1. Affordable Care Act Household Composition Session 4 Presented by Tokie Moriel & John Tvedt 1DHS/DFO/IMTA/2013-07-15

2. Session Objectives Present a high level overview of changes to household composition under ACA. Demonstrate how hh comp and income determinations are made. DHS/DFO/IMTA/2013-07-152

3. How MAGI Rules Affect Household Composition Unless otherwise exempted or included, the tax household will contain: –The primary tax payer, and –Married spouses if filing jointly –All tax dependents, including children under age 19 of the primary tax payer. –Stepparents will be treated like parents (i.e., stepparents will be counted in the family size and their income will be counted in the same way a parent’s income is counted) Individuals cannot choose who is to be included or excluded from their household such as excluding a child to make a parent eligible. DHS/DFO/IMTA/2013-07-153

4. MAGI in Medicaid and CHIP: Household Composition For the vast majority of cases, Medicaid households will use the tax household which is determined by the principles of tax dependency. Parents, children and siblings are included in same household –Stepparents and parents treated the same –Children and siblings with or without income included in same household as rest of family –Older children included in family if claimed as tax dependent by parents –Child income is only counted if child is required to file a tax return DHS/DFO/IMTA/2013-07-154

5. MAGI in Medicaid and CHIP: Differences in HH Composition Extended family Children of non-custodial parents Children of unmarried parents Joint Custody DHS/DFO/IMTA/2013-07-155

6. Rules for Non-Filers Mirror rules for tax filers to maximum extent Spouses, parents, stepparents and children living together included in same household. “Child” defined as under age 19. Rules for non-filers also apply to tax dependents excepted from general rule to use tax definition of household. DHS/DFO/IMTA/2013-07-156

7. Establishing Filing Requirements and Tax Dependency Relationships Filing requirements and tax dependency based on reasonable expectations at time of determination. If taxpayer cannot reasonably establish tax dependency relationship, inclusion of tax dependent in household determined in accordance with non-filer rules. DHS/DFO/IMTA/2013-07-157

8. MAC Infant Deemed newborns are automatically eligible for Medicaid and MAGI rules apply to them. Deemed newborns would be counted as part of the HH size/composition. Eligibility for deemed newborns will remain for 12- months unless a change affects eligibility, for example, moving out of state. DHS/DFO/IMTA/2013-07-158

9. 9 MAGI Household Composition Scenarios

10. Single Parent and Child Pat is the mother of Eli, age 6. Pat works and files taxes. She claims Eli as a dependent. DHS/DFO/IMTA/2013-07-1510 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size PatEli PatY22 EliY22

11. Single Parent and Child Pat works and earn 2,500/month (30,000/year) Pat files taxes and claims Eli as a dependent. DHS/DFO/IMTA/2013-07-1511 Whose Income Is Counted For Medicaid HH Size PatEli Total Income Used Pat2 2,500 Eli2 2,500

12. Married with Common Child Filing Jointly Art and Bea are married and have a common child, Cam. Art and Bea both work. Art and Bea file joint taxes and claim Cam as a dependent. DHS/DFO/IMTA/2013-07-1512 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size ArtBeaCam ArtY33 BeaY33 CamY33

13. Married with Common Child Filing Jointly Art works and earns 2,500/month (30,000/year) Bea works and earns 2,000/month (24,000/year) Cam has no income DHS/DFO/IMTA/2013-07-1513 Whose Income Is Counted For Medicaid HH Size ArtBeaCam Total Income Used Art3 4,500 Bea3 4,500 Cam3 4,500

14. Unmarried Parents with Common Child Filing Separately Lee and Nia are unmarried and have a common child, Bev. Nia is pregnant and Lee is the father of the unborn child Lee and Nia file taxes separately Lee claims Bev as a dependent DHS/DFO/IMTA/2013-07-1514 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size LeeNiaBev LeeY22 NiaY12 BevN24

15. Unmarried Parents with Common Child Filing Separately Nia currently earns $1,500/month (18,000/year) Lee currently earns 2,500/month (30,000/year) Bev has no income DHS/DFO/IMTA/2013-07-1515 Whose Income Is Counted for Medicaid HH Size LeeNiaBev Total Income Used Lee2 2,500 Nia2 1,500 Bev4 4,000

16. Married Parents with No Common Child Filing Jointly Jim and Sue are married. They file jointly and Sue and Eve are claimed as dependents. Sue is the mother of Eve. Eve is an 18 year old student living in another State attending university. DHS/DFO/IMTA/2013-07-1516 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size JimSueEve JimY33 SueY33 EveY33

17. Married Parents with No Common Child Filing Jointly Jim works and earns 2,800/month (33,600/year) and Sue has no income Eve works part-time and earns 400/month (4,800/year) DHS/DFO/IMTA/2013-07-1517 Whose Income Is Counted For Medicaid HH Size JimSueEve Total Income Used Jim3 2,800 Sue3 2,800 Eve3 2,800

18. Married Parents with No Common Child Filing Jointly Jim works and earns 2,800/month (33,600/year) Sue has no income Eve works part-time and earns 1,500/month (18,000/year) DHS/DFO/IMTA/2013-07-1518 Whose Income Is Counted For Medicaid HH Size JimSueEve Total Income Used Jim3 4,300 Sue3 4,300 Eve3 4,300

19. Unmarried Parents with Common Child Filing Taxes Separately Jim and Sue are the unmarried parents of Eve (5). Jim and Sue file taxes separately. Jim claims Eve as a dependent. DHS/DFO/IMTA/2013-07-1519 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size JimSueEve JimY22 SueY11 EveN23

20. Unmarried Parents with Common Child Filing Taxes Separately Jim works and earns 2,800/month (33,600/year) Sue works and earns 3,000/month (36,000/year) Eve has no income DHS/DFO/IMTA/2013-07-1520 Whose Income Is Counted For Medicaid HH Size JimSueEve Total Income Used Jim2 2,800 Sue1 3,000 Eve3 5,800

21. Unrelated Tax Dependent Living in the Household Jim is the unmarried parent of Eve. Sue is an unrelated individual living in the household. Jim claims Eve and Sue as tax dependents. DHS/DFO/IMTA/2013-07-1521 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size JimSueEve JimY33 SueN31 EveY33

22. Unrelated Tax Dependent Living in the Household Jim works and earns 2,800/month (33,600/year) Sue works and earns 300/month (3,600/year) DHS/DFO/IMTA/2013-07-1522 Whose Income Is Counted For Medicaid HH Size JimSueEve Total Income Used Jim3 3,100 Sue1 300 Eve3 3,100

23. Non-Custodial Parent Claiming Child as Tax Dependent Jim and Sue are the unmarried parents of Eve Sue is the non-custodial parent living in her own home Jim and Sue file taxes separately. Sue claims Eve as a tax dependent, but she lives with her dad, Jim Jim requests Medicaid for himself and Eve DHS/DFO/IMTA/2013-07-1523 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size JimEve JimY11 EveN22

24. Non-Custodial Parent Claiming Child as Tax Dependent Jim works and earns 2,800/month (33,600/year) Jim receives child support of 1,200/month for Eve from Sue DHS/DFO/IMTA/2013-07-1524 Whose Income Is Counted For Medicaid HH Size JimEve Total Income Used Jim1 2,800 Eve2 2,800

25. Three Generation Household - 1 Sue is the mother of Eve, 18, and grandmother of Tim, 2. Sue files taxes and claims Eve and Tim as dependents. DHS/DFO/IMTA/2013-07-1525 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size SueEveTim SueY33 EveY33 TimN32

26. Three Generation Household - 1 Sue works and earns 2,000/month (24,000 annual) Eve works and earns 1,000/month (12,000 annual) DHS/DFO/IMTA/2013-07-1526 Whose Income Is Counted For Medicaid HH Size SueEveTim Total Income Used Sue3 2,000 Eve3 2,000 Tim20

27. Three Generation Household - 2 Sue is the mother of Eve and grandmother of Tim. Eve and Pat are the unmarried parents of Tim. Sue, Eve and Pat file taxes separately. Pat claims Tim as a tax dependent. DHS/DFO/IMTA/2013-07-1527 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size SueEvePatTim SueY11 EveY11 PatY22 TimN23

28. Three Generation Household -2 Sue works and earns 3,000/month (36,000/year) Eve works and earns 2,000/month (24,000/year) Pat works and earns 2,500/month (30,000/year) Tim has no income DHS/DFO/IMTA/2013-07-1528 Whose Income Is Counted For Medicaid HH Size SueEvePatTim Total Income Used Sue1 3,000 Eve1 2,000 Pat2 2,500 Tim3 4,500

29. Unmarried Parents with Common and Not Common Children Jim and Sue are unmarried and have a common child, Eve. Jim is also the father of Joe. Jim and Sue file taxes separately. Jim claims both Eve and Joe as his dependents. DHS/DFO/IMTA/2013-07-1529 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size JimSueEveJoe JimY33 SueY11 EveN34 JoeY33

30. Unmarried Parents with Common and Not Common Children Jim works and earns 3,000/month (36,000/year) Sue works and earns 2,500/month (30,000/year) Joe and Eve have no income DHS/DFO/IMTA/2013-07-1530 Whose Income Is Counted For Medicaid HH Size JimSueEveJoe Total Income Used Jim3 3,000 Sue1 2,500 Eve4 5,500 Joe3 3,000

31. Married with Common Child Possible Non-MAGI Stu and Vi are married and have a common child, Ian (6). Stu and Vi file joint taxes and claim Ian as a dependent. Vi applied online indicating Stu may be disabled, but no one receives Medicare. DHS/DFO/IMTA/2013-07-1531 Medicaid Eligibility For Apply Tax Rules? Tax HH Size Medicaid HH Size StuViIan StuY33 ViY33 IanY33

32. Processing Eligibility on Non-MAGI Basis Vi does not indicate on the application that either Vi or Ian may be disabled, that either has high medical expenses or that either needs long term care services. She does indicate that Stu may be disabled. Based on this information, the appropriate actions are: –The agency does not need to evaluate eligibility based on a non-MAGI basis for Vi or Ian, but appropriate information and notice will be provided so that they can request such determination. –The agency must evaluate Stu for eligibility for any applicable non-MAGI coverage groups. DHS/DFO/IMTA/2013-07-1532

33. Processing Eligibility on Non-MAGI Basis –The agency will collect additional information from Stu needed to determine eligibility based on disability. –It will apply the SSI-based methods to determine Stu’s income and resources, including any optional disregards, to determine Stu’s income under non-MAGI coverage groups. –Determination of eligibility for Stu based on disability does not affect the Medicaid MAGI households used for Vi or Ian. –Vi and Stu will be evaluated for eligibility under MAGI coverage groups. If not eligible, refer to the Marketplace and evaluated for CSR/APTCs and enrollment even as Stu’s determination is being considered. DHS/DFO/IMTA/2013-07-1533

34. Conclusion Additional ACA webinars Session review – Income Maintenance Workers ONLY DHS/DFO/IMTA/2013-07-1534