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Household Composition. What’s Changing For Medicaid?. Classic Medicaid –The financial eligibility rules for these programs are not subject to the new MAGI methodology rules .

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Household Composition


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what s changing for medicaid
What’s Changing For Medicaid?
  • Classic Medicaid –The financial eligibility rules for these programs are not subject to the new MAGI methodology rules.
  • MAGI-based Medicaid – Refers to individuals who are relatable to Medicaid/CHIP that includes family, Apple Health for Kids, pregnant women, or the newly eligible adults between the age of 19 up to 65.
      • Does not relate to classic Medicaid groups. HealthPlanFinder will get you to the right place
  • Washington Apple Health (WAH) – the new brand name for all Medicaid programs.
household calculation is also applied to subsidies
Household Calculation is also applied to Subsidies
  • Calculated differently than Medicaid
are you confused anxious
Are you confused/Anxious?
  • It will be ok!
  • What you need to know
    • Definitions of filing status
    • Why family members may have differing eligibility
    • Importance of telling the Exchange of any change in household or income as it occurs
    • Very general understanding of household calculations.
what you don t need to know
What you don’t need to know
  • How the Exchange calculates every family composition situation
  • Tax law
  • Answers to clients questions about how they should file taxes
key takeaways
Key Takeaways
  • Households for premium credits and Medicaid will not necessarily match people’s actual living situation
  • Household rules could split families into different coverage programs (subsidies or Medicaid)
slide7
Why
  • Medicaid and premium subsidies are calculated by income and family size.
  • Medicaid and premium subsidies define who is in a family differently.
why household size and composition matter
Why Household Size and Composition Matter
  • Necessary to convert income to a federal poverty level (FPL) standard
  • Who is in the household determines whose income counts in determining eligibility
slide10

New Medicaid Household Composition

  • An assistance unit is comprised of those household members who must be looked at together due to income, age or tax-filing status in order to determine the household size.
  • Household size determines the income standard we use to determine an individual household member’s eligibility.
  • MAGI assistance rules can be found in Washington Administrative Code 182-506-0010 effective October 1, 2013.
  • Although income of other household members may be used in determining the household’s income eligibility and size for an assistance unit, each individual in the family unit will have their own Medicaid determination.
slide11

Key Components

There are several key components required to create assistance units such as:

• A individual’s tax filing status;

• How household members are related to each other;

• Their age; and

• If a woman in the household is pregnant*

*If there is a pregnant woman in the household, the assistance unit (or units) she is included in, is increased by one count for each unborn child.

slide12

Households for Premium Tax Credits

Household = individuals for whom a taxpayer

claims a deduction for a personal exemption

Household for Medicaid

Household = Individuals living under one roof

Don’t worry – the HealthPlanFinder will sort this out!

slide13

Terms you need to know

Head of Household - You can claim the Head of Household filing status on your tax return if you are unmarried at the end of the year, have cared for a closely-related dependent for over half the year, and paid more than half the cost of maintaining a home for yourself and your dependent or dependents

Dependent - see next slide

Filer - files taxes

Non-filer - does not file taxes

Married filing single

Married filing jointly

The term you chose will be the one your client filed on his or her taxes

definitions
Definitions
  • Tax Filer: A tax filer is an individual who files taxes and is not claimed as a tax dependent by another tax filer. 
  • Tax Dependent: A tax dependent is an Individual who is claimed as tax a dependent by another person who is a tax filer. 
  • Non-Filer/Non-tax dependent: A non-filer/non-tax dependent is an individual who does not file a tax return and who is also not claimed as a tax dependent by another tax payer.
slide17

Even though Washington Healthplanfinder will establish the assistance units, it will be helpful for individuals who assist families in the application process to understand the assistance unit rules so that they can:

    • Confirm that the system results are correct and no error was made in the data entry; and
    • Explain why some household members received different results
slide18

On the “Primary Applicant’s Taxes” screen in the

Washington Healthplanfinder, the following questions

are asked:

  • The tax-filing status of the primary applicant; and
  • How they filed for the past tax year; how they plan to file in the current tax year; and how they plan to file in the next year.

The information gathered on this screen will establish assistance units for determining eligibility.

slide19

WA Healthplanfinder will collect the following information about:

      • Other household members;
      • Their current/future tax filing status;
      • Relationship to the primary applicant;
      • If they live in the same home;
      • Demographics, age, SSN, race, etc.
slide22

There are 3 Rules that determine who must be

  • included in an assistance unit.
  • Rule #1
  • The individual (tax filer) must expect to file taxes for:
  • Themselves;
  • Their spouse living with them;
  • All individuals expected to be claimed as a tax dependent regardless of age
slide25

Rule #2

  • The individual answered NO to Rule #1 – they do not plan to file taxes (tax dependent):
  • Does the individual expect to be claimed as a tax dependent by someone else?
    • If no: They are a non-filer and must go onto Rule #3
    • If yes: The basic rule is that their household is exactly the same as the tax filer that claims them, but there are some exceptions.
slide26

Rule #2 Exceptions

  • A child under age 19 living with parents who do not file a joint tax return
  • A child under age 19 who expects to be claimed by a non-custodial parent
  • A child under the age of 19 who lives with both parents and the parents are not married to each other
  • The individual expects to be claimed as a tax dependent by someone other than a spouse or parent
slide27

Rule #2 Exceptions

If one of the exceptions applies to the tax dependent, then the individual is treated as a non-filer and the assistance unit is determined according to Rule #3

slide28

Married Parents with a Common Child

  • Bob and Suzie are married and file taxes jointly with their child in common, Tommy
  • Bob and Suzie claim Tommy as their tax dependent
slide30

Single Adult Claimed as a Tax Dependent

  • Jon is an unmarried 20 year old residing in his parent’s home
  • Parents claim Jon as a tax dependent
slide32

Married Parents with a Child not in Common

  • Steve and Donna are married and file taxes jointly
  • Donna’s child, Jonny (10), from a previous relationship, lives with them
  • Steve and Donna claim Jonny, as their tax dependent
slide34

Rule # 3

  • If the individual answered no to rule #1, no to rule #2 or, yes to rule #2 but an exception applies, the individual is considered a NON-FILER.
  • A non-filer’s assistance unit includes:
    • The individual
    • Their spouse
    • Their children under age 19
    • If the applicant is under age 19, include their parents and siblings under age 19
slide35

Single Mom with Children

  • Ann is a single parent and is not filing taxes
  • Ann has two children, Drew (12) and Annabelle (7)
  • Drew’s father claims him as his tax dependent but Drew is currently living with his mother, Ann
slide37

Let’s stop here and discuss how to implement this with a client

1. How might you explain the results to a family when the child is eligible for Medicaid (CHIP), the mom is eligible for a subsidy, and the dad is not eligible for a subsidy?

2. How might you answer questions such as “should I claim my child next year on my taxes or have his dad do so?” or “ should I file separately from my spouse instead of together?”

slide38

Questions

End here.

slide39

Exception Examples

Examples of how each of the four exceptions apply when determining who to include in the assistance unit

slide40

Exception Examples

  • Exception 1:
  • “A child under the age of 19 living with parents that do not file a joint tax return”
slide41

Exception 1: Married Parents with a Child in Common Filing Taxes Separately

  • Brad and Julie are married with child in common, Jesse (1)
  • Brad and Julie file taxes separately
  • Brad claims child, Jesse, as his tax dependent
slide43

Exception Examples

Exception 2

“A child under the age of 19 who expects to be claimed by a non-custodial parent”

slide44

Exception 2: Non-Custodial Parent Claims Child as Tax Dependent

  • Ryan and Kari are married with a child in common, Austin, and Kari’s child, Monica, from a previous relationship
  • Ryan and Kari file taxes jointly and claim their child, Austin, as their tax dependent
  • Monica’s father (non-custodial parent) claims her as his tax dependent
slide46

Exception 2: Child Claimed as a Tax Dependent of a Non-Custodial Parent

  • Kevin files taxes and lives with his daughter, Jane (18)
  • Jane is claimed as a tax dependent by her mother, Ann, who does not live in Kevin and Jane’s home
  • Kevin applies for medical for himself and child Jane
slide48

Exception Examples

Exception 3

“A child under the age of 19 who lives with both parents and the parents are not married to each other”

slide49

Exception 3: Unmarried Parents with a Child in common

  • Chris and Carrie are unmarried with a common child, Bertha (3)
  • Chris and Carrie file taxes separately
  • Chris claims child, Bertha, as his tax dependent
slide51

Exception 3: Unmarried Parents with Child in Common and Uncommon

  • Ron and Lucy are unmarried with a child in common, Frankie (7) and a child from a previous relationship. Sara (13) is Ron’s child from a previous relationship.
  • Ron and Lucy files taxes separately
  • Ron claims both children, Frankie and Sara, as his tax dependents
slide53

Exception Examples

Exception 4

“The individual expects to be claimed as a tax dependent by someone other than a spouse or parent”

slide54

Exception 4: Grandparents Claim Grandchild as a Tax Dependent

  • Grandpa, Grandma and grandchild, Melissa (16), live together
  • Grandpa claims Grandma and grandchild, Melissa, as his tax dependents
slide57

Single Adult Not Claimed as a Tax Dependent

  • Theresa is an unmarried 24 year old residing in her parent’s home
  • Parents do not claim Theresa as a tax dependent and she will file her own taxes this year without any dependents
slide59

Married Couple No Dependents

  • Dan and Jennifer are married and file taxes jointly
  • Dan and Jennifer do not have any dependents
slide61

Married Parents with a Common Child

  • Dan and Jennifer are married and file taxes jointly with their child in common, Kim who is a minor child.
  • Dan and Jennifer claim Kim as their tax dependent
slide63

Single Adult Claimed as a Tax Dependent

  • Kim is an unmarried 19 year old residing in parent’s home
  • Parents claim Kim as a tax dependent
slide65

Parents with Children

  • Daniel and Gabriela are married and are not filing taxes
  • Daniel and Gabriela have two children at home, Sofia, who is a minor and Jessie who is 19 years old.
slide67

Married Parents with a Child in Common Filing Taxes Separately

  • Daniel and Gabriela are married and have a minor child, Sofia in common
  • Daniel and Gabriela file separately
  • Daniel is claiming child Sofia as his tax dependent
slide69

Non-Custodial Parent Claims Child as Tax Dependent

  • Jason and Amanda are married with a child in common, Jared, and Amanda’s child, Sonia, from a previous relationship
  • Jason and Amanda file taxes jointly and claim their child, Jared, as their tax dependent
  • Sonia’s father (non-custodial parent) claims her as his tax dependent
slide71

Child Claimed as a Tax Dependent of a Non-Custodial Parent

  • Gloria files taxes and lives with her son, Michael (18)
  • Michael is claimed as a tax dependent by his father, Devin, who does not live in Gloria and Michael’s home
  • Gloria applies for medical for her and son Michael
slide73

Unmarried Parents with a Child in common

  • Sean and Kelly are unmarried with a child in common, Molly (3)
  • Sean and Kelly file taxes separately
  • Kelly claims child, Molly as her tax dependent
slide75

Parents unmarried, with Child in Common and Child Not in Common

  • Karl and Amy are unmarried with a common child, Corey (5) and Brenda (16) Karl’s child from a previous relationship
  • Karl and Amy files taxes separately
  • Karl claims both Corey and Brenda, as his tax dependents
slide77

Non-parent or spouse claim Tax Dependent

  • Tamara and her husband Darryl have Tamara’s sister Krisanne (15) living with them
  • Darryl and Tamara file jointly and claim Krisanne as their tax dependent
questions
Questions?

Melissa Rivera

Eligibility Policy & Service Delivery

Office of Medicaid, Medicare, Eligibility & Policy

melissa.rivera@hca.wa.gov

360-725-1713