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:
An SSI
or APA cash recipient (Interim Assistance
recipients are not included in this exemption);
The sibling of a dependent
child who does not meet FM age or
deprivation requirements;
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 5160-14
A.
Example:
Jennifer lives at home with her mother, Mary. Her father is dead. 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 effect by John’s income, Mary
would still be counted in the household size of 2 even though Mary is
ineligible for coverage.
An alien who is not
eligible for Medicaid and who is not the dependent child's natural
or adoptive parent;
An individual for
whom state or Title IV-E Foster Care maintenance payments are being
paid.
The sibling of a child
who would lose eligibility if the sibling were included in the household.
See Section 5160-14
A for the rules on sibling deeming.
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.
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