0905.012.10 Assistance Group (MAF)

The assistance group starts with the dependent children for whom MC+ healthcare coverage is requested. Next determine whether to consider income and needs of an individual(s) in a child's household in an assistance group. A household includes those persons sharing common quarters and facilities as a unit, excluding boarders.

The ASSISTANCE GROUP is comprised of certain identified persons living together in the same household. MAF eligibility is based on those individuals' needs. It MAY INCLUDE A NEEDY RELATED CARETAKER or LEGAL GUARDIAN living in the same home with the children. With respect to a SPOUSE, do not consider TEMPORARY separation expected to last less than six months (such as hospitalization, vocational training, etc.), as interrupting the continuity of living together for budgeting purposes. However, for separations on a CONTINUING BASIS (such as desertion; abandonment; confinement in a penal, medical, or mental institution; or living in a professional, practical, or domiciliary nursing or boarding home), budget the household and exclude the person separated from the family.

Consider any person or group of persons described below as an assistance group and consider their total needs and income in determining eligibility.

When a household contains both a parent and a non-parent caretaker relative or a parent and a legal GUARDIAN, the parent is always the caretaker payee for his/her child unless that parent is also an age eligible child.

NOTE: When a parent is also an age eligible child, see Minor Parent Assistance Group Provision for further information. (Section 0905.012.15 )

0905.012.10.05 Assistance Group Mandatory Persons Include:

The needs and income of the following persons living in the household must be included in the assistance group, unless they are a mandatory exclusion:

• The dependent children (including legally adopted children) for whom coverage is requested.
• Biological or adoptive parents of one or more of the eligible children.

If parents are actively exercising a joint physical custody arrangement, evaluate whether both parent’s income and needs should be included when determining the child’s eligibility.  If both parents are exercising care and control of the child, consider both parent’s income and needs.

NOTE:  The income and needs of parents who are ineligible aliens meeting the above criteria must be included even though not eligible for coverage.  The needs of a dependent child who is an ineligible alien, must be included even thought not eligible for coverage.

Include the needs and income of a parent sanctioned for failure to apply for or supply a Social Security Number in the assistance group. Show the parent on the IMU5 as a level of care “S” and with sanction reason of “N”.

A parent sanctioned for refusal to cooperate in establishing paternity or pursuing medical support is a mandatory member of the assistance group. The family size and need remain the same for the purpose of determining the children's MAF eligibility, whether or not the parent cooperates. The parent will be shown on the IMU5 as Sanctioned (“S” loc) with sanction reason of “C” in field 13g2 since failure to cooperate will make the caretaker ineligible for MC+ healthcare coverage under MAF.

NOTE:  A pregnant women sanctioned on MAF for failure to cooperate may be eligible for MC+ for Pregnant Women.

0905.012.10.10 Assistance Group Mandatory Exclusions (MAF)

• EXCLUDE the needs and income of parents and NPCRs receiving SSI, SP or SAB in determining eligibility of other members of a family. Parents and NPCRs receiving SSI, SP or SAB are not eligible for MAF. Parents and NPCRs may be eligible for Medicaid benefits through their conversion status or through the Medical Assistance program.
• EXCLUDE the needs and income of the following individuals in the assistance group:
  1. Brothers and sisters, including half-brothers and half-sisters, whose husbands or wives live in the home.
  2. Brothers and sisters, including half-brothers and half-sisters, who do not meet the dependent child requirements.
  3. A Legal Guardian or non-parent caretaker relative (NPCR), other than a stepparent, if a biological or adoptive parent is in the home. See 0905.012.35 Stepparent Cases for information on when a stepparent may be included in an assistance group.

0905.012.10.15 Assistance Group Optional Inclusions (MAF)

The needs and income of the following persons (unless a mandatory exclusion) may be included if it benefits the family:

• Biological and adoptive siblings of the dependent child, who are themselves dependent children. This includes half-brothers and half-sisters.
• Non-sibling dependent children in the home.
• Children under the age of 19 receiving SSI. Include an SSI child's needs and income, other than SSI, in the assistance group to determine his/her MAF eligibility. When the only MAF eligible child receives SSI, eligibility for the eligible caretaker and/or second parent may still exist even if the SSI child is excluded.
• A DEPENDENT child receiving foster care maintenance payment or adoption subsidy under Title IV-E, Title XIX-FFP or HDN funding.
• A needy non-parent caretaker relative (NPCR).
• A needy legal GUARDIAN caretaker.
• A stepparent may be included to determine eligibility of other assistance group members. A stepparent is not eligible for coverage unless he/she is a needy NPCR and there is not a biological or adoptive parent in the home.

The needs and income of an optional member who has failed to apply for or supply a social security number may be included to determine the eligibility of other family members. On IMU5 show the individual who did not comply with SSN requirement as sanctioned (loc “S”) with a reason code of “N”.

Optional persons may be included or excluded whichever is most beneficial to all persons applying. Exclude any optional child whose inclusion would result in ineligibility of the assistance group. Approve the remaining family members for MAF and EXPLORE ELIGIBILITY FOR THE EXCLUDED CHILD(REN) UNDER THE MC+ FOR CHILDREN PROGRAM.

A caretaker may change a decision regarding optional inclusion of dependent children at any time.

NOTE: A caretaker may choose to include optional persons in the MAF assistance group even though they were excluded from the Temporary Assistance cash assistance group.

0905.012.15 Minor Parent Assistance Group Provision (MAF)

When a minor parent lives with his/her parent(s) and the parent(s) of the minor parent is eligible for or receiving MAF for siblings of the minor parent who are also in the home, the minor parent may be considered a separate MAF assistance group from his/her parent(s) MAF group. All members may also be combined in one assistance group. This is the family's option. If they choose to be combined in one assistance group, do not apply the disregard of 100% of the poverty level to any earnings the parent of the minor parent may have.