household composition
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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 . - PowerPoint PPT PresentationTRANSCRIPT
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.
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Household Calculation is also applied to Subsidies
• Calculated differently than Medicaid
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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.
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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
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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)
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Why
• Medicaid and premium subsidies are calculated by income and family size.
• Medicaid and premium subsidies define who is in a family differently.
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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
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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
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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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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
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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!
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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.
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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.
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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.
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Drop Down Choices for Health Plan Finder
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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
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Name Name
Applicant for Medicaid
Jon
Filing Status to select in Healthplanfinder
Individual/Head of Household
Coding Household Members
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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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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
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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
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• 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
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Name Name Name
Applicant for Medicaid
Bob Suzie Tommy
Filing Status to select in Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Coding Household Members
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• 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
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Name Name
Applicant for Medicaid
Jon
Filing Status to select in Healthplanfinder
Tax dependent
Coding Household Members
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• 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
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Name Name Name
Applicant for Medicaid
Steve Donna Jonny
Filing Status to select in Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Coding Household Members
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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
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• 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
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Name Name Name
Applicant for Medicaid
Ann Drew Annabelle
Filing Status to select in Healthplanfinder
Non-filer Tax dependent
Non-filer
Coding Household Members
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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?”
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Questions
End here.
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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
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Exception 1:
• “A child under the age of 19 living with parents that do not file a joint tax return”
Exception Examples
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• 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
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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
Coding Household Members
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Exception 2
“A child under the age of 19 who expects to be claimed by a non-custodial parent”
Exception Examples
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• 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
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Name Name Name Name
Applicant for Medicaid
Ryan Kari Austin Monica
Filing status to Select in Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Tax dependent by someone outside of the HH
Coding Household Members
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• 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
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Name NameApplicant for Medicaid Kevin Jane
Filing Status to select in WA Healthplanfinder
Individual or head of household
Tax dependent of an individual outside the HH
Coding Household Members
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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
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• 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
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Name Name NameApplicant for Medicaid
Chris Carrie Bertha
Filing Status to select in WA Healthplanfinder
Individual or head of household
Individual or head of household
Tax dependent
Coding Household Members
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• 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
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Name Name Name NameApplicant for Medicaid
Ron Lucy Frankie Sara
Filing Status to Select in Healthplanfinder
Individual or head of household
Individual or head of household
Tax dependent
Tax dependent
Coding Household Members
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Exception 4
“The individual expects to be claimed as a tax dependent by someone other than a spouse or parent”
Exception Examples
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• 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
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Name Name Name
Applicant for Medicaid
Grandpa Grandma Melissa
Filing Status to Select in Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Coding Household Members
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Exercises
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• 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
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Name Name
Applicant for Health Care Coverage
Theresa
Filing Status to select in WAHealthplanfinder
Individual/Head of Household
Coding Household Members
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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
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Name Name
Applicant for Health Care Coverage
Dan Jennifer
Filing Status to select in WAHealthplanfinder
Married filing jointly Married filing jointly
Coding Household Members
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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
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Name Name Name
Applicant for Health Care Coverage
Dan Jennifer Kim
Filing Status to select in WA Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Coding Household Members
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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
KimIncluded in Applicant’s Household
Kim
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Name Name
Applicant for Health Care Coverage
Kim
Filing Status to select in WAHealthplanfinder
Tax Dependent
Coding Household Members
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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
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Name Name Name NameApplicant for Health Care Coverage
Daniel Gabriela Sofia Applicant for Health Care Coverage
Jessie
Filing Status to select in WA Healthplanfinder
Non-filer
Non-filer Non-filer Filing Status to select in WA Healthplanfinder
Non-filer
Coding Household Members
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Married Parents with a Child in Common Filing Taxes Separately
Applicant for Health Care Coverage
Daniel Gabriela Sofia
Included in Applicant’s Household
Daniel Gabriela Sofia
• 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
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Name Name Name
Applicant for Health Care Coverage
Daniel Gabriela Sofia
Filing Status to select in WAHealthplanfinder
Individual or head of household
Individual or head of household
Tax dependent
Coding Household Members
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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
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Name Name Name NameApplicant for Health Care Coverage
Jason Amanda Jared Sonia
Filing Status to select in WA Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Tax dependent
Coding Household Members
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Applicant for Health Care Coverage
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
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Name NameApplicant for Health Insurance Care
Gloria Michael
Filing Status to select in WA Healthplanfinder
Individual or head of household
Tax
dependent
Coding Household Members
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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
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Name Name Name
Applicant for Health Care Coverage
Sean Kelly Molly
Filing Status to select in WA Healthplanfinder
Individual or head of household
Individual or Head of household
Tax dependent
Coding Household Members
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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
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Name Name Name NameApplicant for Health Care Coverage
Karl Amy Corey Brenda
Filing Status to select in WA Healthplanfinder
Individual or head of household
Individual or head of household
Tax dependent
Tax dependent
Coding Household Members
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Applicant for Health Care Coverage
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
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Name Name Name
Applicant for Health Care Coverage
Darryl Tamara Krisanne
Filing Status to select in WA Healthplanfinder
Married filing jointly
Married filing jointly
Tax dependent
Coding Household Members
Questions?
Melissa RiveraEligibility Policy & Service Delivery
Office of Medicaid, Medicare, Eligibility & [email protected]
360-725-1713
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