How many people are in the Household?
What is the definition?

IRS and CPA Video on Tax Filing Status

ITA Interactive Tax Assistant - Filing Status

The sample redetermination form  MC 216 states:

We may need some information about people in your household who live with you or are listed on your tax return, who do not have Medi-Cal and who do not want to apply for Medi-Cal.Sample MC 216

Please note that, Medi-Cal wants to cover everyone and may go beyond the law to gather information to do that.  There are also many other programs that Medi-Cal has that you might qualify for and no one would know unless they asked.  Such as:

MORE Social Services – In Addition to Medi-Cal

IHSS In Home Supportive Services

 

Scroll down to view Household Size Flow Chart

IRS Publication 501
Dependents, Standard Deduction & Filing Status 

Who Must File 
Who Should File 
Filing Status 
Dependents 
Social Security Numbers for Dependents
Standard Deduction 

Historical - Federal Poverty Level & Program Chart - Cost Sharing Reduction - Enhanced Silver at 100% of FPL is only theoretical
Federal Poverty Level & Program Chart

Check out the Household Size Flow chart  below, or click on it to get a sharper image,  for a simpler way of looking at the 42 CFR 435.603 rules.
 
 
Household Size for Medi Cal qualification
 
(5) For purposes of paragraph (f)(1) of this section, if, consistent with the procedures adopted by the State in accordance with § 435.956(f) of this part, a taxpayer cannot reasonably establish that another individual is a tax dependent of the taxpayer for the tax year in which Medicaid is sought, the inclusion of such individual in the household of the taxpayer is determined in accordance with paragraph (f)(3) of this section.  Copied from  42 CFR 435.603 – Application of modified adjusted gross income (MAGI) 
 

We’ve divided up  four sub-pages the major classifications of tax filing status of those who may apply-qualify  for Medi-Cal.  See child pages below.

Resources & Links
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MAGI Modified Adjusted Gross Income for Covered CA Subsidies and Enhanced Silver  citing IRS  26 USC § 151  appears to only apply to those actually on your tax return.  Please contact competent tax counsel.   We do not give tax or legal advise.  Volunteer Income Tax Assistance VITA

Federal regulatory reference is 42 CFR 435.603

Western Poverty Law on Tax Filer Rules

Orange County Covered OC FAQ # 5  – doesn’t really answer your question.

 
See our contact Medi-Cal  page if you would prefer to ask Medi-Cal directly for help.  It’s pro-bono work for us.

Disability Benefits 101 – Medi-Cal the Details

Travel Policies

72 comments on “Household Definition – Who counts?

  1. Steve,

    I want to give you my greatest gratitude for everything you’ve assisted us with and how knowledgeable you are.
    I’m truly grateful for you.

    Rachel F

  2. i am on SSDI dac [disabled adult child] under my fathers record

    i do NOT file taxes

    will i get a 1095b? Proof of Insurance from Medi Cal?

    does the 1095b have anything to do with my annual medi-cal/medicaid re-newal?

    or is the 1095 something seperate?

  3. My boyfriend is currently going to school and has no health insurance. I however have Medi Cal. We live together. Is there a way to add him to my Medi cal?

  4. My 71 year old mother-in-law is immigrating to the US via green card, she will be filing her own tax returns (zero income) and no one will be claiming her as a dependent, nor will she be claiming anyone as a dependent.

    She will live in my home with my wife, myself and 3 year old daughter.

    In filling out the Medi-Cal application, it’s asking about EVERYONE in the ‘household’, even if they don’t want insurance, including roommates and boyfriends and girlfriends and also asking for sensitive income information.

    Are myself, my wife and child considered “living in her household”?

    Do I need to provide my tax information?

    I am minimally insured through work as well as my wife and daughter but they won’t add her on as a mother-in-law.

    Very confused.

    Thanks!

    • Oh sorry for the trouble I re-read some of the earlier posts and based on what you said, my mother-in-law’s household size would be ONE (herself only), she in essence is just someone living in my home for free and filing her own tax returns, her Medi-Cal eligibility has nothing to do with me, my wife or child since she is not our dependent,

      cheers.

  5. 1. My girlfriend lives with me and we have a child together. She stays home to take care of our son. She teaches a class for children 2 hours a week but she earns less than $4000/year.

    2. She’s had medi-cal for some time now but now they’re asking about my income and any child support payments my girlfriend receives.

    3. It seems like they’re trying to get me to pay for child support when I already support both her and my child under one roof.

    4. She’s worried she will no longer be eligible for medi-cal although based on my research that does not seem to be the case.

    5. My son and I have insurance through my employer. I will be claiming my son as a dependent on my tax return but will NOT be claiming her.

    6. Is she still eligible?

    7. Do I need to fill out the child support paperwork?

    • 7. I would say yes. Please review the research below. Namely, bartering. She might well be earning an income that would no longer qualify for Medi-Cal, see chart. Is she a household of one or two?

      Also, it’s quite likely that you earn more $$ than I as a Covered CA agent, mandated to “facilitate” enrollment into Medi-Cal and don’t even get paid to do that.

      Why do I and all the other taxpayers have to support your girlfriend’s health insurance when IMHO you ought to just marry her and pay all her and your child’s expenses.

      2 & 7 – Here’s information on child support and Medi-Cal

      Medi-Cal eligibility procedure manual See page 37 about value of in kind for food, utilities, housing, clothing, this manual was written in the 80’s so add inflation.

      Child Support Handbook

      Employer Medical Support FAQ’s
      What if the child is covered under Medi-Cal?

      Medi-Cal is not considered a substitute for private health care coverage. The employer must still comply with the medical withholding order.

      IRS.gov In kind Contributions

      IRS.gov Bartering

  6. question i thought i would be too high of a income for disabled medi-cal because i get 1368, the medi-cal lady said no i would not because the 1368 comes off my fathers record not mine, reason i ask is if it it is same for the medicaire savings/extra help programs i rather switch to them medi-cal is to fricking nosey, medicaire extra help/savings programs all they ask is anyone related to you or your wife thats IT so if my 1368 would not count against me for those programs i would just drop medi-cal

  7. My boyfriend does not file taxes and is living with me. I fully support him while he gets a business started. He is filing for Medi-Cal. What is his household size?

    • Are you taking the deduction for him on your taxes?

      If you are not, then he can be a non-filer and the household would be 1, till you get married.

      If you are, then: * Household size consists of individual and the taxpayer and all other persons whom the taxpayer expects to claim as a tax dependent step # 4 in the chart in the upper right hand corner

  8. I have a family of 4 including my spouse and 2 kids under 10.

    My mother aged 71 just immigrated to US recently as a permanent resident. She is a widow and is currently living with us. She does not work and has no income.

    Does she qualify as a separate household for the purpose of Medi-Cal eligibility?

    I do not intend to claim her as a dependent.

    • It’s my understanding that even if you did claim her as a dependent, under the non-filer rules above F 2, she would be in a household on her own.

      By herself and not filing, it’s my understanding under F 3 that she would be in her own household of one.

      This is pro bono work. Please double check on your own, seek competent tax or legal counsel, paid Medi-Cal Social Workers and verify in official Medi-Cal brochures. We link to many of them.

      She may also qualify for the aged and disabled program.

  9. I am 55 and my kids receive Medi- Cal and I do not.

    Is their Medi-Cal coverage subject to estate recovery, under My Estate when I die?

    I know If I were receiving Medi-Cal it would be but I cannot find any info concerning if they are receiving it and I am over 55.

  10. I live with my two teenage children (from a previous marriage and we are since divorced), my 2-year old daughter and her father, my EX-boyfriend. Him and I are no longer in a relationship and do not share food or expenses.

    I receive wage income and he receives unemployment.

    I let him live rent free because I do not have a babysitter and he watches her while I work.

    Do we qualify separately for calfresh [food stamps, wic?] and medi-cal or are we considered part of the same household?

  11. I live with my son and daughter in law; we live with them rent free and they provide food/clothes/basic necessities for us. They also claim us on their tax return.

    My daughter in law doesn’t disclosure their income to us and would have us move out if they had to pay for our insurance.

    Am I required to list them as family?

  12. My 19 year old daughter and her baby live with us and have Medi-Cal. Her 18 year old boyfriend just started staying with us so they can be together with the baby. Medi-Cal now wants his income info. i am trying to find what the income guidelines are for a child to qualify for medi-cal with two parents. Does anyone know? I would hate for baby to lose benefits.

  13. My husband is a full time student and i have a part time work and we also we have 4 months old baby. We currently live for free in my husband’s parent’s house

    In filling out the additional income and property information needed for medi-cal

    should i check the box that states a member of the household is a child who is being cared for by a relative?

  14. 1. My stepdaughter is 13 and lives with me. Her mother is deceased and the father is unknown and unnamed on her birth certificate.

    2. I was told that I cannot claim her as a dependent

    3. and I cannot include her on my insurance and work,

    4. yet my income makes her ineligible for Medi-Cal?

    5. Even though Covered California says that her household income is $0?

  15. I live with my boyfriend. He pays the mortgage. I pay the the utilities. It about evens out. We don’t claim each other on our taxes. What is my household size? a 1 or a 2? I am trying to apply for medi-cal

    • See the flow chart above right. Step 3 – No, since neither of you are claiming the other as a dependent.

      * Household size consists of the individual and all persons whom such individual expects to claim as a tax dependent.

      *Household size = Total number of persons counted in household composition

      • I was trying to get clarification on Bryanna above. Are you saying she would be a household size of 1 or 2 then based on the flowchart? Did you mean she would be a HH size of one since she didn’t claim him as a dependent? Thank you.

  16. I am 20 years old and I am going to school full time. I stay with my boyfriend. He does not have his own place so I technically stay at his grandparents house. I do not pay any rent but i work part time and pay for all of my own things including food. What do I put down for my household?

  17. My grandchildren live with me. I am their legal guardian and I claim them on my taxes as dependents. Medi cal determined that they were each their own separate household and said they were eligible for medical. Why?

    • I don’t like to deal with hearsay. Would you please send any actual papers or documents that Medi-Cal sent you.

      How old are the children?

      What is your income?

      Did you want to purchase health insurance for them without Covered CA subsidies?

      What health insurance do you have?

      What coverage did the children have before?

      It’s my opinion that if the grandkids just lost Covered CA that they have a special enrollment period, if you want to buy coverage and pay an unsubsidizd premium.

      Click here to get quotes for the kids.

      I don’t get paid to help the public with Medi-Cal…

    • In reply to Mary who claims her grandchildren as tax dependents…

      If you look at the flow chart it explains it. They meet what is called a Non-filer exemption:
      Does the individual meet one of the following exceptions?

      The tax dependent is-

      1. Someone other than the spouse or child (biological, adopted, or step; minor or adult) of the taxpayer.
      Since they are not your spouse or child, they meet this exemption.

      Non‐Filer Rules-
      Household size consists of the individual plus the following people living with the individual:
       Individual’s spouse;
       Individual’s children under age 19 (natural, adopted and step), or if full‐time student, under age 21;

       For individuals under age 19, or if full‐time student, under age 21:
       Individual’s parents (natural, adopted and step); and
       Individual’s siblings under age 19 (natural, adopted and step), or if full‐time student, under age
      21
      Household size = 1 + total number of people listed above living with the individual.

      Basically, as you are not the spouse, parent, child, or sibling of your grandchildren you do not count as a part of their household and so your income does not count towards them, giving them $0 income.

      • Thank you very much for pointing out the non-filer rules, clearly shown in the flow chart. I will now point that out to another person who asked a similar question.

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