5104 HOUSEHOLD ELIGIBILITY
Some people present in a home may be eligible to receive Medicaid and others may not. When determining eligibility for one person in a home, the income, resources, and needs of some people in the home may count while those of others in the home may not count. For Family Medicaid, those individuals whose income and resources are counted and whose need for coverage is considered when determining Medicaid eligibility are referred to as the household.
When processing an application, the caseworker must determine:
Who meets the non-financial eligibility requirements for Family Medicaid and can, therefore, be included in the household; and
Whose income and resources must be counted to determine financial eligibility for the household.
Some individuals whose income and resources are used to determine eligibility may not be eligible for coverage for a variety of reasons outlined in this section.
To determine financial eligibility, the caseworker must determine what need standard is appropriate. The need standard varies according to the individuals in the household whose need for Medicaid coverage is considered. To determine the need standard, define the minimum household as described in Section 5104-1 and then add individuals according to the rules set out in Sections 5104-2 through 5104-9. If a household does not pass financial eligibility criteria using the largest household possible under these rules, eliminate optional members as allowed whose income or resources may be causing the household to exceed the financial criteria and redetermine eligibility.
Note:
Depending on the relation of individuals living together in a common home, an application may require a caseworker to consider Medicaid eligibility for more than one household in the home at the same time.
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