5104-6        INDIVIDUALS NOT INCLUDED IN THE HOUSEHOLD AND WHOSE INCOME AND RESOURCES DO NOT COUNT

Certain individuals living in the same home as a dependent child may not be included in the household either because they do not meet the non-financial requirements for Medicaid or they are already receiving Medicaid under a different eligibility category. The resources and income of these excluded individuals do not count in determining eligibility. These individuals include:

1. An SSI Supplemental Security Income or APA Adult Public Assistance cash recipient (Interim Assistance recipients are not included in this exemption);
    

2. The sibling of a dependent child who does not meet FM Family Medicaid age or deprivation requirements;

Note:

 A half-sibling may not be included in the assistance unit unless the adult in the household qualifies as a caretaker relative to the child.  If the adult in the household does not meet the definition of caretaker relative in Section 5120, the half-sibling cannot be included in the assistance unit even if they are related to the other children in the household.  The caseworker should determine the half-sibling’s eligibility for DKC Denali KidCare.  

3. A stepparent and his or her children must be excluded from the household, if including that parent and children in an established household causes another child in the home who is deprived by reason of death or continued absence of a parent to lose eligibility because of the income or resources of that stepparent.
   
   Eligibility for Family Medicaid may exist for the child who is deprived by death or continued absence of a parent and for that child's parent. If the parents are married, stepparent resource and income deeming rules apply.  See Section 5160-14A.
    

Example:

Jennifer lives at home with her mother, Mary. Her father is deceased. Also in the home is, John, the father of Mary’s other two children. Mary and John are not married. John is currently unemployed. This entire blended family was included in the same Family Medicaid household until John received an inheritance of a lake cabin. This lake cabin causes the blended family to exceed the resource limit. Since parental deprivation still exists for Jennifer, her eligibility must be redetermined excluding entirely the needs, income, and resources of John and his children. Jennifer and her mother become a separate household.

If Mary and John were married, spouse to spouse deeming rules could make Mary ineligible. However, to assure that Jennifer’s eligibility is not affected by John’s income, Mary would still be counted in the household size of two even though Mary is ineligible for coverage.

4. An alien who is not eligible for Medicaid and who is not the dependent child's natural or adoptive parent;
    

5. An individual for whom state or Title IV-E Foster Care maintenance payments are being paid. (See Section 5120-4B for information about OCS Office of Children's Services children returning to the home for a trial visit.)
    

6. The sibling of a child who would lose eligibility if the sibling were included in the household. See Section 5160-14A for the rules on sibling deeming.
    

7. The parents of a pregnant woman, age 18 or older, who is applying for third trimester Family Medicaid when she has no other children in the household.