5420           INDIVIDUAL UNDER 21 LIVING WITH PARENT (S)

An individual under age 21 who lives with his or her birth parent or adoptive parent (except for Title IV-E and state-only adoption assistance children -- see Sections 5195 and 5460) and who meets the eligibility criteria as defined in Section 5410 is eligible for Under 21 Medicaid coverage.  For a single parent household and a two parent household, both the under 21 year old and the parent(s) are coded FR, causing the Family Medicaid Adult Included (AI) standard to be used.

Example 1:

A household consisting of 2 natural parents and their two children, ages 19 and 20, applies for Under 21 Medicaid.  The mother and father have no income, but the 20-year-old has earnings, which cause the 4-person household to exceed the Family Medicaid AI 04 standard.  Because a sibling's income cannot be considered available, financial eligibility is redetermined using the Family Medicaid AI 03 standard for a 3-person household excluding the needs and income of the 20-year-old.  This redetermination finds the 19 year old eligible for Under 21 Medicaid.

Example 2:

A household consisting of a birth mother, her 19-year-old child, and a stepfather applies for Under 21 Medicaid.  The mother has no income, but the stepfather is employed.  Eligibility is determined using the Family Medicaid AI 02 household size including only the mother and child.  The stepfather is not included because he is not a member of the Family Medicaid household.  However, if this household also included a common child, the stepfather could be included but would be "opted out" if his income or resources caused ineligibility for his stepchild reducing again the household size to AI 02.