All Medicaid Programs |
Obsolete Policy |
Policy Effective January 1, 2014 - February 28, 2015
Definition of Deprivation
A child is deprived of parental support if:
A parent is absent from the home.
A parent is deceased.
A parent is incapacitated.
The primary wage earner in a two-parent household is unemployed or employed less than 100 hours per month.
A child may be deprived of parental support if the primary wage earner in a three-parent household is unemployed or employed less than 100 hours per month.
A child is not deprived of parental support if the child lives with two legally responsible parents who do NOT meet a deprivation reason.
Children whose household income is under the income limit for the MAGI-based Child Medicaid program do not have to be deprived of support. Deprivation is a requirement for a parent or caretaker relative to qualify for the Parent/Caretaker Relative group, or the Family Medically needy group.
Meeting Deprivation
Deprivation Due To Absence
A child may be deprived of parental support when a parent is absent from the home the child lives in. A child is also deprived of support if the criteria in d. is met. If the child is not deprived due to absence of a parent, a child could be deprived for some other reason.
A child is deprived of parental support due to absence, if a parent is absent from the home and:
The absence interrupts or terminates the parent's ability to provide maintenance, physical care, or guidance for the child; AND
The expected or unknown duration of the absence prevents counting on that parent to plan for the present support or care of the child.
A child may be deprived of support when the parents have joint custody. Determine if deprivation exists based on the individual circumstances of each household. For joint custody situations, criteria in a. must be met to consider the child deprived of support, and the child must not spend 3 or more nights a week, every week with the absent parent.
A child is deprived of support when a parent is an inmate of a public institution such as a jail or prison. If the parent goes from the public institution to an inpatient stay at a hospital, the parent is still absent from the family household.
A child is deprived of support due to absence when a parent is living in the home and:
The parent has been convicted and sentenced by a court; AND
The sentence says the parent must perform unpaid public service; AND
The parent is performing the unpaid public service; AND
The court is allowing the parent to live at home.
For a MAGI-based Parent/Caretaker Relative eligibility group, count such parent in the MAGI-household size for other family members based on the MAGI household policy. The convicted parent cannot qualify for the Parent/Caretaker Relative group.
For non-MAGI-based medically needy family coverage, the convicted parent cannot be counted in the household for the Family coverage group, and cannot receive coverage under that group.
A child is not deprived of parental support due to absence if one of the following statements is true:
The parent is absent only because of military service.
The parent is absent only because of employment, schooling, training or another temporary purpose.
The parent will return to live in the home within 30 days from the date of the application.
The absent parent is the primary child care provider for the child and such care is frequent enough that the child is not deprived of the parental support, care and guidance as defined above.
The absent parent has joint physical custody, whether court ordered or not, which is defined as: the child actually stays overnight with the absent parent at least 3 of 7 days per week, every week.
Before denying or closing a Medicaid program for no deprivation due to absence, provide enough acceptable evidence to prove that a parent is not absent.
Deprivation Due to Death
A child is deprived of parental support when:
a parent is deceased and
The surviving parent has not remarried.
The surviving parent or specified relative must apply for other benefits the child might be entitled to receive. See section 223.
Deprivation Due To Incapacity
A child is deprived of support when either parent has a physical or mental incapacity. Do not consider the role filled by the parent prior to the onset of the incapacity. The incapacity must:
Be expected to last for at least 30 days from its onset, AND
Substantially reduce or eliminate the person's ability to work or provide care for the child.
A parent is incapacitated if the parent:
Is an SSI recipient, OR
Has been determined to be disabled by SSA, OR
Has been determined to be disabled by the State Medicaid Disability Office, OR
Is recognized as 100% disabled by the Veteran's Administration (VA), OR
Can provide a Form 21, Medical Report, or other medical evidence that indicates he or she has an incapacity that is expected to last at least 30 days and will substantially reduce his or her ability to work or care for a child. The Form 21 or other medical evidence must be completed and signed by one of the following licensed medical professionals:
Medical doctor
Doctor of Osteopathy
Advanced Practice Registered Nurse
Physician’s Assistant
Mental health therapist (This includes: a psychologist, Licensed Clinical Social Worker, Certified Social Worker, Marriage and Family Therapist, Professional counselor, or MD, DO or APRN engaged in the practice of mental health therapy.)
A child is deprived of support through the end of the month in which the parent’s incapacity ends.
Employment of 100 hours or more per month nullifies a parent’s claim to incapacity unless the parent meets b. i, b. ii or b. iii above.
Deprivation Due To Unemployment
A child who lives in a two (or three) parent household is deprived of parental support if the parent who is the Primary Wage Earner is unemployed or employed less than 100 hours a month.
The Primary Wage Earner (PWE)
The Primary Wage Earner is the parent who had the most earnings in the 24 months before the application month. This also applies to self-employed persons. If there is not enough information to decide which parent is the PWE or if both parents earned the same amount, the household may choose the PWE.
The same parent will be the PWE for as long as the family continues to receive Parent/Caretaker Relative coverage or Family Medically Needy Medicaid without interruption. The household may not choose a new PWE at review. Make a new PWE determination only if the Parent/Caretaker Relative or Family Medically Needy program closes and the household later reapplies.
Employment of Less Than 100 Hours a Month
The PWE must have worked or be expected to work less than 100 hours in the benefit month for the household to meet deprivation due to underemployment.
This applies to the application month, any retroactive months and ongoing months with the following exception:
The PWE worked 100 or more hours in the current month, AND
The PWE worked less than 100 hours in the 2 previous months, AND
Is expected to work less than 100 hours in the following month.
A parent on paid leave (sick, vacation pay, etc.) is not considered to be unemployed or working less than 100 hours if the combination of paid leave hours and any paid work hours equal or exceed 100 hours. Any paid hours count as employed hours.
100 hour rule for the Self-employed primary wage earner.
A self-employed person may declare how many hours they work each month. If the client reports working less than 100 hours per month, the client must explain why this is so. This information must be added to the other self-employment information on the case.