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All County Welfare Directors Letter No.: 20-10 Page 22 April 30, 2020
4) Is anyone in the household composition pregnant? No. 5) Is anyone included in the household composition pregnant? No. 6) No additional changes, end household composition determination here.
Medi-Cal Household Victim of an intimate partner Spouse Family Size Person 1 Included Not Included 1
Note: For Covered California program eligibility, the tax household size cannot be determined. Individuals must attest to self-attest to planning to file taxes in order to be eligible for financial assistance through Covered California.
2) Institutionalized Children For a child that resides outside of a parent’s home in an institutional facility such as a psychiatric hospital, penal institution, or children’s home facility and is requesting Medi- Cal coverage, the household composition will vary depending on if the child will be claimed as a tax dependent. Detailed below is guidance on how to evaluate institutionalized children with various tax filing statuses. • Institutionalized child claimed as a tax dependent: If the child living in an institution and is claimed as a tax dependent, the county shall follow the Tax Dependent Rules outlined in the “MAGI Household Composition and Tax Filing Rules” section above when determining eligibility. If the child is not MAGI Medi-Cal eligible based on the parent’s income, the CEW shall evaluate the child for Non- MAGI Medi-Cal and the child’s parent(s) may be excluded in the Medi-Cal determination pursuant to California Code of Regulations (C.C.R.), Title 22, Sections 50373 and 50381. • Institutionalized child not claimed as a tax dependent: If no one claims the institutionalized child as a tax dependent or if the institutionalized child is unsure of their expected filing status, the Non-Filer Rules shall be used to determine household composition for MAGI Medi-Cal eligibility. As a result, the child’s parent(s) would not be included in the household composition.
Note: In circumstances where the child will be claimed as a tax dependent of their parent but the county is unable to obtain the tax information needed to determine eligibility the household composition shall be determined based on Non-Filer Rules as permitted by 42 C.F.R. Section 435.603(f)(5).