Medicaid Policy                                                                 

404-1 Parents and Caretaker Relatives Medically Needy Household Composition

Effective Date: November 1, 2021

Previous Policy (404-1 was previously found in 345 D until November 1, 2021)

 

 

A.   Household Structure for the Family Medically Needy Program

The Parents and Caretaker Relatives Family Needy program is also known as the Family Medically Needy. Family relationships are used to determine who must be included in the same Medicaid household. A person may be counted in the household size even though the person does not qualify for coverage under the medically needy program. A child may be counted in the household size but receive benefits under the MAGI Child Medicaid program if the household income is within the limits of that program.

1.    Spouses, parents and dependent children who live together are counted in the household size.

 

a.    Do not include a parent, step-parent or adoptive parent who receives SSI in the household size.

b.   For a parent to be eligible, there must be a dependent child in the household (345-1). The child must be deprived of parental support (345-2).

 

2.    Do not count a child who receives SSI in the household size. The child may meet the criteria of being a dependent child to qualify a parent for coverage even if there are no other dependent children in the home.

 

3.    Count an adopted child who receives a Federal, State or Local government special needs adoption payment in the household size. The child must meet the criteria in 345-1 and 345-2.  A subsidized adoption child cannot receive coverage under Family Medically Needy (355).

 

4.    Count an unborn child, or children, of a pregnant woman in the household size. The unborn child may be considered a dependent child in the third trimester to qualify her for the Family Medically Needy program, if there are no other dependent children in the home.

 

5.    The unmarried father of an unborn child may receive Family Medically Needy if he:

a.    is living in the home with the pregnant woman who is in her third trimester; and

b.    has acknowledged paternity on Form 941.

Do not include the unmarried father in the same Medicaid household as the pregnant woman.