Appendix B: Chart: Who Must Be, Who May Be, and Who Must Not Be Included in the Standard Filing Unit with the Individual Who Is Applying for or Receiving Medical Assistance

Healthy Horizons (HH)

Must be included: When determining the HH family, the CAO must include the following household members and count their income :

 

NOTE:  The CAO must not deem income from a parent to a child between the ages of 18 and under age 21 in the PH00 category

 

May be included: When determining the HH family, the CAO may include the following household members and count their income:

 

NOTE:  If the HH applicant/recipient chooses to include a natural or adopted child or stepchild, the child’s income (including TANF, GA, SBP, or SSI income) is counted.

 

 

NOTE:  If the HH applicant/recipient chooses to include a child under age 21, the child’s income (including TANF, GA, SBP, or SSI income) is counted.

 

 

May not be included: When determining in the HH family, the CAO must not include the following household members:

 

Categorically Needy Nonmoney Payment (NMP for the Family)

Must be included: When determining the NMP for the Family (NMPF) applicant/recipient group, the CAO must include the following household members and count their income:

 

 

Exceptions: An individual is not included if he or she:

 

NOTE:  The individual is not included as a member of a TANF budget group unless the child is receiving federal, state, or local adoption assistance and including the child in the budget group would increase the benefits for the budget group. If including the adopted child would increase the benefits, then the child must be included in the budget group. The child’s income from the federal, state, or local subsidies is counted in the eligibility and benefit determinations. (See Cash Assistance Handbook, Chapter 150, Income.)

 

 

NOTE:  When the individual becomes eligible, he or she must be included in the applicant/recipient group.

 

May be included: When determining the NMPF family, the CAO may include the following other individuals who live with the child:

 

Healthy Beginnings (HB)

It is important not to confuse the applicant/recipient group with the Healthy Beginnings family. The Healthy Beginnings family includes those household members whose income is counted when determining eligibility.

An applicant/recipient group for HB may include any woman who is pregnant and any qualified child if the pregnant woman and qualified child are related by blood or marriage to at least one member of the applicant/recipient group.

 

Must be included: When determining the HB applicant/recipient group, the CAO must include the following household members and count their income:

NOTE:  For Healthy Beginnings, a individual is emancipated if he or she is:

 

NOTE:  The individuals who must be included must be living in the same household as the pregnant woman or the qualified child.

 

 

Exception: A sibling under age 21 must not be included with the pregnant woman who is age 18 (whether emancipated or unemancipated) and not in school.

May be included: When determining the HB applicant/recipient group, the CAO may include the following household members and count their income:

 

NOTE:  When the child is born, the CAO must not include the putative father in the family size when determining the child's eligibility until paternity is legally proven.

 

 

Must not be included: When determining the HB applicant/recipient group, the CAO must not include the following household members:

Categorically Needy Nonmoney Payment (NMP)

Must be included: When determining the NMP applicant/recipient group, the CAO must include the following household members and count their income:

 

NOTE:  The HB client's income is included and the NMP income limit is increased to include the HB spouse and the unborn child, but the HB spouse is not approved for NMP.

 

 

NOTE:  The HB client's income is included and the NMP income limit is increased to include the HB parent or spouse and the unborn child, but the HB parent or spouse is not approved for NMP.

 

 

Exception: An emancipated child or a stepchild is not required to be included in the same applicant/recipient group with his or her parent when applying for or receiving NMP. Income is deemed from a parent to a child under age 21, whether or not the child is emancipated.

May be included: When determining the NMP applicant/recipient group, the CAO may include the following household members and count their income:

 

NOTE:  If the child is included in the eligibility determination for the remaining members of the household applying for or receiving TANF-related or GA-related NMP, the child's income must be included. The NMP income limit is increased to include the HB child, but the HB child is not approved for NMP.

 

NOTE:  If the child is included in the eligibility determination for the remaining members of the household applying for or receives SSI-related NMP, the child's income must be included.

 

May not be included, but income is deemed: When determining the NMP applicant/recipient group, the CAO must not include the following household members, but the CAO must deem their income as available to the child or spouse:

 

 

NOTE:  The nonapplicant/nonrecipient spouse's income is included, and the NMP income limit is increased to include the nonapplicant/nonrecipient spouse, but the nonapplicant/nonrecipient spouse is not authorized for MA.

 

 

NOTE:  The nonapplicant/nonrecipient spouse's income is included, and the NMP income limit is increased to include the nonapplicant/nonrecipient spouse, but the nonapplicant/nonrecipient spouse is not approved.

 

 

May not be included: When determining the NMP applicant/recipient group, the CAO  may not include the following household members and may not count their income:

 

Medically Needy Only (MNO)

Must be included: When determining the MNO applicant/recipient group, the CAO must include the following household members and count their income:

 

 

NOTE:  The HB client's income is included, and the MNO income limit is increased to include the HB MA spouse and any unborn children, but the HB spouse is not approved for MNO.

 

 

Exception: An emancipated child and a stepchild do not need to be included in the same applicant/recipient group with his or her parent or stepparent when applying for or receiving MNO. Income will be deemed from a parent to a child under 18 whether or not the child is emancipated.

 

NOTE:  The HB income limit is increased to count the HB parent and any unborn children, but the HB parent is not authorized MNO.

 

May be included: When determining the MNO applicant/recipient group, the CAO may include the following household members and count their income:

 

 

NOTE:  If the child is included as a member in the applicant/recipient group for MNO, the child's income must be included. The MNO income limit is increased to include the HB child, but the HB child is not approved for MNO.

 

May not be included, but income is deemed: When determining the MNO applicant/recipient group, the CAO may not include the following household members, but the CAO deems their income as available to the child or spouse:

 

 

NOTE:  The nonapplicant/nonrecipient spouse's income is included, and the MNO income limit is increased to include the nonapplicant/nonrecipient spouse, but the nonapplicant/nonrecipient spouse is not authorized.

 

 

 

 

Not included: When determining the MNO applicant/recipient group, the CAO may  not include the following household members and must not count their income:

 

Updated February 14, 2012, Replacing October 23, 2008