Medicaid Policy
Medicaid Policy
Resource - Household Summary for Family Related Medicaid Programs
Consider MAGI-based coverage for children in the household before determining their eligibility for medically needy coverage. Follow policy 210 when determining a child's age for the various child programs. The household may choose to enroll in CHIP, if eligible, or Child Medically Needy.
A. Child Age 0-1 Born to a Mother on Medicaid
1. Approve a child for Child 0-1 starting with the month of birth when the child's mother was eligible for and received Utah Medicaid in the month of the child's birth. This includes women who are only eligible for emergency coverage. The mother can be on Medicaid without cost. She can also pay a spenddown or MWI premium to receive Medicaid for the month of delivery. The child's coverage lasts from the month of birth until the child turns one.
· If the mother is on RMA or is only presumptively eligible, the child does not qualify for the Child 0-1 coverage.
2. Changes in household circumstances during the first year do not affect eligibility for the child unless the child is no longer a state resident or the family requests the case be closed. If the family returns to Utah before the child turns age 1, reopen the program to complete the year.
3. Request TPL information for the child. Do not delay or discontinue Child Under Age 1 if the parent does not provide the information (225).
4. The child does not have to continue to live with the birth mother. If the child changes households, the new household must re-apply on behalf of the child to continue the coverage for the remainder of the year. In the case of an adoption, the birth mother's Medicaid eligibility in the birth month should be verified without divulging her personal information.
B. Child Under 19
1. The child must meet citizenship and state residency requirements.
2. There is no asset test to determine eligibility.
3. Countable household income must be under the MAGI income standard. There are different income limits for a child 0-5 and a child 6-18. See Table VII.
4. When a child turns 6, determine if the income is under the limit for Child 6-18 and continue coverage if eligible. Otherwise, determine if the child is eligible for CHIP.
C. Child Medically Needy
1. Children may be eligible for Medically Needy Child if they are not eligible for:
a. MAGI-based Child Medicaid because of the income limit, or
b. Medically Needy Family because they are not deprived of parental support. See section 404-4 for the household composition.
2. There is an asset limit test for medically needy child coverage. (See 731-3 for policy on when to accept client statement as verification of assets.)
3. There is an income limit test for medically needy child coverage. See section 441-2 to determine income eligibility and calculation.
4. Ask the adult responsible for the child's care to complete medical support enforcement if a parent is absent from the home (227). However, do not deny or close the child's Medicaid if this is not done.
5. If the household is over the asset limit or they choose not to pay a spenddown, check for CHIP eligibility.