Medicaid Policy
Medicaid Policy
Previous Policy (425-5 was previously found in section 403-14 until November 1, 2021)
Introduction
Certain immigrants are required to have a sponsor when they apply with the U.S. Citizenship and Immigration Services (USCIS) for entry to the United States. When a non-citizen who is required to have a sponsor applies for entry, or a change in status, on or after December 19, 1997, the sponsor must sign a legally-enforceable Affidavit of Support, Form I-864, with USCIS. When the sponsor or sponsors have signed an I-864, public assistance agencies must deem income from the non-citizen's sponsor to determine the non-citizen's eligibility for benefits. This includes the following individuals:
· Certain immediate relatives or family members of a U.S. citizen or lawful permanent resident; and
· Employment-based entrants when a family member owns 5% or more of the business that will employ the immigrant.
Sponsor deeming does not apply when the sponsor is an agency or corporation, it only applies when the sponsor is an individual.
A. MAGI-Based Households
Do not deem sponsor's income to the sponsored non-citizen.
· If the sponsor claims the sponsored non-citizen as a tax dependent, but is not the spouse or parent of the non-citizen, count any cash contributions given to the non-citizen as income of the sponsored non-citizen.
· If the sponsor is the spouse or parent of the non-citizen, follow the MAGI-based income rules on determining household income.
B. Non-MAGI Households
Apply policy only to lawful permanent resident non-citizens who apply for entry or a change in status on or after December 19, 1997. Apply policy for the following groups in the following ways:
(See #5 for how to count sponsor’s income)
1. Sponsored non-citizens
Determine who is a sponsored non-citizen subject to deeming.
a. Sponsored non-citizens enter the United States as lawful permanent residents.
b. Sponsored non-citizens should know they are required to have a sponsor, even though they may not have a copy of the Affidavit of Support. (A non-citizen may have joint sponsors.)
c. Do not require the sponsored non-citizens to provide a copy of the Affidavit of Support if they declare they have a sponsor who has signed the document.
d. The sponsor of a non-citizen is financially liable to repay the Medicaid agency the cost of any benefits the Medicaid agency provides to the sponsored non-citizen, except the cost of emergency services. The State can seek recovery from the sponsor.
e. Do not exclude the sponsored non-citizen from Medicaid eligibility if they do not provide information about their sponsor.
2. When Sponsor Deeming Does Not Apply
Do not deem income from the sponsor:
a. For Emergency-Only Medicaid. When a sponsored non-citizen is still within the five-year bar period, sponsor deeming does not apply to determine eligibility for Emergency-Only Medicaid.
b. Battered non-citizens. Deeming does not apply when the non-citizen is considered a Battered non-citizen as described in Section 205-2, #1-J for the first 12 months. Extensions to the 12 months may be granted through the fair hearing process.
c. For non-citizens who meet the criteria found in Sec. 205-2, 2.A. #1-6, as they are not required to have a sponsor. Even when these individuals change their status to lawful permanent resident, they are not required to have a sponsor.
· Decide if the individual entered under one of these special immigration statuses.
· For example, non-citizens who are victims of a severe form of trafficking as described in Section 205-2, #1-K are not normally required to have a sponsor.
· Workers should ask the non-citizen if he has a sponsor before applying sponsor deeming rules.
d. Non-citizens who received qualified non-citizen status before December 19, 1997. (See their INS verification for the date of qualified status.)
· This applies even if the non-citizen entered the country after August 22, 1996, because the new Affidavit of Support was not in place until December 19, 1997.
· Even if these non-citizens have a sponsor, do not deem income from the sponsor. (If the sponsor is the spouse or parent, deem income just as you would from any spouse or parent.)
e. For qualified non-citizens subject to sponsor deeming as defined above, who are found to be indigent. See #4 below for the definition of "indigent."
f. For other household members who are not sponsored by the same sponsor.
· For example, a sponsored non-citizen may have a child who was born in the U.S., or other household members who immigrated before the new Affidavit of Support was required.
· Do not count deemed income from a sponsor for one household member to determine eligibility of another household member who is not sponsored by the same individual.
· If other household members who are applying for Medicaid are sponsored by a different individual, determine if you must deem income from their sponsor to determine their eligibility.
g. Once the sponsored non-citizen has become a naturalized U.S. citizen.
h. Beginning the month after the sponsored non-citizen has 40 qualifying quarters of work, or can be credited with 40 qualifying quarters of work.
· Qualifying quarters of a spouse or parent can be used to reach the 40 quarters.
· Qualifying quarters of a parent must be accrued while the non-citizen was a minor to be counted.
i. For lawfully present children as described in section 205-2.1.
3. When the Sponsor is a Spouse or Parent
a. When the sponsor is the non-citizen's spouse, or a minor non-citizen's parent, and lives with the non-citizen, do not use sponsor deeming policy. Instead, apply the income rules counting income from a spouse or parent for applicable the Medicaid program.
b. If the sponsor was the non-citizen's spouse or parent when the non-citizen entered, but now the couple is divorced, separated, or the non-citizen is no longer a minor child subject to regular income deeming from a parent, deem the sponsor's income as if the sponsor were not a spouse or parent unless the sponsor's obligation has ended.
· When deeming income in this situation, if the sponsor (who was a spouse or parent) was active-duty military when the non-citizen was sponsored, call a OEP Program Specialist for special deeming policy.
· If the child has at least one U.S. citizen parent, refer to 205-1 to determine if the child gained automatic citizenship. Sponsor deeming does not apply if the child has attained citizenship.
4. Sponsored Non-citizens Who Are Indigent
Once you know that a person is a sponsored non-citizen, you must decide if the person is indigent.
a. A non-citizen is considered indigent when household income does not exceed 133% of the federal poverty level for the household size. (See Table V)
· Count gross income of any member of the household who must be deemed (spouse/parent). This includes income from a sponsor who is the individual's spouse or parent.
· Count cash contributions the non-citizen receives from sponsors and others (non-spouse or non-parent individuals).
· For ABD households, use the PMV rules for in-kind income. 415-10).
b. Apply the income rules of the program for which the sponsored non-citizen is eligible to determine countable income.
· Use ABD income rules for an aged, blind or disabled non-citizen (443). For ABD programs, if the sponsored non-citizen lives in the home of another, either the sponsor or someone else's and does not pay to live there, use the PMV amount for the value of the in-kind income being received. (See ABD Medicaid Section 415-10 and Table II for PMV.)
· Use Family Medicaid income policy for sponsored non-citizens eligible for Family related programs. 404-5)
· Do not include excluded sources of income
c. The household size of the sponsored non-citizen is determined by the program rules for which the non-citizen qualifies. Children are not counted in their parent's household size under ABD programs. Use the rules in 408 for ABD programs and 404 for Family programs to determine who to include in the household.
d. Compare the gross income (income before disregards) to 133% of the FPL for the applicable household size. (See Table V, Sponsor Deeming.) If income does not exceed 133% of the FPL for the non-citizen's household size, then the sponsored non-citizen is considered indigent.
e. When a sponsored non-citizen is indigent, do not deem income from the sponsor for 12 months from the date the Medicaid agency makes the determination.
· Document this 12-month exemption from deeming in the case record.
· Ask the sponsored non-citizen for the name and address of the sponsor, and document that in the case record.
· Do not exclude an indigent sponsored non-citizen from Medicaid eligibility if they do not provide sponsor information.
· Gather the non-citizen indigent information, including their entry date and the sponsor's name. This information will be collected and reported to DHHS on an electronic report.
f. Indigent non-citizens are not reported to the Attorney General. Do not tell a non-citizen that they will be reported to the Attorney General's office.
g. Determine the sponsored non-citizen’s indigence every 12 months even if case reviews are set for shorter periods. There is no limit to the number of 12-month eligibility periods a non-citizen can be considered indigent and exempt from sponsor deeming.
5. How To Determine The Amount Of Income To Be Deemed From The Sponsor
When the sponsored non-citizen does not meet any of the exceptions for sponsor deeming in #2, #3, or #4, calculate how much income to deem from the sponsor.
a. Divide 125% FPL for the household size by the total number of members in the sponsor’s household (if it is a joint sponsor, not husband and wife sponsors, include the members of the joint sponsors household size as well), including all sponsored non-citizens of that sponsor. (See Table V).
b. Compare this amount to any actual amount given to the non-citizen by the sponsor.
c. Count the greater amount as the sponsor’s deemed income.
6. Stop Deeming Income From the Sponsor:
a. When the sponsored non-citizen becomes a naturalized citizen.
b. When the sponsored non-citizen acquires 40 qualifying work quarters or can be credited with 40 qualifying quarters.
c. When the sponsor dies. (If a individual has joint sponsors and at least one is still alive, the non-citizen is still subject to the deeming policy.)