child. The unmarried parents are not financially responsible for each other or for each other's child. They are each financially responsible for themselves, their own child and their common child. Establish 3 MAUs.
MAU 1: The mother and her child
MAU 2: The father and his child
MAU 3: The common child
If either of the children in MAU 1 or 2 had separate income, there could be more than the three MAUs in this family.
EXAMPLE
Grandmother and her two grandchildren. One child has his own income. The grandmother is not financially responsible for either grandchild. The children are not financially responsible for each other. Establish 3 MAUs.
MAU 1:
The grandmother
MAU 2:
The child with income
MAU 3:
The child with no income
EXAMPLE
A single mother and two children. The mother has $900 in a savings account and each child has $1200 in a savings account. The children have separate resources that make another family member (their mother) ineligible for CN medical. Establish 3 MAUs.
MAU 1: The mother
MAU 2: Child with separate resources
MAU 3: Child with separate resources
EXAMPLE
The same household described above, applies solely for children’s medical (F06). Because there is no asset test for children’s medical, the children do not have separate resources that make another family member ineligible for CN medical. Establish 1 MAU.
Parents are financially responsible for their children. A portion of the parent's income and resources is allocated to their children in separate MAUs. A parent's income, in excess of 100% of the FPL is allocated as income to the child in a separate MAU. A parent's resources are allocated equally among the members of the parent's MAU and members of the separate MAUs for which the parent is responsible.
EXAMPLE
A mother and her two children apply. The mother has earned income of $2,200 a month and receives child support of $300 a month for one of the children. Mom pays $400 per month child care. The family has no countable resources
Determine the family's eligibility together:
Mother's earnings
Child support for one child
Total Income
50% work incentive
Child care expense
Countable income
The family is not eligible for CN medical because the countable income of $1000 exceeds the CNIL for a family of 3.
When determining eligibility for family medical (F04), use the 50% work incentive. When determining eligibility for a program with the income standard based on the FPL (e.g. F06), use the $90 work incentive.
Mother's earnings
Child support for one child
Total Income
$90 work incentive
Child care expense
Countable income
Countable income is under 200% FPL children are eligible for F06 in one MAU.
Establish two separate MAUs:
The mother
Both children eligible for F06
Determine family medical (F04) eligibility for mother.
$2200 Mother's earnings
-1100 50% work incentive
- 400 Child care expense
$700 Countable income
The $700 income exceeds the 1 person CNIL so mom is not eligible for family medical (F04) CN.
EXAMPLE
A mother and one child apply. The total income to the family is $550; $400 is child support and $150 is veterans benefit payments for the child. All of the income is the child's.
Determine the family's eligibility together:
$550 Total income (unearned)
Since the total family income exceeds the 2 person CNIL, the family is not eligible for CN family medical (F04).
Establish two separate MAUs:
MAU 1: Mother
MAU 2: Child
Determine eligibility for MAU 1.
$0 Income
The mother has no countable income, she is eligible for CN family medical (F04).
Since the mother has no countable income, none will be allocated to the child.
Determine eligibility for MAU 2.
$150 Veteran's benefits
+400 Child support
$550 Since the income is below the 1 person 200% FPL, the child in MAU 2 is eligible for children's CN medical.
EXAMPLE
A mother and her two children apply. The mother has UC income of $400. One of the children has $2500 in a savings account, established by her grandmother. The mother has $900 in a savings account.
Determine the family's eligibility together:
$400 UC Income (unearned)
$3400 Countable resources ($2500 + $900
The income is below the 3 person cNIL but the resource exceeds the standard of $1000 for applicants. The family is not eligible for CN family medical because of the resources of one child.
Establish two seperate MAUs
MAU 1: Mother and child without resources
MAU 2: Child with resources
Determine eligibility for MAU 1
$400 UC income (unearned)
$600 2/3 of mother's resources (for herself and child in her MAU)
Since the income is below the 2 person CNIL and the countable resources are below the $1000 standard, the members of MAU 1 are eligible for CN family medical (F04).
Determine eligibility for MAU 2
$0 Income (mother's incoem is below the 2 person 100% FPL so none is allocated)
$2800 Resources ($2500 + $300, allocation of 1/3 of mother's countable resources)
The child in MAU 2 is eligible for children's CN medical because the countable incoem is below the 1 person 200% FPL and there are no resource limits for this program.
NOTE:
See #6 under Clarifying Information. If this family applies solely for F06, the seperate resources do not affect eligibility. This family could be one MAU for F06.
EXAMPLE
Unmarried parents with a common child live together and they each have a separate child. The mother has earnings of $1000, pays child care of $300 per month and her child receives $300 child support. The father receives $1150 UC and his child has no income or resources. The parents have no resources. The family is ineligible for F04 as one MAU.
In this example establish 4 separate MAUs:
MAU 1: Mother
MAU 2: Father and his child
MAU 3: Their common child
MAU 4: The mother's child with income
Determine eligibility for family medical (F04) for MAU 1
MAU 1:
$1000 Mother's earnings
- 500 Work incentive - 300 Child care expense
$ 200 Countable income
Since the mother's income is below the one person 100% FPL, none of her income will be allocated to her children in MAU 3 and 4. Her countable income of $200 is below the 1 person CNIL. She is eligible for CN medical.
Determine eligibility for family medical for MAU 2
MAU 2: Father and his child - income allocation for MAU 3 child.
$1150 UC income (unearned
-1141 2 person 100% FPL (needs of the father and child in MAU 2)
$ 9 Income allocated to the child in MAU 3
The father's income of $1150 is above the two person 100% FPL allowed for his and his child's needs in MAU 2.
$9 is allocated to his child in MAU 3. His countable income for determining eligibility for himself and child in MAU 2 is $1141.
MAU 2: Father and his child
$1141 Countable income for this MAU (the 2 person 100% FPL).
Since the income exceeds the 2 person CNIL, the members of MAU 2 are not eligible for CN medical (F04). His child in MAU 2 is eligible for children's CN medical (F06) because the income is below the two person 200% FPL.
Since neither of the parents have excess resources, none are allocated to the children in MAUs 3 or 4.
Determine eligibility for MAU 3
MAU 3: Common Child
$ 9 Income allocated from father in MAU 2
Since this is the only income and it is below the 1 person 200% FPL, this child is eligible for children's CN medical (F06).
Determine eligibility for MAU 4
MAU 4: Mother's child with income
$300 Child support
Since this income is below the 1 person 200% FPL, this child is eligible for children's CN medical (F06).
EXAMPLE
When a family includes an SSI-related person who is not found eligible for family medical coverage under this chapter , refer to Chapter 388-475 WAC. The Sneede financial responsibility and income allocation rules are not used to determine the eligibility of an SSI-related person for S02.
Refer to the family described in Example above. In this example the father is no longer receiving UC but receives Social Security disability income of $1150 per month. Because he is SSI-related and was not found eligible for a family program, he can be considered for S02 eligibility using the SSI-related allocation rules described in 388-475 WAC.
Neither of his children have any income to compare to the FBR. Thus, one-half of the FBR is deducted from the father’s income for each child
$1150 Social Security disability
- 623(Total of one-half of the FBR for each child times the nubmer of chidlren)
- 20 General income disregard
507 Countable income for S02.
$507 is less than the CNIL of $623. Client is CN eligible.
This calculation of income for S02 medical coverage does not change the calculation to determine F06 eligibility for the children using the Sneede methodology. This income calculation is used solely to determine the father’s S02/S99 eligibility. Standards used are based upon the FBR for 2007.
NOTE:
When a family includes an SSI-related person who is not found eligible for Medicaid under this chapter, refer to chapter 388-475 WAC.
