611.04 Determining Budgetary Units For Medical Assistance Programs SR 97-03, 02/97 (FAM-A)

Budgetary units are groups of individuals:

• who are residing in the same housing unit,

• whose needs are taken into account, and

• whose income and resources may be used to determine eligibility for TANF- related medical assistance.

Different assistance program’s criteria require different individuals to be included in the budgetary unit.

For MA-only, Poverty Level Children (PLC), Children with Severe Disabilities (CSD), and Children’s Medical Assistance (CH) In and Out Program, the following individuals who reside together are to be included in the budgetary unit:

• dependent child,

• sibling(s) of dependent child, and

• natural, adoptive and step-related parent(s) of child(ren).

- Include specified relatives in the budgetary unit if they request inclusion.

For Poverty Level Pregnant Women (PLP) and Pregnant Women (PW) In and Out Program, the following individuals who reside together are to be included in the budgetary unit:

• pregnant woman,

• unborn child(ren),

• spouse,

• dependent children of pregnant women,

• dependent children of pregnant women’s spouse, and

• father of dependent children of the pregnant women.

- Include the father of the unborn child and the dependent children of the father of the unborn child only if the man and pregnant woman already have a child in common.

Establish whose income and resources are counted when calculating eligibility by determining the budgetary units using the following procedures:

1.  Open eligible household members that are categorically or medically needy in one case.

2.  If the household is not eligible, determine eligibility separately for each individual under at least one coverage group, starting with the most liberal coverage program for each individual as follows:

• determine the group size by including all the children who meet the age limit for dependent child who are living in the same household, and who are siblings, half-siblings and/or step-siblings, and

• include those children’s natural, adoptive, and step-related parents, and specified relatives who request inclusion, who are also in the same household.

Exception: SSI recipients are only included in the group size when their own eligibility is being determined.

3.  Determine each individual’s financial eligibility using the following incomes (and resources when dictated by policy):

• the individual’s own countable income (and resources),

• the countable income (and resources) of a spouse, unless that income is excluded by policy, and

• the countable income (and resources) of parents (if the individual is under 21), unless that income is excluded by policy.

The only income (or resources) that may be included when calculating eligibility, other than the individual’s, is a spouse or parents.

Exception: Do not include the income (or resources) of any individuals who receive SSI in the budgetary unit.

For individuals who reside in a household where one or more of the household members receive SSI, determine eligibility for each individual as follows:

1.  prorate the countable net income of non-SSI spouses or parents to the total number of individuals in the household, including the SSI recipient,

2.  the prorated amount is then multiplied by the budgetary unit size being used to determine each individual’s eligibility.

Example

There are 5 individuals in the household (mother, father and three children). The mother and one of the children are SSI recipients. The father has a countable net monthly income of $550. The countable net monthly income is divided by five (the total number of members in the household) to determine a prorated amount. In determining each individuals eligibility, the prorated amount ($110) is multiplied by the correct budgetary unit size. When determining the mother’s and the disabled child’s eligibility, they each will have a countable income of $440 (4 X $110). The father and the non-SSI children will each have a countable income of $330 (3 X $110).