“Family size” for Medi-Cal is based on the same definition of “household” under the same rules for Covered CA subsidies APTC – MAGI. as spelled out in 42 CFR Parts 431, 435, and 457 Kaiser Family Foundation
See our pages on definition of Household, based on how your taxes are filed.
- Claimed as a dependent Household Definition f 2
- Family Members? vs Household Question 15 A MC 262
- Married Couples Household definition f 4
- Not Claimed as Tax Dependent – Household Definition F 1
- Not filing a return – nor claimed as a dependent f 3
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.
DHCS FAQ’s for Social Workers 5.19.2011
Western Poverty Law – Guide to keep Health Coverage for Low Income Californians
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?
Related Pages in Household Definition – Who counts? Section
Too much Income for Medi-Cal?
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Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
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