Sec. 10.09.24.06. MAGI Exempt Assistance Unit

A. Purpose and Scope. This regulation establishes who shall be a member of an assistance unit, who may be excluded from an assistance unit, who will have separate eligibility determinations, and whose income and resources will be considered in determining financial eligibility for MAGI Exempt applicants and recipients of Medical Assistance.

A-1. More Than One Assistance Unit Among Individuals Living Together. More than one assistance unit is permissible if:

(1) The parent or other caretaker relative chooses to have a child's eligibility determined as blind or disabled under Regulation .04J of this chapter;

(2) A caretaker relative chooses to have his eligibility determined as aged, blind, or disabled under Regulation .04J of this chapter; and

(3) There are individuals who would have been members of the assistance unit except for their status as automatically eligible Medical Assistance recipients under Regulation .03B of this chapter.

A-2. Separate Eligibility Determinations for Certain Individuals.

(1) An individual eligibility determination shall be conducted for each individual identified in §A-1(1) of this regulation who requests Medical Assistance.

(2) For the aged, blind, or disabled individual identified in §A-1(2) of this regulation:

(a) If the person chooses to have eligibility determined as aged, blind, or disabled and either the person's spouse is non-aged, blind, or disabled or the aged, blind, or disabled spouse chooses to have eligibility determined as a caretaker relative, an individual eligibility determination shall be conducted; or

(b) If the person applies as aged, blind, or disabled and the person's spouse also applies as aged, blind, or disabled, the couple will be considered one unit.

B. Aged, Blind, or Disabled.

(1) This section is applicable to the following:

(a) An aged, blind, or disabled person 21 years old or older who has no unmarried related children younger than 21 years old living with him;

(b) An aged, blind, or disabled person and spouse, with no unmarried related children younger than 21 years old living with the couple;

(c) A blind or disabled child younger than 21 years old who chooses to have his eligibility determined as blind or disabled; and

(d) An aged, blind, or disabled caretaker relative who chooses to have his eligibility determined as aged, blind, or disabled.

(2) Composition-Aged, Blind, or Disabled.

(a) The assistance unit shall include the following persons, except as provided in §B(2)(b)-(c) of this regulation:

(i) The aged, blind, or disabled person; and

(ii) The aged, blind, or disabled spouse of the aged, blind, or disabled person, when living together.

(b) An aged, blind, or disabled caretaker relative who chooses to apply as caretaker relative will not be included in the unit.

(c) A non-aged, blind, or disabled parent or caretaker relative other than parent will not be included in the unit.

(3) Income and Resource Consideration.

(a) In determining financial eligibility, the income and resources of the following persons shall be considered:

(i) All persons included in the assistance unit;

(ii) The spouse of the applicant, when living together, unless the spouse is an SSI recipient; and

(iii) The parent of a blind or disabled child younger than 18 years old, when living together, unless the parent is an SSI recipient.

(b) Treatment of Income and Resources of Persons Not Living Together.

(i) When spouses cease to live together, their income and resources shall be considered available to each other throughout the month in which they cease living together. Beginning with the first full month of separate residence, only actually contributed income and resources from the spouse shall be counted.

(ii) When a blind or disabled child younger than 18 years old ceases to live with his parent, the income and resources of the parent shall be considered available throughout the month in which they cease living together. Beginning with the first full month of separate residence, only actually contributed income and resources from the parents shall be counted.

C. Blind and Disabled Children Living With Parents or Other Caretaker Relatives.

(1) This section applies to blind or disabled children living with a caretaker relative who chooses to have the child's eligibility determined as an individual younger than 21 years old and an aged, blind, or disabled individual who chooses to have his eligibility determined as a caretaker relative.

(2) Persons Living Together. The unit shall be established on the basis of persons living together, including persons who are temporarily absent from the home for purposes of attending school, or pursuing vocational or job training.

(3) Composition - Children Living With Parents or Other Caretaker Relatives. The assistance unit shall include, except as provided in §§A-1 and C(4) of this regulation, the parents, caretaker relatives other than parents, their unmarried children younger than 21 years old, and any other unmarried children younger than 21 years old (including second generation children who are parented by an unmarried person younger than 21 years old) who are related by blood, marriage, or adoption to the parent or caretaker relative other than parent. The relationship between children and caretaker relatives other than parents shall be limited to those specified in Regulation .02B(10)(a) of this chapter.

(4) Exclusion of a Child or Caretaker Relative Other Than Parent.

(a) The provisions of §C(3) of this regulation may not apply when:

(i) A parent or caretaker relative other than a parent chooses to exclude a child from the assistance unit provided at least one child is in the unit and the exclusion does not cause the applicant or recipient to lose Medical Assistance (Title XIX) status as a caretaker relative as defined in Regulation .02B(10)(a) of this chapter.

(ii) A caretaker relative other than a parent chooses to be excluded from the assistance unit. The choice of exclusion includes the caretaker relative's spouse.

(b) An excluded aged, blind, or disabled person retains the option of selecting any federal category in which technical eligibility may be established upon subsequent application.

(c) An excluded non-aged, blind, or disabled person may not have a separate eligibility determination.

(5) Subsequent Application for an Excluded Person.

(a) A person excluded from the assistance unit may apply for Medical Assistance.

(b) If an excluded person applies as aged, blind, or disabled, the following conditions apply:

(i) A separate eligibility determination will be made in accordance with §A-1 of this regulation; and

(ii) Income and resources of a spouse or parent will be considered in accordance with §B(3) of this regulation.

(c) If an excluded person does not apply as aged, blind, or disabled, the following conditions apply:

(i) The period under consideration will be the same as that of the currently eligible assistance unit;

(ii) Eligibility for the new member shall be determined in conjunction with the currently eligible assistance unit established in §C(3) of this regulation;

(iii) The income and resources of the new member shall be added to that of the currently eligible assistance unit beginning with the month for which coverage of the new member is requested;

(iv) The income of the new member may not be averaged to include any months before the month for which coverage is requested;

(v) Certification may not begin earlier than the date the new member becomes eligible; and

(vi) A decision of ineligibility for the new member will not affect the eligibility status of the currently eligible assistance unit for the remainder of the certification period.

(6) Income and Resource Consideration.

(a) In determining financial eligibility, the income and resources of the following persons shall be considered:

(i) All persons included in the assistance unit;

(ii) The spouse of the applicant, when living together, unless the spouse is an SSI recipient; and

(iii) The parent of a child younger than 21 years old, when living together, unless the parent is an SSI recipient.

(b) Treatment of Income and Resources When a Child Leaves the Home. The income and resources of a parent shall be considered throughout the month in which a child leaves the home for the purpose of establishing a new address, when the separation is for reasons other than placement in a foster home, group home, or drug or alcohol abuse treatment center. Beginning with the first full month of separate residence, only actually contributed income and resources from the parent shall be counted.

D. Additions to the Household. A new member of the household will be considered in accordance with all applicable regulations of this chapter.