Household Composition
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
Household Calculation is also applied
to Subsidies
• Calculated differently than Medicaid
3
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
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
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
Why
• Medicaid and premium subsidies are
calculated by income and family size.
• Medicaid and premium subsidies define who
is in a family differently.
7
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
Gross Month Family Income
Self-employed? Use net income
Your whole family qualifies
for
Your whole family
qualifies for a subsidy
or tax credit
Your child qualifies for
Your child qualifies for
coverage costing up to
free coverage
$30 a month
$1322
$1915
$2874
$3832
2
$1784
$2585
$3879
$5172
3
$2246
$3255
$4884
$6512
$3925
$5889
$4595
$6894
Total Number of
Family Members,
parents and children
free coverage
1
4
5
More members?
$2708
$3171
Add $463 for each
additional person
Add $670 for each
additional person
Add $1,005 for each
additional person
$7852
$9192
Add $1,340 for
each additional
person
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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 182-506-0010 effective October 1, 2013.
• 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.
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Key Components
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.
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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!
12
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.
3.
4.
5.
6.
Dependent - see next slide
Filer - files taxes
Non-filer - does not file taxes
Married filing single
Married filing jointly
The term you chose will be the one your client filed on his or her
taxes
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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.
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15
16
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
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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.
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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.
19
20
Drop Down Choices for Health Plan Finder
21
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
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Single Adult Not Claimed as
a Tax Dependent
23
Coding Household Members
Name
Applicant for
Medicaid
Name
Jon
Filing Status to Individual/Head of
select in
Household
Healthplanfinder
24
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.
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Rule #2 Exceptions
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
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Rule #2 Exceptions
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
27
Married Parents with
a Common Child
• Bob and Suzie are married and file taxes jointly with their child
in common, Tommy
• Bob and Suzie claim Tommy as their tax dependent
28
Coding Household Members
Applicant for
Medicaid
Name
Name
Name
Bob
Suzie
Tommy
Married
filing
jointly
Tax
dependent
Filing Status Married
to select in
filing
Healthplanfin jointly
der
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Single Adult Claimed
as a Tax Dependent
• Jon is an unmarried 20 year old residing in his parent’s home
• Parents claim Jon as a tax dependent
30
Coding Household Members
Name
Applicant for
Medicaid
Name
Jon
Filing Status to Tax
select in
dependent
Healthplanfinder
31
Married Parents with
a Child not in Common
• 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
32
Coding Household Members
Applicant for
Medicaid
Name
Name
Name
Steve
Donna
Jonny
Filing Status Married
to select in
filing jointly
Healthplanfin
der
Married filing Tax dependent
jointly
33
Rule # 3
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 NONFILER.
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
34
Single Mom with Children
• 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
35
Coding Household Members
Applicant for
Medicaid
Name
Name
Name
Ann
Drew
Annabelle
Filing Status to Non-filer Tax
Non-filer
select in
dependent
Healthplanfinder
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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?”
37
Questions
End here.
38
Exception Examples
Examples of how each of the four exceptions
apply when determining who to include in the
assistance unit
39
Exception Examples
Exception 1:
• “A child under the age of 19 living with parents
that do not file a joint tax return”
40
Exception 1: Married Parents with
a Child in Common Filing Taxes Separately
• 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
41
Coding Household Members
Name
Name
Name
Applicant for
Medicaid
Brad
Julie
Jesse
Filing Status to
select in
Healthplanfinder
Individual or
head of
household
Individual
or head of
household
Tax dependent
42
Exception Examples
Exception 2
“A child under the age of 19 who expects to be
claimed by a non-custodial parent”
43
Exception 2: Non-Custodial Parent Claims
Child as Tax Dependent
• 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
44
Coding Household Members
Applicant for
Medicaid
Name
Name
Name
Name
Ryan
Kari
Austin
Monica
Married
filing
jointly
Tax
Tax
dependent dependent by
someone
outside of the
HH
Filing status to Married
Select in
filing
Healthplanfinder jointly
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Exception 2:
Child Claimed as a Tax Dependent
of a Non-Custodial Parent
• 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
46
Coding Household Members
Name
Name
Applicant for Medicaid
Kevin
Jane
Filing Status to
select in WA
Healthplanfinder
Individual or
head of
household
Tax dependent
of an individual
outside the HH
47
Exception Examples
Exception 3
“A child under the age of 19 who lives with both parents
and the parents are not married to each other”
48
Exception 3: Unmarried Parents
with a Child in common
• 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
49
Coding Household Members
Applicant for
Medicaid
Name
Name
Name
Chris
Carrie
Bertha
Filing Status to Individual or Individual or Tax
select in WA
head of
head of
dependent
Healthplanfinder household
household
50
Exception 3: Unmarried Parents with Child
in Common and Uncommon
• 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
51
Coding Household Members
Applicant for
Medicaid
Filing Status to
Select in
Healthplanfinder
Name
Ron
Name
Lucy
Name
Frankie
Individual Individual Tax
or head of or head of dependent
household household
Name
Sara
Tax
dependent
52
Exception Examples
Exception 4
“The individual expects to be claimed as a tax dependent by
someone other than a spouse or parent”
53
Exception 4: Grandparents Claim
Grandchild as a Tax Dependent
• Grandpa, Grandma and grandchild, Melissa (16), live together
• Grandpa claims Grandma and grandchild, Melissa, as his tax
dependents
54
Coding Household Members
Name
Name
Name
Applicant for
Medicaid
Grandpa Grandma Melissa
Filing Status to
Select in
Healthplanfinder
Married
filing
jointly
Married
filing
jointly
Tax
dependent
55
Exercises
56
Single Adult Not Claimed
as a Tax Dependent
• 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
Applicant for Health Care Coverage
Theresa
Included in Applicant’s Household
Theresa
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Coding Household Members
Name
Applicant for Health
Care Coverage
Theresa
Filing Status to
select in WA
Healthplanfinder
Individual/Head of
Household
Name
58
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
Dan
Jennifer
Included in Applicant’s
Household
Dan
Jennifer
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Coding Household Members
Applicant for
Health Care
Coverage
Filing Status to
select in WA
Healthplanfinder
Name
Name
Dan
Jennifer
Married filing jointly Married filing jointly
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Married Parents with
a Common Child
• 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
Applicant for Health Care
Coverage
Dan
Jennifer
Kim
Included in Applicant’s
Household
Dan
Jennifer
Kim
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Coding Household Members
Name
Name
Applicant for
Dan
Jennifer
Health Care
Coverage
Filing Status to Married filing Married filing
select in WA
jointly
jointly
Healthplanfinder
Name
Kim
Tax
dependent
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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
63
Coding Household Members
Name
Name
Applicant for Health Kim
Care Coverage
Filing Status to
select in WA
Healthplanfinder
Tax Dependent
64
Parents with Children
• 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.
Applicant for Health
Care Coverage
Daniel
Gabriela
Sofia
Jessie
Gabriela
Sofia
Jessie
Included in Applicant’s
Household
Daniel
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Coding Household Members
Applicant for
Health Care
Coverage
Name
Name
Daniel
Gabriela Sofia
Filing Status to Nonselect in WA
filer
Healthplanfinder
Name
Name
Applicant for
Health Care
Coverage
Jessie
Non-filer Non-filer Filing Status to Nonselect in WA
filer
Healthplanfinde
r
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Married Parents with
a Child in Common Filing Taxes Separately
• 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
Applicant for Health Care Coverage
Daniel
Gabriela
Sofia
Gabriela
Sofia
Included in Applicant’s Household
Daniel
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Coding Household Members
Name
Name
Name
Applicant for Health
Care Coverage
Daniel
Gabriela
Sofia
Filing Status to
select in WA
Healthplanfinder
Individual or Individual or
head of
head of
household
household
Tax
dependent
68
Non-Custodial Parent Claims
Child as Tax Dependent
• 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
Applicant for Health Care Coverage
Jason
Amanda
Jared
Sonia
Amanda
Jared
Sonia
Included in Applicant’s Household
Jason
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Coding Household Members
Name
Name
Name
Applicant for Health Jason
Care Coverage
Amanda Jared
Sonia
Filing Status to
select in WA
Healthplanfinder
Married
filing
jointly
Married
filing
jointly
Name
Tax
Tax
dependent dependent
70
Child Claimed as a Tax Dependent
of a Non-Custodial Parent
• 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
Applicant for Health Care Coverage
Gloria
Michael
Included in Applicant’s Household
Gloria
Michael
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Coding Household Members
Name
Name
Applicant for Health
Insurance Care
Gloria
Michael
Filing Status to
select in WA
Healthplanfinder
Individual or
head of
household
Tax
dependent
72
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
Applicant for Health Care Coverage
Sean
Kelly
Molly
Kelly
Molly
Included in Applicant’s Household
Sean
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Coding Household Members
Name
Name
Name
Applicant for
Health Care
Coverage
Sean
Kelly
Molly
Filing Status to
select in WA
Healthplanfinder
Individual or Individual or Tax
head of
Head of
dependent
household household
74
Parents unmarried, with Child in
Common and Child Not in Common
• 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
Applicant for Health Care Coverage
Karl
Amy
Corey
Brenda
Amy
Corey
Brenda
Included in Applicant’s Household
Karl
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Coding Household Members
Applicant for
Health Care
Coverage
Filing Status to
select in WA
Healthplanfinder
Name
Karl
Name
Amy
Name
Corey
Name
Brenda
Individual Individual Tax
Tax
or head of or head of dependent dependent
household household
76
Non-parent or spouse claim Tax
Dependent
• 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
Applicant for Health Care
Coverage
Darryl
Tamara
Krisanne
Tamara
Krisanne
Included in Applicant’s Household
Darryl
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Coding Household Members
Applicant for
Health Care
Coverage
Name
Name
Name
Darryl
Tamara
Krisanne
Married
filing
jointly
Tax
dependent
Filing Status to Married
select in WA
filing
Healthplanfinder jointly
78
Questions?
Melissa Rivera
Eligibility Policy & Service Delivery
Office of Medicaid, Medicare, Eligibility & Policy
melissa.rivera@hca.wa.gov
360-725-1713
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