Relatives who are not members of the immediate family may be included in the same applicant/recipient group or may receive MA in a separate applicant/recipient group.
55 Pa. Code § 181.2 55 Pa. Code § 178.2
A stepchild or stepsibling who is under age 21 and unemancipated may be in a separate applicant/recipient group or may be included in the same applicant/recipient group with his or her stepparent or stepsibling. If the child's biological or adoptive parent also lives in the household and is applying for or receiving MA, the child is included in the parent's applicant/recipient group. The family can determine which option best meets their medical needs.
55 Pa. Code § 181.2 55 Pa. Code § 178.2
If MA benefits are received in separate applicant/recipient groups, the eligibility of each group for either NMP or MNO is determined separately.
Examples:
Mrs. M. applies for MA for herself and for her stepson, Juan, age 16. Both have income from employment. Her husband, Juan's father, deserted the family last week. The CAO determines that Mrs. M. and Juan will not be eligible for MA if they are included in the same applicant/recipient group but will be eligible in two separate applicant/recipient groups: TC for Mrs. M, and PC for Juan.
The family consists of Mr. and Mrs. C., Mr. C.'s daughter from a previous marriage, and Mrs. C.'s son from a previous marriage.
If Mr. and Mrs. C. apply only for either or both of the children, each child may be in their own applicant/recipient group.
If Mr. C. applies for himself, his daughter, and his stepson and Mrs. C. does not apply, Mr. C. must be included in the same applicant/recipient group as his daughter. His stepson may be in a separate group.
If Mrs. C. applies for herself, her son, and her stepdaughter and Mr. C. does not apply, Mrs. C must be included in the same applicant/recipient group as her son. Her stepdaughter may be in a separate group.
If Mr. and Mrs. C. apply for themselves and both of the children, all must be in one applicant/recipient group. (Spouses, parents, and children must belong to the same group.)
Mr. and Mrs. D. apply for MA for themselves, his 17-year-old daughter from a previous marriage, and her 16-year-old son from a previous marriage. Mrs. D. is not a U.S. citizen and is unable to provide acceptable papers showing her alien status. She is not eligible for MA. The CAO authorizes MA for Mr. D. and his daughter in one applicant/recipient group and MA for Mrs. D.'s son in a separate applicant/recipient group. Three months later, Mrs. D. provides proof of eligible alien status and requests MA. The CAO authorizes MA for all four members of the D. family in one applicant/recipient group.
Other related individuals who live together, but are not members of the immediate family may be in their own separate applicant/recipient group or may be included with their relatives. Such relationships include, but are not limited to, an aunt living with a niece, two adult brothers living together, or a 10-year-old child living with her grandmother.
Examples:
Bertha W., age 55, lives with her 50-year-old brother, Ernest. Neither is disabled, and neither meets the criteria for an SSI-related category . Bertha and Ernest can be in a single two-person applicant/recipient group, or they can be in two separate one-person applicant/recipient groups. The CAO will tell them about the choices and let them know how each choice would affect their eligibility.
Mrs. McC. applies for MA for herself, her husband, their two children, and her 7-year-old nephew, Jack, who lives with the family. Jack receives Social Security benefits on the claim of his father, who has died. Jack can be included in the same applicant/recipient group with his aunt, uncle, and cousins (a five-person applicant/recipient group), or he can be in a separate, one-person applicant/recipient group. His aunt, uncle, and cousins would then be in a four-person applicant/recipient group.
An individual must apply for and receive MA in a separate applicant/recipient group if he or she is not related to another individual who is living in the household. Unrelated individuals may not choose to be included in the applicant/recipient group of other members of the household.
Examples:
Violet E., age 56, and Guy M., age 60, apply for MA. They have lived together for six years but are not married. Each will receive MA in a separate applicant/recipient group.
Joy L. applies for MA for herself, her son Jeremy, and her boyfriend, Jason E. Mr. E. says he is the father of Jeremy, but paternity has not been proven. Mr. E. is considered unrelated to the other household members. So, he is in a separate applicant/recipient group.
Lucy J, age 30 is caring for her best friend’s three year old daughter. The mother of the child (best friend) is incarcerated. Lucy is exercising care and control of the three year old. Lucy J is applying for MA for herself and the three year old. Since Lucy J is unrelated to the three year old, each will receive MA in a separate applicant/recipient group.
Updated February 14, 2012, Replacing March 31, 2010