0920.010.35 Need (MC+)

Section 1902(a)(17)(D) of the Social Security Act prohibits the consideration of income of persons not financially responsible for an individual. All MAF budgeting methodologies apply to MC+ except:

• Assistance grouping rules,
• Stepparent deeming,
• The $50 child support disregard is not allowed, and
• SSI income of assistance group members is included, refer to Section 0920.010.35.10.

Definitions of income and income exclusions are the same as MAF unless otherwise stated.

The net income maximums for Non-CHIP children are:

• 185% FPL - Children under age one;
• 133% FPL - Children ages one-five;
• 100% FPL - Children ages six-18.

The gross income maximum for CHIP children is less than 300% FPL - see MC+ eligibility for CHIP children.

0920.010.35.05 Assistance Group (MC+)

Some family members are mandatory for inclusion in the assistance group and some are optional. Others are mandatory for exclusion. Determine the assistance group by including mandatory members, and optional members whose inclusion does not adversely effect eligibility. Mandatory exclusions take precedence over the mandatory inclusions for assistance grouping.

1. Assistance Group Mandatory Persons Included (MC+)
IM-#6 January 11, 2000

The following persons must be included in the assistance group, unless they are a mandatory exclusion:

• person for whom MC+ healthcare coverage is requested
• spouse of the person (if in the home)
• parent(s) of person (if in the home or exercising care and control, and the person for whom MC+ healthcare coverage is requested is a child)
• parent(s) of an optional child included in the assistance group (if in the home or exercising care and control)

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.

2. Assistance Group Mandatory Exclusions (MC+)
IM-#6 January 11, 2000

The following persons must be excluded from the assistance group:

• adult caretaker who is not financially responsible for anyone included in the assistance group
• a married child whose spouse is in the home (unless the married child is a caretaker of a child for whom MC+ coverage is requested)
• a parent of a married child, when the child's spouse is in the home (the parents income will be deemed)

The caretaker has the option to include the following persons in the assistance group, unless they are a mandatory exclusion:

• spouse or age-eligible child of an assistance group member (or sanctioned individual)
• age-eligible siblings (full, half, step, adoptive) of an assistance group member
• any child related (by blood or marriage) to a child in the assistance group with the same caretaker

0920.010.35.10  SSI/SAB Income (MC+)

Individuals receiving SSI or SAB may be included in the assistance group. Include the SSI or SAB payment in determining eligibility for this program, if the SSI or SAB recipient is part of the assistance group.