Assistance Units - Medical Programs
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Assistance Units - Medical Programs


Revised December 31, 2013



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.

WAC 182-506-0010Medical assistance units (MAU) for MAGI-based Washington apple health programs.

WAC 182-506-0010

WAC 182-506-0010

Effective October 1, 2013

WAC 182-506-0010 Medical assistance units (MAU) for MAGI-based Washington apple health programs.



(1) A person's financial eligibility for programs that use modified adjusted gross income (MAGI) methodology, as described in WAC 182-509-0300, is based on multiple factors including relationship to other household members, age, tax status and pregnancy. The rules in this section describe which household members' income is counted in determining a person's eligibility. These household members comprise the person's "medical assistance unit" (MAU). Members of a single household may have different MAUs.

(2) The determination of countable income for MAGI-based programs is described in chapter 182-509 WAC.

(3) A person's MAGI-based countable income equals the total countable income of the members of the person's MAU (see WAC 182-509-0001). This income is compared to the income standard for the MAU size when determining eligibility for programs based on a federal poverty limit standard.

(4) The number of persons in the MAU is increased by one for each verified unborn child for each pregnant woman already included in the MAU under this section.

(5) For any given tax year in which an initial eligibility determination, renewal of eligibility, post-eligibility review or change of circumstance is made, MAUs are determined as follows:

(a) The MAU for a person who expects to file a federal tax return and does not expect to be claimed as a tax dependent by another tax filer includes the following:

(i) The person (tax filer) and all persons the tax filer expects to claim as a tax dependent; and

(ii) The following additional persons, but only if they live in the same residence:

(A) The person's spouse;

(B) The person's natural, adopted and step-children less than nineteen years of age;

(C) If the person is less than nineteen years of age, the per-son's natural, adopted and step-parents; and

(D) If the person is less than nineteen years of age, the natu-ral, adoptive and step-siblings who are less than nineteen years of age.

(b) The MAU for a person who expects to be claimed as a tax de-pendent by a tax filer includes:

(i) The person (tax dependent), the tax filer, and any other persons in the tax filer's MAU (as determined according to (a) of this subsection), except if:

(A) The person is not the spouse or biological, adopted, or natural child of the tax filer;

(B) The person is under age nineteen and living in the same residence as both parents, but is expected to be claimed as a tax dependent by only one parent, either because the parents are unmarried or do not expect to file taxes jointly; or

(C) The person is under age nineteen and expects to be claimed by a noncustodial parent.

(ii) If (b)(i)(A), (B) or (C) of this section applies, the per-son's MAU is determined according to the nonfiler rules described in (c) of this subsection.

(c) The MAU for a person who does not expect to file a federal tax return and who either does not expect to be claimed as a tax dependent or meets one of the tax dependent exceptions in (b) of this subsection includes the following persons, but only if they live in the same residence:

(i) The person (self);

(ii) The person's spouse;

(iii) The person's natural, adopted and step-children less than nineteen years of age;

(iv) If the person is less than nineteen years of age, the per-son's natural, adopted and step-parents; and

(v) If the person is less than nineteen years of age, the natu-ral, adoptive and step-siblings who are less than nineteen years of age.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION



*** As a result of implementation of the Affordable Care Act (ACA), this clarifying page may no longer be effective for medical coverage applications received on or after 10/01/2013. Please see the ACA Transition Plan for more information. Clients under 65 years of age who need to apply for medical coverage on or after 10/01/2013 should be referred to Washington Healthplanfinder. Applications for medical coverage for households where all members are 65 years of age and older should be referred to Washington Connection. ***

 

  1. The federal Medicaid program does not recognize same-sex marriage due to the Defense of Marriage Act, but state programs do recognize same-sex marriage. Household composition for medical programs can vary. For assistance in processing a medical case, contact a HCA representative for assistance.

  2. 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.

  3. Determine eligibility as separate MAU's when the household meets one of the criteria in WAC 182-506-0010 (5) and:

    1. The family is not eligible for family medical (F04) as a single MAU; or

    2. All of the children are not eligible for a (CN) program as a single MAU.

  4. 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).  

  5. Determine eligibility 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.

  6. 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 182-512-0900 through WAC 182-512-0960.  The income allocation rules described in this chapter are not used when determining eligibility for the SSI-related medical program (S02).

  7. 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.

  8. 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, and F07).  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
  1. If the family is not eligible for CN medical as a single MAU, and a member of the family meets the criteria in  WAC 182-506-0010 (5),establish separate MAUs. The balance of the family members not meeting criteria in WAC 182-506-0010 and not eligible for CN medical together are established as another MAU.
  2. 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.


Allocating Income or Resources to MAUs

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 separate 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 income 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 income 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 separate 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 182-512 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 182-512 WAC.

Since he is not married, there is no deduction from his income to either of his children - allocations to children are only deducted from the income of a non-applying spouse for CN medical.   Since his separate income exceeds the CNIL, he is not eligible for S02.

$1150 Social Security disability
   - 20 General income disregard
$1130 Countable income for S02.

$1130 is greater than the CNIL of $698. Client is not CN eligible, so look at MN eligibility.

In the MN calculation, income can be allocated directly from an unmarried applicant to their dependent children.  In this case, since neither of the children have any separate income, each child can be allocated 1/2 the FBR or a total of $698.  

           $1150 Social Security Disability

          -   $20 General Income Disregard

          - $698 Child allocation

    =     $432  Net countable income  

Since $432 is less than the MNIL of $698, he is eligible for medically needy coverage without a spenddown (S95).

This calculation of income for SSI-related 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 2012.


NOTE: When a family includes an SSI-related person who is not found eligible for Medicaid under this chapter, refer to chapter 182-512 WAC.

ACES PROCEDURES

See Assistance Units - Medical Case

See Assistance Units - Sneede - Kizer

Modification Date: December 31, 2013