How many people does Medi-Cal count as being in your Household?
What is the definition?

The  Medi-Cal 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

For one thing, you have to remember 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

(f) Household
Definition (1)Basic rule for taxpayers

not claimed as a tax dependent.

In the case of an individual who expects to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made, and who does not expect to be claimed as a tax dependent by another taxpayer, the household consists of the taxpayer and, subject to paragraph (f)(5) of this section, all persons whom such individual expects to claim as a tax dependent.

(2) Basic rule for individuals

(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) 

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.

Flow Chart
Flow Chart based on 42 CFR 435.603
For other scenarios – check out the related pages in  Household Definition – Who counts?  section
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7 comments on “Not Claimed as Tax Dependent – Household Definition F 1

  1. Health Insurance is just too expensive as I don’t qualify for subsidies. Would it make sense for me not to take the deduction for my adult children and let them go on Medi-Cal?

  2. We originally obtained MediCal for my wife and I when I entered “disability retirement” in California’s teacher retirement system, and had a share of cost. We paid for Healthy Families coverage for our 3 children. The ACA changed the state’s calculations, and they extended full free Medi-Cal to the whole family based on income. Our 19 year old son (our oldest) is seeking full-time employment with benefits, and if his new income were used in redetermination, my wife and I would lose coverage.

    If we no longer claim him as a dependent when we file next year (for this year’s taxes), will that automatically remove him from the household for Medi-Cal purposes, or does he also have to physically move out of our home?

    • Since he’s over 19 and I presume won’t be a full-time student too, your OK. Check the chart above. Double check with your county worker. They get paid to help you. I don’t. Review your redetermination form. Note also, that when your son gets a job, you must report it to Medi-Cal.

      If you do one way or another earn more than the Medi-Cal limits, you will be notified. Then you can get Covered CA with subsidies and we would be compensated to help you with that. Click here for quotes.

      Residence is not the issue. It’s the tax return.

      Medi-Cal is not FREE. It’s coming from my pocket and other taxpayers. In 2016, $260 billion will be from taxpayer money.

      If your son doesn’t find a job with benefits, he can qualify for Medi-Cal or Covered CA on his own. Covered CA though mandates he file a tax return. See above link for quotes.

  3. Hi, me and my boyfriend live together and have a 7 month old baby.

    He works and I currently do not.

    Is it possible to ad him to my Medi-cal insurance?

    • I doubt it, as you are not married and probably not all on the same tax return.

      Who is taking whom as a dependent?

      What is your boyfriends expected MAGI Income for 2018?

      Is coverage offered to him at work?

      He can get Covered CA quotes here, as he’s probably earning more than $17k and won’t qualify for Medi-Cal on his own.

      If he’s taking the child as a dependent, he can list the child as a dependent and the quote engine will calculate his cost and show if the child still qualifies for Medi-Cal. See the income chart.

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