400 Income Standards and Household Composition

Effective Date: November 1, 2021

A. Introduction

1. To qualify for CHIP, individuals must meet an income requirement. Section 400 covers the steps in determining an individual's household composition and temporary absence, whose income and what income counts in the eligibility determination, deeming income from other household members, excluded income types, and income deductions.

2. This section includes the income methodologies for MAGI-based Medicaid groups.

B. Section 400 Organization

To qualify for CHIP, individuals must meet an income test requirement. The policies in section 400 cover the steps in determining;

· The household size and composition, including temporary absence;

· Policy about whose income must be counted to determine eligibility;

· The calculation of MAGI Methodology;

· The types of income, including unearned income and earned income;

· Income exclusions;

· Income deductions; and

· Budgeting concepts and methods.

C. Worker Requirements

The Department prohibits employees of the Departments of Human Services, Workforce Services, or Health from advising or encouraging applicants for, or recipients of, public assistance programs to terminate employment or otherwise reduce income to qualify for an assistance program. This does not mean employees cannot tell applicants or recipients about the Medicaid spenddown program and the ways to reduce or meet the medical excess with medical bills to receive Medicaid coverage.

Workers can explain eligibility policies, tell individuals how we decide if someone is eligible for Medicaid, explain what income deductions an individual receives, and answer questions a individual asks about policies. (See 461-5 for rules on medical bills.)

If the individual has expenses and not enough income to cover the expenses, the individual must verify how they are meeting their expenses (731-1).