0805.020.00 MEDICAL ASSISTANCE FOR DISABLED CHILDREN (MADC)

If otherwise eligible, disabled children (under age 18) may receive Medicaid as spenddown, non-spenddown or vendor. Eligibility requirements for disabled children are the same as those for disabled individuals age 18 and over, except that income and resources of the disabled child's parents are deemed in certain circumstances. Parental income and resources are deemed if the child meets the definition of living with a parent.

NOTE: Always consider the disabled child's (and spouse's as appropriate) income and resources. DO NOT deem the income or available resources of any other persons (including a stepparent or sibling) living with the disabled child.

0805.020.05 DEFINITION OF LIVING WITH A PARENT

Deeming of parental income and resources is based on the living arrangement and marital status of the disabled child.

A disabled child is considered to be living with a parent when the child resides in the same home with a natural or adoptive parent (unless the disabled child's spouse is in the home). A child is also considered as living with a parent:

when the child is out of the home to attend school;
when the child is hospitalized for 30 days or less;
when the child is in a psychiatric treatment facility (JCAHO)for 30 days or less; or
during a period of temporary absence.

A disabled child is NOT considered to be living with a parent if:

a natural or adoptive parent is not in the home;
the child is married and living with their spouse, even though a parent may be in the same home;
the child resides in a Nursing Facility or IMR;
the child is the custody of a state agency and placed in Foster Care or a Group Home;
the child is in a hospital or psychiatric treatment facility (JCAHO), and the stay is expected to be for more than 30 days; or
the child and parent are not residing in the same household for a period of time longer than that which is considered a temporary absence.

A temporary absence exists when an individual (child or parent) leaves the household but intends to, and does, return in the same month or following month. When a child is out of the home to attend school, the absence is always considered temporary when the parents retain custody, care and control of the child.

Parental income and resources are only deemed if the child meets the above definition of living with a parent. If a child is not considered to be living with a parent, do not deem parental income and resources. However, include any income that the parent actually contributes to the child as the child's unearned income.

When a disabled child reaches age 18 or moves from the parent's home, stop deeming effective with the following month.

Example: If a child turns age 18 on February 10, the parent's income and resources are deemed to determine February eligibility. Determine March eligibility without deeming the parent's income and resources.

0805.020.10 DEEMING PARENTAL RESOURCES

IM-#48 August 07, 2018

If the disabled child meets the definition of living in the home with a natural or adoptive parent, deem the entire amount of the parent's available resources to the child. If there is a stepparent in the home, consider the full value of available resources owned jointly by the parent and stepparent. Do not consider the value of resources owned solely by the stepparent.

EXCEPTION: DO NOT deem the available resources of the parent if the parent or spouse of the parent is receiving MA (non-spenddown).

To determine the parents' available resources follow the instructions in Section 1030.000.00 on what is included as an available resource. All resources that would be considered available if the parent were the applicant are deemed, with the exception of retirement accounts. For the purpose of deeming resources to disabled children, exclude retirement accounts (individual accounts, 401(k) plans, 403(b) plans, Keogh plans, pension plans, etc.) that belong to their parents.

Add the deemed resources to the child's available resources. If the total is $3000.00 or less, the child is eligible on the factor of available resources. If the total exceeds $3000.00, the child is ineligible.

0805.020.15 DEEMING PARENTAL INCOME

IM-#67 December 07, 2018, IM-35 March 21, 2013, IM-73 November 30, 1993

If the disabled child meets the definition of living in the home with a natural or adoptive parent, deem income from the parent(s). Do not deem the income of any other persons in the home, including a stepparent.

EXCEPTIONS: Do not deem parental income if the parent or spouse of the parent is receiving Title XIX under a MA non-spenddown case. Do not deem income of a parent receiving cash public assistance: Temporary Assistance cash, SSI, SAB, SP, Refugee Assistance, Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, and Veteran' Administration pensions.

For MO HealthNet for Disabled Child (MHDC) spend down, incurred medical expenses, not subject to payment by a third party, of the following may be used to determine if the disabled child meets spend down:

the disabled child, and
the disabled child's natural or adoptive parent/s whose income is used in determining eligibility.

NOTE: This does not include a stepparent because under Missouri law stepparents are not legally liable for the support of step children.

Use the following method for deeming income from parents to disabled children:

Determine an allocation for each minor child (under age 18) who is living in the home and who is not applying for MA. Do not include an allocation for any child who receives cash public assistance: Temporary Assistance cash, SSI, Refugee Assistance, Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, and Veteran' Administration pensions. Determine the allocation by subtracting the SSI maximum for one person from the SSI maximum for two persons. For each child who is receiving an allocation, deduct that child's own income to determine the final amount of the allocation.
Determine the parental income, earned and unearned. Income exclusions in Section 0805.015.10 deduction of overhead expenses in Section 0805.015.15 apply to the parents' income. Do not consider payments from the Missouri Family Trust Fund made to the parent for the disabled child as income of the parent or child.
Subtract the allocation determined in Step 1 from the parental unearned income. If the allocation is greater than the unearned income, or if there is no unearned income, subtract the excess allocation from the parental earned income.
Subtract the $20 personal income exclusion from any remaining parental unearned income. If the remaining unearned income is less than $20, subtract the remainder of the $20 from the parental earned income.
Subtract $65 from the remaining earned income.
Subtract one-half of the remaining earned income from the result of Step 5.
Add any unearned income remaining from Step 4 to the result of Step 6.
Subtract the parental living allowance from the result of Step 7. The parental living allowance is the SSI maximum for the number of parents in the home whose income was used in deeming.
The amount in Step 8 must be deemed to the disabled children in the home who are applying for MHDC. If there is more than one disabled child, divide the deemed income equally among them.

Example #1: Mrs. Boulanger has two children, Marie and Jane. She is applying for MHDC benefits for Marie. Jane has no income; Marie receives $140.00 OASDI from her father's account. Mrs. Boulanger receives $418.00 OASDI benefits from her deceased husband's account. She also earns $2,297.00 per month.

SSI maximum for two persons	$ 1157.00
SSI maximum for one person	- $ 771.00
Maximum allocation per non-MHDC child	$ 386.00

Total allocation for Jane	$ 386.00

Parent's unearned income	$ 418
Total allocation for Jane	- $ 386.00
	$ 32.00
Personal income exclusion	- $ 20.00
Remainder of unearned income	$ 12.00

Parent's earned income	$2297.00
Standard earned income exemption	- $ 65.00
	$2232.00
Subtract half	- $1116.00
	$1116.00
Add remainder of unearned income	$ 12.00
Total net income	$1128.00
SSI maximum for one
(The number of parents in the home)	- $ 771.00
Amount to deem to Marie	$ 357.00

Example #2: Mr. and Mrs. Johnson apply for their disabled child, Kay. They have two other children, Cindy and Denise. Cindy receives OASDI benefits of $258.00. Denise has no income. Mr. and Mrs. Johnson have gross unearned income of $452.00 and gross earned income of $4000.00

SSI maximum for two persons	$1157.00
SSI maximum for one person	- $ 771.00
Maximum allocation per non-MHDC child	$ 386.00

Cindy's allocation ($386-258)	$ 128.00
Denise's allocation	$ 356
Total allocation for non-MHDC children	$ 454.00

Parent's unearned income	$ 452.00
Total allocation for non-MHDC children	- $ 514.00
Remainder of unearned income	$ 0.00
Leftover allocation not taken out of
parent's unearned income	$ 62.00

Parent's earned income	$4000.00
Leftover allocation	- $ 62.00
	$3938.00
Personal income exclusion	- $ 20.00
	$3918.00
Standard earned income exemption	- $ 65.00
	$3853.00
Subtract half	-$1926.50
	$1926.50
SSI maximum for two
(The number of parents in the home)	-$1157.00
Amount to deem to Kay	$ 769.50