Medical Assistance Eligibility Handbook
Click here to see this page in full context

Appendix A: Multiple Applicant/Recipient Group Examples

Do not count the income  and resources of a person who is receiving Temporary Assistance for Needy Families (TANF), General Assistance (GA), Supplemental Security Income (SSI), or State Blind Pension (SBP), or Medical Assistance (MA) in the Special SSI Recipient Status (PA/PJ/PM 85).

The examples provided do not include an exhaustive listing of all options available to each particular household. The options do provide a recommended progression on how to determine MA eligibility for various coverage groups that are available.

Elderly or Disabled Husband and GA-Related Wife

Application Made For:

Applicant/Recipient Group Options:

Albert E, age 71
Minnie E, age 58, not disabled.

1.

Healthy Horizons for Albert.

-
-

Count the income and resources of both.
2-person HH limit.

 

if eligible…

-
-

1-person HH applicant/recipient group.
NMP, then MNO for Minnie. Do not count Albert's income and resources. Minnie is a 1-person applicant/recipient group.

2.

NMP for both.

-

1-person SSI-related applicant/recipient group for Albert (PJ). 1-person GA-related applicant/recipient group for Minnie (PD).
Deem income and resources from Minnie to Albert.
Use the 1-person SSI-related income and 2-person resource limit for Albert. (If Minnie's countable income after allowable deductions exceeds 50% of the FBR, use the 2-person NMP SSI-related income limit.)
Use 1-person FSA (GA-related NMP income limit) for Minnie.

 

 

 

-



-

 

if Albert is eligible…

-

Do not deem his income or resources to Minnie.

 

if Albert is not eligible…

-

Deem his income and resources to Minnie.

3.

NMP Spend-down for both

-

1-person SSI-related applicant/recipient group for Albert (PJ22). 1-person GA-related MNO applicant/recipient group for Minnie (PD22).
Deem income and resources from Minnie to Albert.
Use the 1-person SSI-related income and 2-person resource limit for Albert. (If Minnie's countable income after allowable deductions exceeds 50% of the FBR, use the 2-person NMP-MA SSI-related income limit.)
Use 1-person FSA (GA-related NMP income limit) limits for Minnie.



-

-




-

 

if Albert is eligible...

-

Do not deem his income or resources to Minnie.

 

if Albert not eligible

-

Deem his income and resources to Minnie.

4.

MNO Spend-down for both.

-

2-person applicant/recipient group.

Disabled Parent and Child

Application Made For:

Applicant/Recipient Group Options:

Mrs. E, age 41 (disabled).
Son Ralph, age 12 (not disabled).

1.

NMP for the family for son.
Healthy Horizons for Mrs. E

-

Use a 2-person limit. Count Mrs. E’s income.
Count the income for Mrs. E only. Use 1-person limit.
If the income exceeds the one person Healthy Horizons limit, then:
Count the income of both. Use the 2-person limit.

-



-

 

if eligible...

-

Authorize Healthy Horizons for Mrs. E and
PC 27 for son. Use a 2-person limit for NMPF.

2.

NMP for Mrs. E.
Healthy Beginnings for son

-

1-person SSI-related applicant/recipient group.
Use two person income limit for the son for Healthy Beginnings

-

3.

NMP Spend-down for Mrs. E.

-

1-person SSI-related applicant/recipient group.
Income considered separately.

-

 

if eligible...

-

NMP, then MNO for son.
Do not count Mrs. E's income.

-

4.

MNO Spend-down for Mrs. E and son.

-

2-person applicant/recipient group.

5.

NMP or MNO for son only.

-

1-person applicant/recipient group.

 

 

-

Deem income from Mrs. E if not receiving, or not determined eligible for, SSI-related NMP or HH.

Parent and Disabled Child

Application Made For:

Ms. G, age 32 (not disabled).
Son Randy, age 5, permanently and totally disabled.

Applicant/Recipient Group Options:

 

1.

Healthy Horizons for son.

-

2-person applicant/recipient group.
You must count parent's income. (The HH income limit is increased appropriately.)

-

if eligible...

-

1-person HH applicant/recipient group.
NMP, then MNO for Ms. G. Count only the mother's income for the mother.

2.

NMP for the family.
Healthy Horizons for son.

-

Count all income. Use a 2-person limit.

if eligible…

-

Authorize mother NMPF, son Healthy Horizons.

If child is ineligible for Healthy Horizons:

3.

NMP for mother

-

Count the mother's income and the child's income.

Healthy Beginnings for son.

-

Use 2-person HB income limit for the son.

if eligible…

-

Determine NMP for Ms. G. Count income of both OR count
Ms. G's income only.
Use the 1-person NMP income limit if only the mother's income is counted.
Use the 2-person NMP income limit if the mother's and child's income are counted.


-

-

 

-

4.

MNO for mother (child eligible HB)

-

Determine MNO for Ms. G. Count income of both OR count Ms. G's income only (the child is optional).

 

-

Use the 1-person MNO income limit, if only the mother's income is counted.
Use the 2-person MNO income limit if the child's income is added to the mother's income.


-

5.

NMP for both (including Spend-down).

-

1-person applicant/recipient group for mother (PC), 1-person for son (PJ).
Count income separately. 1-person limit for each. Do not deem income or resources.


-

6.

MNO for both (including Spend-down).

-

2-person applicant/recipient group.
Count income of both.
Use 2-person MNO income limit.

-

-

7.

PH 95 for the child

-

1-person applicant/recipient group. Do not count or deem the mother’s income.

Application Made For:

 

Mr. C (not applying).
Mrs. C. (not applying)
Daughter, age 13
Son, age 9 (disabled)

Applicant/Recipient Group Options:

 

1.

Healthy Horizons for son
if eligible…

-

1-person HH applicant/recipient group

-

Count all income – 3 person income limit

2.

NMP for the Family
Healthy Horizons for son

if eligible…

-

2-person applicant/recipient group

-

Count all income – 4 person income limit

-

1-person applicant/recipient group HH and
1-person applicant/recipient group NMPF

-

If the son is not eligible for Healthy Horizons:

3.

Healthy Beginnings

if eligible…

-

2-person applicant/recipient group

-

Count all income – 4 person income limit

-

2-person applicant/recipient group

4.

NMP and MNO

if eligible…

-

2-person applicant/recipient group

-

Count all income – 4 person limit

-

2-person applicant/recipient group

5.

Children With Special Needs


if eligible…

-

1-person applicant/recipient group

-

Use child’s income only (excluding court-ordered child support and survivor’s benefits)

-

1-person applicant/recipient group

Healthy Horizons/NMP or MNO

Application Made For:

Mr. S, age 32.
Mrs. S, age 28, disabled.
Son Josh, age 12.

Applicant/Recipient Group Options:

 

1.

Healthy Horizons for Mrs. S.

NMP for the family.

-

If Josh not included, do not count his income. Use a
2-person limit.
Use a 3 person limit. Count all income.

 

-

2.

Healthy Horizons for Mrs. S

-

Count income of all members. Use 3 person HH limits.
If Josh not included, do not count Josh’s income. Use 2-person income limit.

-

- if eligible…
NMP, then MNO for Mr. S and Josh

-
-

-

1-person HH applicant/recipient group.
NMP, then MNO for Mr. S and Josh. Do not count Mrs. S’s income.
Use 2-person NMP or MNO limits.

3.

NMP Spend-down for 3 person family

-

1-person SSI-related applicant/recipient group for Mrs. S. Deem Mr. S’s income to Mrs. S.
If Mrs. S is eligible, do not deem income from Mrs. S to Mr. S and Josh.
2-person applicant/recipient group for Mr. S and Josh

 

-

-

4.

MNO for 3 person family (including Spend-down)

-

3 person applicant/ recipient group.

NOTE: If Mrs. S is pregnant, it may be to her benefit to receive HH instead of HB. When determining the HH eligibility for Mrs. S, count the unborn child(ren). Her income is not considered for other family members if she is an HH recipient.

Stepchildren

Application Is Made For:

Mr. J, age 37.
Mrs. J, age 38.
Mrs. J’s child to a prior marriage, age 16.

Applicant/Recipient Group Options:

 

1.

NMP for the family.

-

Use a 3 person limit. Count all family income.

If eligible…

-

Three person limit, entire family is PC 27 (Mr. J’s eligibility status code is EE).

2.

Healthy Beginnings

-

Use a two person limit for HB for child using Mrs. J and child. Mr. J can be an optional member if it benefits the child’s eligibility determination.

3.

NMP for the individual
(including spend-down).
if eligible…

-

Use a two person limit if both Mr. J and Mrs. J meet NMP criteria. Child and his income are optional if eligible for HB.
If only Mrs. J meets NMP criteria, use a one person limit for NMP for Mrs. J using Mrs. J’s income and deeming Mr. J’s income. Child and his income are optional if eligible for HB.

4.

MNO for the entire family
(including spend-down).

-

Use a 3 person limit. Count income of all family members.

 

Parent and Emancipated Minor Child

Application Is Made For:

Mrs. L, age 43.
Daughter Kim, age 17, emancipated. She is not a TANF-eligible child.

Applicant/Recipient Group Options:

 

1.

Healthy Beginnings

-

1-person applicant/recipient group. Only count Kim’s income.

2.

NMP for each (Kim emancipated).

-

Two separate 1-person applicant/recipient groups.
Count income separately.
Use 1-person NMP income limit for each applicant/recipient group.

-

-

NOTE: If NMP is first determined for Mrs. L and she is found eligible, there is no deeming of income from Mrs. L to Kim.

3.

MNO for both, if they choose to apply together since they are related.

-

2-person applicant/recipient group.
Count income of both.
Use 2-person MNO income limit.

-

-

4.

MNO for each
(Kim emancipated).

-

Two separate 1-person applicant/recipient groups.
Count income separately.
Use 1-person income limit for each applicant/recipient group.

-

-

NOTE: IF MNO is first determined for Mrs. L and she is found eligible, there is no deeming of income from Mrs. L to Kim.

Healthy Beginnings/NMP or  MNO

Application Is Made For:

Mr. B, age 32.
Mrs. B, age 28, pregnant.
Daughter Laura, age 14.

Applicant/Recipient Group Options:

 

1.

NMP for Family.

-
-
-

3-person applicant/recipient group.
Count income of all members.
Use NMP 4 person income limit (counting unborn child).

2.

Healthy Beginnings for Mrs. B. and Laura and NMP for Mr. B.

-

Count income of Mr. and Mrs. B and Laura.
Use HB 4 person limit (counting unborn child)
2-person HB applicant/recipient group.
NMP for Mr. B. 1-person applicant/recipient group.
Use NMP 3 person income limit (counting unborn child).
Laura and her income are optional if eligible for HB.

-


if eligible…

-

-

-


-

3.

Healthy beginnings for Mrs. B. and Laura and MNO for Mr. B.

-

Count income of Mr. and Mrs. B.
Use HB 4 person limit (counting unborn child).
2-person HB applicant/recipient group.
MNO for Mr. B. 1-person applicant/recipient group.
Use MNO 3 person income limit (counting unborn child).
Laura and her income are optional, if eligible for HB.

-

if eligible…

-

-

-


-

Healthy Beginnings Children/Mother and Nephew

Application Is Made For:

Dorothy M, age 27.
Son Lester, age 9.
Daughter April, age 4.
Daughter Sharon, age 3
Nephew James, age 17.

Applicant/Recipient Group Options:

 

1.

NMP for the family.
or…

-

Use a 5-person limit. Include all family income, or
Use a 4-person limit. Do not count James or his income.
Use a 1-person limit. Only count James and his income.

-


-

2.

Healthy Beginnings for April, Sharon and Lester AND James, and NMP or MNO for Dorothy.

-

3-person HB applicant/recipient group. Count income of mother and children except James. Use appropriate
4-person HB income limit for each age group.
1-person applicant/recipient group. Count only income of James

 

-

-

 

if eligible…

-
-

1-person NMP applicant/recipient group.
Determine NMP, then MNO for mother. Count only income of the mother. Her children and their income are optional, if eligible for HB.

Elderly or Disabled Father/Children and Grandchildren

Application Is Made For:

Mr. S, age 43, disabled.
Mrs. S, age 38.
Daughter Mary, age 16 (emancipated). (Tim's mother).
Daughter Linda, age 10.
Daughter Bobbie Sue, age 8.
Son Junior, age 6
Son Tommy, age 5.
Grandson Tim, age 6 months.

Applicant/Recipient Group Options:

 

1.

Healthy Horizons for Mr. S.

-

Use a 2-person limit. Only count Mr. and Mrs. S's income.
Children (except Mary) and their income are optional.


-

2.

NMP for the family.

-

Use an 8-person limit. Count all family income.

if eligible…

-

Authorize Healthy Horizons for Mr. S. and PC 27 for the remaining family members.

 

3.

Healthy Beginnings for Linda, Bobbie Sue

-

4-person HB applicant/recipient group for Linda, Bobbie Sue, Junior and Tommy, and
1-person HB applicant/recipient group for Tim.
Count parents' income and any income of siblings included as family members in the eligibility determination for HB.
Use HB limit for family size of 6 persons for Linda, Bobbie Sue, Junior, Tommy and Tim (HB children plus parents).
Use HB limit for family size of 2 persons for Tim (Tim plus his mother), or
5-persons HB applicant/recipient group for Linda, Bobbie Sue, Junior, Tommy and Tim.
Count parents' income and any income of siblings included as family members in the eligibility determination for HB.
Use HB limit for family size of 8 persons for Linda, Bobbie Sue, Junior, Tommy and Tim (HB children plus all parents).

Junior, Tommy and Tim

 

 

-

Healthy Horizons for Mr. S.

-

 

 

 

 

 

-

and NMP, then MNO for Mr. S. and Mary

 

 

 

 

-

 

 

 

 

 

 

 

-

 

-

 

 

 

 

 

 

 

if eligible…

-

4-person and 1-person HB applicant/recipient groups or 5-person HB applicant/recipient group.
Determine HH for Mr. S. and NMP then MNO for Mrs. S. and daughter, Mary
1-person HH applicant/recipient group for Mr. S.
Count wife's income and income of children, if included.
Use HH income limit for family size (up to 8 persons).
2-person NMP-MA or MNO-MA for Mrs. S. and Mary.
Do not count income of Mr. S., if found eligible for HH. Include income of Linda, Bobbie Sue, Junior, Tommy and Tim (all optional).
Use 2-person NMP or MNO limit, if only Mrs. S's and Mary's income is counted.
Use 7-6-5-4-3 person NMP/MNO income limit if the child(ren) are included as family members.

 

-

 

-

-

-

-

-

-

 

-

 

-

 

4.

Healthy Horizons for Mr. S. NMP then MNO for remaining family

-

1-person HH applicant/recipient group.
Count wife's income and income of children, if included.
Use HH income limit for family size (up to 8 persons).

-

-

if eligible…

-

1-person HH applicant/recipient group.
NMP then MNO for wife, 5 children, and 1 grandchild. Do not count income of Mr. S.

-

-

5.

NMP for Mr. S, Mrs S, their children and grandson

-





-
-

1-person NMP applicant/recipient group for Mr. S.,
7-person NMP applicant/recipient group for Mrs. S., her children or 5-person NMP applicant/recipient group for Mrs. S., Linda, Bobbie Sue, Junior and Tommy and
2-person
NMP applicant/recipient group for Mary and Tim.
Deem wife's income to Mr. S.
Use 2-person NMP income limit for Mr. S.

 

 

NOTE: If NMP is first determined for Mr. S, deem Mrs. S's income to Mr. S. If Mr. S is eligible, do not deem income from Mr. S to Mrs. S.

 

if eligible…

-

7-person or 5 and 2-person NMP applicant groups. Do not deem or consider Mr. S.'s income.

6.

MNO for entire family.

-

8-person MNO applicant/recipient group.

7.

Application made for:

-

Ms. L age 31.
Son Adam, age 10.
Tony, age 7 (Neighbor’s child)

 

If eligible…

 

 

 

NMP for the Family

-

2-person A/R group for Ms. L and Adam.
Count family income (they would be PC 27).

 

MNO

-

2-person A/R group for Ms. L and Adam.
County family income (they would be TC)

 

Healthy Beginnings

-

1-person A/R group for Tony.
No income counted (he would be PS16).

 

Application made for:

-

Ms. B age 31.
Sam, age 4 (Neighbor’s child).

 

MNO

-

1-person A/R group for Ms. B (TD00).

 

Healthy Beginnings

-

1-person A/R group for Sam.
No income counted (he would be PS 16).

Updated February 14, 2012, Replacing March 31, 2010