household composition

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.

Household Calculation is also applied to Subsidies

• Calculated differently than Medicaid

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.

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

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)

• Medicaid and premium subsidies are calculated by income and family size.

• Medicaid and premium subsidies define who is in a family differently.

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

Gross Month Family IncomeSelf-employed? Use net income

Total Number of Family Members, parents and children

Your whole family qualifies for

free coverageYour 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 $3832

2 $1784 $2585 $3879 $5172

3 $2246 $3255 $4884 $6512

4$2708

$3925 $5889$7852

5 $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

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.

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

Households for Premium Tax Credits

Household = individuals for whom a taxpayerclaims a deduction for a personal exemption

Household for MedicaidHousehold = Individuals living under one roof

Don’t worry – the HealthPlanFinder will sort this out!

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 single6. Married filing jointly

The term you chose will be the one your client filed on his or her taxes

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.

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

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.

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.

Drop Down Choices for Health Plan Finder

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

Single Adult Not Claimed as a Tax Dependent

Name Name

Applicant for Medicaid

Filing Status to select in Healthplanfinder

Individual/Head of Household

Coding Household Members

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.

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

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

• 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

Name Name Name

Bob Suzie Tommy

Married filing jointly

Tax dependent

• 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

Name Name

Tax dependent

• 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

Name Name Name

Steve Donna Jonny

Tax dependent

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

• 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

Name Name Name

Ann Drew Annabelle

Non-filer Tax dependent

Non-filer

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?”

Questions

End here.

Ex amp les o f how each o f t he f ou r ex cep t i ons

app l y when de te rm in ing who t o i nc l ude i n t he

ass i s tance un i t

Exception Examples

Exception 1:

• “A child under the age of 19 living with parents that do not file a joint tax return”

Exception Examples

• 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

Name Name Name

Brad Julie Jesse

Individual or head of household

Tax dependent

Exception 2

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

Exception Examples

• 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

Name Name Name Name

Ryan Kari Austin Monica

Filing status to Select in Healthplanfinder

Tax dependent

Tax dependent by someone outside of the HH

• 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

Name NameApplicant for Medicaid Kevin Jane

Filing Status to select in WA Healthplanfinder

Tax dependent of an individual outside the HH

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

• 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

Name Name NameApplicant for Medicaid

Chris Carrie Bertha

Tax dependent

• 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

Name Name Name NameApplicant for Medicaid

Ron Lucy Frankie Sara

Filing Status to Select in Healthplanfinder

Tax dependent

Exception 4

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

Exception Examples

• 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

Name Name Name

Grandpa Grandma Melissa

Filing Status to Select in Healthplanfinder

Tax dependent

Exercises

• 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

Name Name

Theresa

Filing Status to select in WAHealthplanfinder

Individual/Head of Household

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 CoverageDan JenniferIncluded in Applicant’s HouseholdDan Jennifer

Name Name

Dan Jennifer

Married filing jointly Married filing jointly

Applicant for Health Care CoverageDan Jennifer Kim

Included in Applicant’s HouseholdDan Jennifer Kim

• 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

Name Name Name

Dan Jennifer Kim

Tax dependent

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

KimIncluded in Applicant’s Household

Name Name

Tax Dependent

Applicant for Health Care CoverageDaniel Gabriela Sofia JessieIncluded in Applicant’s HouseholdDaniel Gabriela Sofia Jessie

• 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

Name Name Name NameApplicant for Health Care Coverage

Daniel Gabriela Sofia Applicant for Health Care Coverage

Jessie

Non-filer

Non-filer Non-filer Filing Status to select in WA Healthplanfinder

Non-filer

Married Parents with a Child in Common Filing Taxes Separately

Daniel Gabriela Sofia

Included in Applicant’s Household

• 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

Name Name Name

Tax dependent

Applicant for Health Care CoverageJason Amanda Jared SoniaIncluded in Applicant’s HouseholdJason Amanda Jared Sonia

• 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

Jason Amanda Jared Sonia

Tax dependent

Gloria MichaelIncluded in Applicant’s HouseholdGloria Michael

• 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

Name NameApplicant for Health Insurance Care

Gloria Michael

dependent

Applicant for Health Care CoverageSean Kelly MollyIncluded in Applicant’s HouseholdSean Kelly Molly

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

Name Name Name

Sean Kelly Molly

Individual or Head of household

Tax dependent

Parents unmarried, with Child in Common and Child Not in Common

Applicant for Health Care CoverageKarl Amy Corey BrendaIncluded in Applicant’s HouseholdKarl Amy Corey Brenda

• 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

Karl Amy Corey Brenda

Tax dependent

Darryl Tamara KrisanneIncluded in Applicant’s HouseholdDarryl Tamara Krisanne

• 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

Name Name Name

Darryl Tamara Krisanne

Tax dependent

Questions?

Melissa RiveraEligibility Policy & Service Delivery

Office of Medicaid, Medicare, Eligibility & Policymelissa.rivera@hca.wa.gov

360-725-1713

household composition

medicaid programs

magibased medicaid

new medicaid group

medicare medicaid expansion

classic medicaid groups

family size

income counts

gross month family incomeself

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