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 .
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.
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!
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
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:
Washington Healthplanfinder, the following questions
The information gathered on this screen will establish assistance units for determining eligibility.
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
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?”
Examples of how each of the four exceptions apply when determining who to include in the assistance unit
Exception 1: Married Parents with a Child in Common Filing Taxes Separately
“A child under the age of 19 who expects to be claimed by a non-custodial parent”
Exception 2: Child Claimed as a Tax Dependent of 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”
Eligibility Policy & Service Delivery
Office of Medicaid, Medicare, Eligibility & Policy