Eligibility Online Manual
POL M1204A: DETERMINING ELIGIBILITY FOR FAMILY MAGI
1. Applicants Must Meet Basic Eligibility Factors
Refer to Section M600 for a description of all basic eligibility factors.
Adults must have a child, under age 18, who is eligible Medicaid and lives in the household.
2. Adults Must Be Caretaker Relatives
Adults must be a caretaker relative in the household of a child under the age of 18.
3. Adults Participating In A Strike Are Not Eligible
Refer to Section M200 for the definition of participating in a strike.
4. Applicants Must Meet Income Requirements
5. Applicants Do Not Have A Resource Test
6. Benefits Begin First Day Of The Application Month If Determined Eligible
7. Applicants May Be Eligible For Retroactive Medicaid
Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to the month of application.
Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.
8. Applicants Under Age 19 May Have Eligibility For 12 Continuous Months
The eligibility continues for 12 months from the effective date of eligibility or for 12 continuous months from the last periodic review.
9. Clients May Need To Cooperate With Child Support
Child support cooperation is required for adults when the absent parent is not in the home or when paternity has not been established, unless Good Cause is approved.
Clients must cooperate in establishing paternity and in obtaining medical support and payments. Clients must also cooperate in identifying and providing information to assist in pursuing third parties who may be liable to pay for care.
Unmarried women who give birth while on Medicaid will be required to cooperate with child support enforcement per birthing costs requirements in the statutes listed below.
A step-parent can be closed if the Absent Parent Questionnaire is not returned.
10. Non-Cooperation Is Refusal To Fill Out Form Or Provide Information
Non-Cooperation is defined as any of the following:
Refusing to fill out the Absent Parent Questionnaire.
Refusing to provide necessary information on the Absent Parent Questionnaire to identify the absent parent.
Refusing to provide information to Child Support.
11. Clients Are Waived From Cooperation If Good Cause Is Approved
Child support cooperation is not required when Good Cause has been approved.
12. Birth Costs Clients Are Waived From Cooperation If a Newborn Passes Away
Clients will be granted Good Cause if a child born to a Medicaid eligible mother passes away within 60 days of the birth because of anticipated emotional harm to the mother or other family member.
13. Clients Must Cooperate If Good Cause Is Denied
Clients may choose to do one of the following if Good Cause is denied:
Refuse to cooperate, but receive medical assistance for the children
Withdraw the application.
Clients not choosing to withdraw their application and still wanting medical assistance must be referred to Child Support.
14. Clients Must Be Reviewed
Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
15. Clients May Lose Benefits
Adult's benefits may end due to non-cooperation with child support.
The case will close on the first day of the next month when any of the following occur:
Client does not complete review.
Eligible child leaves the home.
Eligible child turns 18.
Client moves out of state.
Client determined no longer eligible.
16. Clients May Have Benefits Suspended
Clients who are reported as incarcerated in a jail or prison will have benefits suspended until they are released.
A child is defined as a dependent between birth and 17 years of age who is not an emancipated minor or a minor parent.
Resource Transfer Provisions Do Not Apply.
Children Receiving Medicare Still Qualify.
Determining Retroactive Benefits
1. Determine whether each approved or denied applicant incurred medical bills during any of the three months prior to the date of application.
1. Send 15-Day closure notice when adverse action has occurred.
Maintaining Confidentiality When Child Transfers To New Case
1. Send closure notice stating child no longer in the home.
2. Do not identify new location of child.