My sister is on disability (stroke) and she lives with me.

Am I a “family member” as stated on the  MC 262 Medi-Cal – Long Term Care Redetermination form?

“Family size” pre ACA – Obamacare for  Medicaid – Medi Cal is now the same as the  definition of “household” used under the same rules for Covered CA subsidies APTC –  MAGI. as spelled out in  42 CFR Parts 431, 435, and 457  Kaiser Family Foundation

MC 262 Medi-Cal - Long Term Care Redetermination
MC 262 Medi-Cal – Long Term Care Redetermination

Household Size for Medi Cal qualification

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.

See our pages on  Household Definition for MC 216 MAGI Income Medi-Cal Redetermination.

DHCS FAQ’s for Social Workers   5.19.2011

Western Poverty Law – Guide to keep Health Coverage for Low Income Californians

 

States have the option of defining what is meant by a “family of the size involved” for purposes of determining eligibility for QMBs and SLMBs, section 1905(p); QDWIs, section 1905(s); the optional aged and disabled group, section 1902(m); and the COBRA continuation group, section 1902(u).

States may continue to use the current definition i.e., a “family” is either an individual or a couple, with additional family members accounted for through the SSI deeming process.

However, the States can establish a different definition if they choose to do so. As one example, an eligible individual with an ineligible spouse and three children could be defined as a family of five, with the poverty level for a family five used as the income standard. Other variations are possible; what alternative definition, if any, to use would be up to the State  Medicaid.Gov

***

Medicaid financial eligibility for most groups will be based on modified adjusted gross income (MAGI), (Line 37 1040) as defined in the Internal Revenue Code. The rule generally adopts MAGI household income counting methods, eliminating various income disregards currently used by states. CMS also generally aligns “family size” in the current Medicaid rules with the MAGI definition of “household” and provides household composition rules for individuals, such as non-tax filers, who are not addressed by MAGI methods. Certain groups are exempt from use of MAGI; their financial eligibility will continue to be determined using existing Medicaid rules.

The move to MAGI for many groups will result in some changes from current Medicaid rules related to calculating family size and income and will largely align Medicaid financial eligibility determinations with the standards used to determine eligibility for premium tax credits and cost-sharing reductions through the Exchanges.

The new rule 42 CFR Parts 431, 435, and 457 under Obamacare – ACA generally aligns references to “family size” in the current Medicaid rules with the definition of “household” used under MAGI.    Kaiser Family Foundation

Ask a question below or read more FAQ’s

I just don’t understand why they would need information about my insurance, etc. Other than the fact that I do take care of her,

***Maybe you will qualify for payments under IHSS In Home Supportive Services?

I am not legally responsible for her, so I should not have to answer any personal questions about myself. Correct?

***Is she on your tax return?  A dependent?  Mentioned in the Medi-Cal Household size flow chart?  See our webpage on household definition where we answered a very similar question.

10 comments on “Family Members? vs Household Question 15 A MC 262

  1. I am applying for medi-cal:

    20 years old student
    file my own taxes
    live with my two parents and
    they also claim myself in their taxes.

    What will be the household # for my medi-cal application? ( I am the only one applying for the medi-cal ) my parents don’t want to apply.

    Also what household income I need to report theirs?

    Only mine PT job income or both?

    • See our page on being claimed as a dependent.

      If an adult is claimed as a tax dependent by their parents, will their parents income count towards the dependent adult’s income for eligibility?

      Yes. The adult who expects to be claimed as a tax dependent by his/her parents will have his parents income counted when determining income eligibility under the MAGI methodology. Federal regulatory reference is 42 CFR 435.603(f)(2). dhcs.ca.gov *

      What’s the total income? Maybe you qualify for Covered CA subsidies, get quotes here.

      Let your parents know that next year there is a tax penalty if you don’t have coverage!

  2. My son is an adult and lives with us.

    He qualifies for Medicare as a Disabled Adult Child (DAC) and therefore qualified for Medi-Care without MAGI [Modified Gross Income — Chart] requirements.

    He needs to file a Redetermination Form for 2018.

    Are we (my wife and I file jointly) required to be included in his “household” even though he is a DAC?

  3. My step daughter, who turns 21 9.2018 moved out of our home and found a job somewhere. We don’t have any information about any of her income.

    We don’t file taxes at the moment yet.

    Should I remove her from our household?

    • Remove her, as IMHO she is not in your household as you would not expect to claim her as a dependent, when you do file taxes. See also the definition of dependent Section 152

      (c) Qualifying childFor purposes of this section—
      (1) In generalThe term “qualifying child” means, with respect to any taxpayer for any taxable year, an individual—

      (B) who has the same principal place of abode as the taxpayer for more than one-half of such taxable year…

    • That’s a good question. Give me a few days to research further. This is pro bono work. The main problem here that I see is that if the household income is over 138% of federal poverty level, then your Mother would not qualify for MAGI-Medi-Cal. For a family of two, that would be $23,413.

      Your Mother might qualify for Covered CA subsidies… Use this link to get quotes.

      I’m not a tax attorney, but my understanding is that if your sister is taking your Mother as a deduction, she’s going to have to release the income information, one way or the other.

      I will also ask Medi-Cal to review your question and respond here mailto:[email protected]

  4. 1. I live with my brother rent free but he does not support me or claim me as a dependent on taxes, so I applied as 1 household and 0 income to Medi-cal.

    2. If my brother does claim me as dependent do I change the household to 2 and put his income down?

    3. And since he makes a good income will I lose my Medical benefits?

    Thank you for your time with my inquiry.

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