|
All Medicaid Programs |
|
Obsolete Policy |
Effective Date: November 1, 2017 - October 31, 2021
Previous Policy for Deprivation of Support MAGI
Previous Policy for Deprivation of Support Family Medically Needy
Meeting Deprivation
A child is deprived of parental support if:
A parent is absent from the home.
A parent is deceased.
A parent is incapacitated.
A parent in a two or more parent household is unemployed or employed less than 100 hours per month.
Definition of Deprivation
Deprivation Due to Absence
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 separated or divorced parents have joint custody. Determine if deprivation exists based on the individual household circumstances.
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 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.
A child is deprived of support when a parent is living in the home under the following conditions:
The parent has been convicted by a court; AND
The sentence requires that the parent perform unpaid public work or unpaid community service; AND
The court is allowing the parent to live at home.
The convicted parent is treated as though absent from the home. Count the parent in the MAGI household as indicated in section 234. The parent can receive coverage under the PCR program if otherwise eligible.
NOTE: Before denying or closing PCR for a lack of deprivation due to absence, you must provide enough acceptable evidence to prove that a parent is not absent. Evaluate each case carefully.
Deprivation Due to Death
A child is deprived of parental support when:
a parent is deceased and
The surviving parent has not remarried.
NOTE: The surviving parent or specified relative must apply for Social Security, Veteran's Administration, or any other benefits the parent and child might be entitled to receive (223).
Deprivation Due To Incapacity
A child is deprived of support when either parent has a physical or mental incapacity. The parent is incapacitated when he or she:
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).
Employment of 100 hours or more per month nullifies a parent’s claim to incapacity unless the parent meets a. i, a. ii or a. iii above.
Deprivation Due To Unemployment
A child who lives in a two (or more) parent household is deprived of parental support if one of the parents is unemployed or employed less than 100 hours a month.
Employment of Less Than 100 Hours a Month
At least one parent of a two (or more) parent household 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 parent worked 100 or more hours in the current month, AND
The parent worked less than 100 hours in the 2 previous months, AND
Is expected to work less than 100 hours in the following month.
Note: If the parent is on paid leave from his employer (sick, vacation pay, etc.) he is not considered to be unemployed or working less than 100 hours. Any paid hours count as employed hours.
100 hour rule for the Self-employed parent.
A self-employed person may declare how many hours they work each month. If the client reports that he works less than 100 hours per month, he must explain the reason for the reduction in hours. This information must be added to the other self-employment information and narrated on the case.
Temporary Absence
Joint Custody Situations
Do not base household composition SOLELY on a court order awarding custody. Consider the actual circumstances of where the child lives on a case-by-case basis.
A child’s physical living arrangement is where the child returns to after a temporary absence or visitation to the other parent.
When living arrangements show the child is living 50% of the time in each parent’s household, count the child in the household of the parent who applies first and is found eligible.
If both parents apply on the same day, they may decide together in which household to count the child. Document their agreement.
If parents dispute which household they want the child to be a part of, request an investigation.
When both parents claim they have physical custody of the child more than 50% of the time, refer an investigation. The investigator will make the decision based on the household circumstances.
If there is an actual change of residence of a Medicaid recipient (child begins living in the other parent's household more than 50% of the time), remove the child from the open Medicaid case using 10-10-10 rules. If the other parent has an open medical assistance case, refer to 815-4 about adding a new household member to re-determine the child's eligibility.