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Affordable Care Act Household Composition

Affordable Care Act Household Composition. Session 4 Presented by Tokie Moriel & John Tvedt. Session Objectives. Present a high level overview of changes to household composition under ACA. Demonstrate how hh comp and income determinations are made.

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Affordable Care Act Household Composition

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  1. Affordable Care ActHousehold Composition Session 4 Presented by Tokie Moriel & John Tvedt DHS/DFO/IMTA/2013-07-15

  2. Session Objectives • Present a high level overview of changes to household composition under ACA. • Demonstrate how hh comp and income determinations are made. DHS/DFO/IMTA/2013-07-15

  3. How MAGI Rules Affect Household Composition • Unless otherwise exempted or included, the tax household will contain: • The primary tax payer, and • Married spouses if filing jointly • All tax dependents, including children under age 19 of the primary tax payer. • Stepparents will be treated like parents (i.e., stepparents will be counted in the family size and their income will be counted in the same way a parent’s income is counted) • Individuals cannot choose who is to be included or excluded from their household such as excluding a child to make a parent eligible. DHS/DFO/IMTA/2013-07-15

  4. MAGI in Medicaid and CHIP: Household Composition • For the vast majority of cases, Medicaid households will use the tax household which is determined by the principles of tax dependency. • Parents, children and siblings are included in same household • Stepparents and parents treated the same • Children and siblings with or without income included in same household as rest of family • Older children included in family if claimed as tax dependent by parents • Child income is only counted if child is required to file a tax return DHS/DFO/IMTA/2013-07-15

  5. MAGI in Medicaid and CHIP: Differences in HH Composition • Extended family • Children of non-custodial parents • Children of unmarried parents • Joint Custody DHS/DFO/IMTA/2013-07-15

  6. Rules for Non-Filers • Mirror rules for tax filers to maximum extent • Spouses, parents, stepparents and children living together included in same household. • “Child” defined as under age 19. • Rules for non-filers also apply to tax dependents excepted from general rule to use tax definition of household. DHS/DFO/IMTA/2013-07-15

  7. Establishing Filing Requirements and Tax Dependency Relationships • Filing requirements and tax dependency based on reasonable expectations at time of determination. • If taxpayer cannot reasonably establish tax dependency relationship, inclusion of tax dependent in household determined in accordance with non-filer rules. DHS/DFO/IMTA/2013-07-15

  8. MAC Infant • Deemed newborns are automatically eligible for Medicaid and MAGI rules apply to them. • Deemed newborns would be counted as part of the HH size/composition. • Eligibility for deemed newborns will remain for 12-months unless a change affects eligibility, for example, moving out of state. DHS/DFO/IMTA/2013-07-15

  9. MAGI Household Composition Scenarios DHS/DFO/IMTA/2013-07-15

  10. Single Parent and Child Pat is the mother of Eli, age 6. Pat works and files taxes. She claims Eli as a dependent. DHS/DFO/IMTA/2013-07-15

  11. Single Parent and Child Pat works and earn 2,500/month (30,000/year) Pat files taxes and claims Eli as a dependent. DHS/DFO/IMTA/2013-07-15

  12. Married with Common Child Filing Jointly Art and Bea are married and have a common child, Cam. Art and Bea both work. Art and Bea file joint taxes and claim Cam as a dependent. DHS/DFO/IMTA/2013-07-15

  13. Married with Common Child Filing Jointly Art works and earns 2,500/month (30,000/year) Bea works and earns 2,000/month (24,000/year) Cam has no income DHS/DFO/IMTA/2013-07-15

  14. Unmarried Parents with Common Child Filing Separately Lee and Nia are unmarried and have a common child, Bev. Nia is pregnant and Lee is the father of the unborn child Lee and Nia file taxes separately Lee claims Bev as a dependent DHS/DFO/IMTA/2013-07-15

  15. Unmarried Parents with Common Child Filing Separately Nia currently earns $1,500/month (18,000/year) Lee currently earns 2,500/month (30,000/year) Bev has no income DHS/DFO/IMTA/2013-07-15

  16. Married Parents with No Common Child Filing Jointly Jim and Sue are married. They file jointly and Sue and Eve are claimed as dependents. Sue is the mother of Eve. Eve is an 18 year old student living in another State attending university. DHS/DFO/IMTA/2013-07-15

  17. Married Parents with No Common Child Filing Jointly Jim works and earns 2,800/month (33,600/year) and Sue has no income Eve works part-time and earns 400/month (4,800/year) DHS/DFO/IMTA/2013-07-15

  18. Married Parents with No Common Child Filing Jointly Jim works and earns 2,800/month (33,600/year) Sue has no income Eve works part-time and earns 1,500/month (18,000/year) DHS/DFO/IMTA/2013-07-15

  19. Unmarried Parents with Common Child Filing Taxes Separately Jim and Sue are the unmarried parents of Eve (5). Jim and Sue file taxes separately. Jim claims Eve as a dependent. DHS/DFO/IMTA/2013-07-15

  20. Unmarried Parents with Common Child Filing Taxes Separately Jim works and earns 2,800/month (33,600/year) Sue works and earns 3,000/month (36,000/year) Eve has no income DHS/DFO/IMTA/2013-07-15

  21. Unrelated Tax Dependent Living in the Household Jim is the unmarried parent of Eve. Sue is an unrelated individual living in the household. Jim claims Eve and Sue as tax dependents. DHS/DFO/IMTA/2013-07-15

  22. Unrelated Tax Dependent Living in the Household Jim works and earns 2,800/month (33,600/year) Sue works and earns 300/month (3,600/year) DHS/DFO/IMTA/2013-07-15

  23. Non-Custodial Parent Claiming Child as Tax Dependent Jim and Sue are the unmarried parents of Eve Sue is the non-custodial parent living in her own home Jim and Sue file taxes separately. Sue claims Eve as a tax dependent, but she lives with her dad, Jim Jim requests Medicaid for himself and Eve DHS/DFO/IMTA/2013-07-15

  24. Non-Custodial Parent Claiming Child as Tax Dependent Jim works and earns 2,800/month (33,600/year) Jim receives child support of 1,200/month for Eve from Sue DHS/DFO/IMTA/2013-07-15

  25. Three Generation Household - 1 Sue is the mother of Eve, 18, and grandmother of Tim, 2. Sue files taxes and claims Eve and Tim as dependents. DHS/DFO/IMTA/2013-07-15

  26. Three Generation Household - 1 Sue works and earns 2,000/month (24,000 annual) Eve works and earns 1,000/month (12,000 annual) DHS/DFO/IMTA/2013-07-15

  27. Three Generation Household - 2 Sue is the mother of Eve and grandmother of Tim. Eve and Pat are the unmarried parents of Tim. Sue, Eve and Pat file taxes separately. Pat claims Tim as a tax dependent. DHS/DFO/IMTA/2013-07-15

  28. Three Generation Household -2 Sue works and earns 3,000/month (36,000/year) Eve works and earns 2,000/month (24,000/year) Pat works and earns 2,500/month (30,000/year) Tim has no income DHS/DFO/IMTA/2013-07-15

  29. Unmarried Parents with Common and Not Common Children Jim and Sue are unmarried and have a common child, Eve. Jim is also the father of Joe. Jim and Sue file taxes separately. Jim claims both Eve and Joe as his dependents. DHS/DFO/IMTA/2013-07-15

  30. Unmarried Parents with Common and Not Common Children Jim works and earns 3,000/month (36,000/year) Sue works and earns 2,500/month (30,000/year) Joe and Eve have no income DHS/DFO/IMTA/2013-07-15

  31. Married with Common Child Possible Non-MAGI Stu and Vi are married and have a common child, Ian (6). Stu and Vi file joint taxes and claim Ian as a dependent. Vi applied online indicating Stu may be disabled, but no one receives Medicare. DHS/DFO/IMTA/2013-07-15

  32. Processing Eligibility on Non-MAGI Basis • Vi does not indicate on the application that either Vi or Ian may be disabled, that either has high medical expenses or that either needs long term care services. She does indicate that Stu may be disabled. Based on this information, the appropriate actions are: • The agency does not need to evaluate eligibility based on a non-MAGI basis for Vi or Ian, but appropriate information and notice will be provided so that they can request such determination. • The agency must evaluate Stu for eligibility for any applicable non-MAGI coverage groups. DHS/DFO/IMTA/2013-07-15

  33. Processing Eligibility on Non-MAGI Basis • The agency will collect additional information from Stu needed to determine eligibility based on disability. • It will apply the SSI-based methods to determine Stu’s income and resources, including any optional disregards, to determine Stu’s income under non-MAGI coverage groups. • Determination of eligibility for Stu based on disability does not affect the Medicaid MAGI households used for Vi or Ian. • Vi and Stu will be evaluated for eligibility under MAGI coverage groups. If not eligible, refer to the Marketplace and evaluated for CSR/APTCs and enrollment even as Stu’s determination is being considered. DHS/DFO/IMTA/2013-07-15

  34. Conclusion • Additional ACA webinars • Session review – Income Maintenance Workers ONLY DHS/DFO/IMTA/2013-07-15

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