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Household Composition. What’s Changing For Medicaid? Classic Medicaid –The financial eligibility rules for these programs are not subject to the new MAGI.

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Presentation on theme: "Household Composition. What’s Changing For Medicaid? Classic Medicaid –The financial eligibility rules for these programs are not subject to the new MAGI."— Presentation transcript:

1 Household Composition

2 What’s Changing For Medicaid? Classic Medicaid –The financial eligibility rules for these programs are not subject to the new MAGI methodology rules. MAGI-based Medicaid – Refers to individuals who are relatable to Medicaid/CHIP that includes family, Apple Health for Kids, pregnant women, or the newly eligible adults between the age of 19 up to 65. Does not relate to classic Medicaid groups. HealthPlanFinder will get you to the right place Washington Apple Health (WAH) – the new brand name for all Medicaid programs. 2

3 Household Calculation is also applied to Subsidies Calculated differently than Medicaid 3

4 Are you confused/Anxious? It will be ok! What you need to know – Definitions of filing status – Why family members may have differing eligibility – Importance of telling the Exchange of any change in household or income as it occurs – Very general understanding of household calculations. 4

5 What you don’t need to know How the Exchange calculates every family composition situation Tax law Answers to clients questions about how they should file taxes 5

6 Key Takeaways Households for premium credits and Medicaid will not necessarily match people’s actual living situation Household rules could split families into different coverage programs (subsidies or Medicaid) 6

7 Why Medicaid and premium subsidies are calculated by income and family size. Medicaid and premium subsidies define who is in a family differently. 7

8 Why Household Size and Composition Matter Necessary to convert income to a federal poverty level (FPL) standard Who is in the household determines whose income counts in determining eligibility 8

9 Gross Month Family Income Self-employed? Use net income Total Number of Family Members, parents and children Your whole family qualifies for free coverage Your child qualifies for free coverage Your child qualifies for coverage costing up to $30 a month Your whole family qualifies for a subsidy or tax credit 1 $1322 $1915$2874 $ $1784 $2585$3879 $ $2246 $3255$4884 $ $2708 $3925$5889 $ $3171 $4595$6894 $9192 More members? Add $463 for each additional person Add $670 for each additional person Add $1,005 for each additional person Add $1,340 for each additional person 9

10 10 New Medicaid Household Composition An assistance unit is comprised of those household members who must be looked at together due to income, age or tax-filing status in order to determine the household size. Household size determines the income standard we use to determine an individual household member’s eligibility. MAGI assistance rules can be found in Washington Administrative Code effective October 1, Although income of other household members may be used in determining the household’s income eligibility and size for an assistance unit, each individual in the family unit will have their own Medicaid determination.

11 11 There are several key components required to create assistance units such as: A individual’s tax filing status; How household members are related to each other; Their age; and If a woman in the household is pregnant* *If there is a pregnant woman in the household, the assistance unit (or units) she is included in, is increased by one count for each unborn child. Key Components

12 12 Households for Premium Tax Credits Household = individuals for whom a taxpayer claims a deduction for a personal exemption Household for Medicaid Household = Individuals living under one roof Don’t worry – the HealthPlanFinder will sort this out!

13 13 Terms you need to know 1.Head of Household - You can claim the Head of Household filing status on your tax return if you are unmarried at the end of the year, have cared for a closely-related dependent for over half the year, and paid more than half the cost of maintaining a home for yourself and your dependent or dependents 2.Dependent - see next slide 3.Filer - files taxes 4.Non-filer - does not file taxes 5.Married filing single 6.Married filing jointly The term you chose will be the one your client filed on his or her taxes

14 Definitions  Tax Filer: A tax filer is an individual who files taxes and is not claimed as a tax dependent by another tax filer.  Tax Dependent: A tax dependent is an Individual who is claimed as tax a dependent by another person who is a tax filer.  Non-Filer/Non-tax dependent: A non-filer/non-tax dependent is an individual who does not file a tax return and who is also not claimed as a tax dependent by another tax payer. 14

15 15 Must be claimed on taxes as dependent to count

16 16 Must be claimed on taxes as dependent to count

17 17 Even though Washington Healthplanfinder will establish the assistance units, it will be helpful for individuals who assist families in the application process to understand the assistance unit rules so that they can: Confirm that the system results are correct and no error was made in the data entry; and Explain why some household members received different results

18 On the “Primary Applicant’s Taxes” screen in the Washington Healthplanfinder, the following questions are asked: The tax-filing status of the primary applicant; and How they filed for the past tax year; how they plan to file in the current tax year; and how they plan to file in the next year. The information gathered on this screen will establish assistance units for determining eligibility. 18

19 19 WA Healthplanfinder will collect the following information about: Other household members; Their current/future tax filing status; Relationship to the primary applicant; If they live in the same home; Demographics, age, SSN, race, etc.

20 20

21 21 Drop Down Choices for Health Plan Finder

22 22 There are 3 Rules that determine who must be included in an assistance unit. Rule #1 The individual (tax filer) must expect to file taxes for: Themselves; Their spouse living with them; All individuals expected to be claimed as a tax dependent regardless of age

23 23 Single Adult Not Claimed as a Tax Dependent

24 24 Name Applicant for Medicaid Jon Filing Status to select in Healthplanfinder Individual/Head of Household Coding Household Members

25 25 Rule #2 The individual answered NO to Rule #1 – they do not plan to file taxes (tax dependent): Does the individual expect to be claimed as a tax dependent by someone else? o If no: They are a non-filer and must go onto Rule #3 o If yes: The basic rule is that their household is exactly the same as the tax filer that claims them, but there are some exceptions.

26 26 1.A child under age 19 living with parents who do not file a joint tax return 2.A child under age 19 who expects to be claimed by a non-custodial parent 3.A child under the age of 19 who lives with both parents and the parents are not married to each other 4.The individual expects to be claimed as a tax dependent by someone other than a spouse or parent Rule #2 Exceptions

27 27 If one of the exceptions applies to the tax dependent, then the individual is treated as a non-filer and the assistance unit is determined according to Rule #3 Rule #2 Exceptions

28 28 Bob and Suzie are married and file taxes jointly with their child in common, Tommy Bob and Suzie claim Tommy as their tax dependent Married Parents with a Common Child

29 29 Name Applicant for Medicaid BobSuzieTommy Filing Status to select in Healthplanfin der Married filing jointly Tax dependent Coding Household Members

30 30 Jon is an unmarried 20 year old residing in his parent’s home Parents claim Jon as a tax dependent Single Adult Claimed as a Tax Dependent

31 31 Name Applicant for Medicaid Jon Filing Status to select in Healthplanfinder Tax dependent Coding Household Members

32 32 Steve and Donna are married and file taxes jointly Donna’s child, Jonny (10), from a previous relationship, lives with them Steve and Donna claim Jonny, as their tax dependent Married Parents with a Child not in Common

33 33 Name Applicant for Medicaid SteveDonnaJonny Filing Status to select in Healthplanfin der Married filing jointly Tax dependent Coding Household Members

34 34 If the individual answered no to rule #1, no to rule #2 or, yes to rule #2 BUT an exception applies, the individual is considered a NON- FILER. A non-filer’s assistance unit includes: The individual Their spouse Their children under age 19 If the applicant is under age 19, include their parents and siblings under age 19 Rule # 3

35 35 Ann is a single parent and is not filing taxes Ann has two children, Drew (12) and Annabelle (7) Drew’s father claims him as his tax dependent but Drew is currently living with his mother, Ann Single Mom with Children

36 36 Name Applicant for Medicaid AnnDrewAnnabelle Filing Status to select in Healthplanfinder Non-filerTax dependent Non-filer Coding Household Members

37 37 Let’s stop here and discuss how to implement this with a client 1. How might you explain the results to a family when the child is eligible for Medicaid (CHIP), the mom is eligible for a subsidy, and the dad is not eligible for a subsidy? 2. How might you answer questions such as “should I claim my child next year on my taxes or have his dad do so?” or “ should I file separately from my spouse instead of together?”

38 38 Questions End here.

39 39 Examples of how each of the four exceptions apply when determining who to include in the assistance unit Exception Examples

40 40 Exception 1: “A child under the age of 19 living with parents that do not file a joint tax return” Exception Examples

41 41 Brad and Julie are married with child in common, Jesse (1) Brad and Julie file taxes separately Brad claims child, Jesse, as his tax dependent Exception 1: Married Parents with a Child in Common Filing Taxes Separately

42 42 Name Applicant for Medicaid BradJulieJesse Filing Status to select in Healthplanfinder Individual or head of household Tax dependent Coding Household Members

43 43 Exception 2 “A child under the age of 19 who expects to be claimed by a non-custodial parent” Exception Examples

44 44 Ryan and Kari are married with a child in common, Austin, and Kari’s child, Monica, from a previous relationship Ryan and Kari file taxes jointly and claim their child, Austin, as their tax dependent Monica’s father (non-custodial parent) claims her as his tax dependent Exception 2: Non-Custodial Parent Claims Child as Tax Dependent

45 45 Name Applicant for Medicaid RyanKariAustinMonica Filing status to Select in Healthplanfinder Married filing jointly Tax dependent Tax dependent by someone outside of the HH Coding Household Members

46 46 Kevin files taxes and lives with his daughter, Jane (18) Jane is claimed as a tax dependent by her mother, Ann, who does not live in Kevin and Jane’s home Kevin applies for medical for himself and child Jane Exception 2: Child Claimed as a Tax Dependent of a Non-Custodial Parent

47 47 Name Applicant for Medicaid KevinJane Filing Status to select in WA Healthplanfinder Individual or head of household Tax dependent of an individual outside the HH Coding Household Members

48 48 Exception 3 “A child under the age of 19 who lives with both parents and the parents are not married to each other” Exception Examples

49 49 Chris and Carrie are unmarried with a common child, Bertha (3) Chris and Carrie file taxes separately Chris claims child, Bertha, as his tax dependent Exception 3: Unmarried Parents with a Child in common

50 50 Name Applicant for Medicaid ChrisCarrieBertha Filing Status to select in WA Healthplanfinder Individual or head of household Tax dependent Coding Household Members

51 51 Ron and Lucy are unmarried with a child in common, Frankie (7) and a child from a previous relationship. Sara (13) is Ron’s child from a previous relationship. Ron and Lucy files taxes separately Ron claims both children, Frankie and Sara, as his tax dependents Exception 3: Unmarried Parents with Child in Common and Uncommon

52 52 Name Applicant for Medicaid RonLucyFrankieSara Filing Status to Select in Healthplanfinder Individual or head of household Tax dependent Coding Household Members

53 53 Exception 4 “The individual expects to be claimed as a tax dependent by someone other than a spouse or parent” Exception Examples

54 54 Grandpa, Grandma and grandchild, Melissa (16), live together Grandpa claims Grandma and grandchild, Melissa, as his tax dependents Exception 4: Grandparents Claim Grandchild as a Tax Dependent

55 55 Name Applicant for Medicaid GrandpaGrandmaMelissa Filing Status to Select in Healthplanfinder Married filing jointly Tax dependent Coding Household Members

56 56 Exercises

57 57 Theresa is an unmarried 24 year old residing in her parent’s home Parents do not claim Theresa as a tax dependent and she will file her own taxes this year without any dependents Single Adult Not Claimed as a Tax Dependent Applicant for Health Care Coverage Theresa Included in Applicant’s Household Theresa

58 58 Name Applicant for Health Care Coverage Theresa Filing Status to select in WA Healthplanfinder Individual/Head of Household Coding Household Members

59 59 Married Couple No Dependents Dan and Jennifer are married and file taxes jointly Dan and Jennifer do not have any dependents Applicant for Health Care Coverage DanJennifer Included in Applicant’s Household DanJennifer

60 60 Name Applicant for Health Care Coverage DanJennifer Filing Status to select in WA Healthplanfinder Married filing jointly Coding Household Members

61 61 Applicant for Health Care Coverage DanJenniferKim Included in Applicant’s Household DanJenniferKim Dan and Jennifer are married and file taxes jointly with their child in common, Kim who is a minor child. Dan and Jennifer claim Kim as their tax dependent Married Parents with a Common Child

62 62 Name Applicant for Health Care Coverage DanJenniferKim Filing Status to select in WA Healthplanfinder Married filing jointly Tax dependent Coding Household Members

63 63 Single Adult Claimed as a Tax Dependent Kim is an unmarried 19 year old residing in parent’s home Parents claim Kim as a tax dependent Applicant for Health Care Coverage Kim Included in Applicant’s Household Kim

64 64 Name Applicant for Health Care Coverage Kim Filing Status to select in WA Healthplanfinder Tax Dependent Coding Household Members

65 65 Applicant for Health Care Coverage DanielGabrielaSofiaJessie Included in Applicant’s Household DanielGabrielaSofiaJessie Daniel and Gabriela are married and are not filing taxes Daniel and Gabriela have two children at home, Sofia, who is a minor and Jessie who is 19 years old. Parents with Children

66 66 Name Applicant for Health Care Coverage DanielGabrielaSofia Applicant for Health Care Coverage Jessie Filing Status to select in WA Healthplanfinder Non- filer Filing Status to select in WA Healthplanfinde r Non- filer Coding Household Members

67 67 Married Parents with a Child in Common Filing Taxes Separately Applicant for Health Care Coverage DanielGabrielaSofia Included in Applicant’s Household DanielGabrielaSofia Daniel and Gabriela are married and have a minor child, Sofia in common Daniel and Gabriela file separately Daniel is claiming child Sofia as his tax dependent

68 68 Name Applicant for Health Care Coverage DanielGabrielaSofia Filing Status to select in WA Healthplanfinder Individual or head of household Tax dependent Coding Household Members

69 69 Applicant for Health Care Coverage JasonAmandaJaredSonia Included in Applicant’s Household JasonAmandaJaredSonia Jason and Amanda are married with a child in common, Jared, and Amanda’s child, Sonia, from a previous relationship Jason and Amanda file taxes jointly and claim their child, Jared, as their tax dependent Sonia’s father (non-custodial parent) claims her as his tax dependent Non-Custodial Parent Claims Child as Tax Dependent

70 70 Name Applicant for Health Care Coverage JasonAmandaJaredSonia Filing Status to select in WA Healthplanfinder Married filing jointly Tax dependent Coding Household Members

71 71 Applicant for Health Care Coverage GloriaMichael Included in Applicant’s Household GloriaMichael Gloria files taxes and lives with her son, Michael (18) Michael is claimed as a tax dependent by his father, Devin, who does not live in Gloria and Michael’s home Gloria applies for medical for her and son Michael Child Claimed as a Tax Dependent of a Non-Custodial Parent

72 72 Name Applicant for Health Insurance Care GloriaMichael Filing Status to select in WA Healthplanfinder Individual or head of household Tax dependent Coding Household Members

73 73 Applicant for Health Care Coverage SeanKellyMolly Included in Applicant’s Household SeanKellyMolly Unmarried Parents with a Child in common Sean and Kelly are unmarried with a child in common, Molly (3) Sean and Kelly file taxes separately Kelly claims child, Molly as her tax dependent

74 74 Name Applicant for Health Care Coverage SeanKellyMolly Filing Status to select in WA Healthplanfinder Individual or head of household Individual or Head of household Tax dependent Coding Household Members

75 75 Parents unmarried, with Child in Common and Child Not in Common Applicant for Health Care Coverage KarlAmyCoreyBrenda Included in Applicant’s Household KarlAmyCoreyBrenda Karl and Amy are unmarried with a common child, Corey (5) and Brenda (16) Karl’s child from a previous relationship Karl and Amy files taxes separately Karl claims both Corey and Brenda, as his tax dependents

76 76 Name Applicant for Health Care Coverage KarlAmyCoreyBrenda Filing Status to select in WA Healthplanfinder Individual or head of household Tax dependent Coding Household Members

77 77 Applicant for Health Care Coverage DarrylTamaraKrisanne Included in Applicant’s Household DarrylTamaraKrisanne Tamara and her husband Darryl have Tamara’s sister Krisanne (15) living with them Darryl and Tamara file jointly and claim Krisanne as their tax dependent Non-parent or spouse claim Tax Dependent

78 78 Name Applicant for Health Care Coverage DarrylTamaraKrisanne Filing Status to select in WA Healthplanfinder Married filing jointly Tax dependent Coding Household Members

79 Questions? Melissa Rivera Eligibility Policy & Service Delivery Office of Medicaid, Medicare, Eligibility & Policy


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