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3200.00.00 ASSISTANCE GROUPS

This chapter contains the following sections:

• Assistance Group Definition (Section 3205) • Medicaid Assistance Groups (MED 1) (Section 3210) • Medicaid Assistance Groups (MED 2) (Section 3215) • Medicaid Assistance Groups (MED 3) (Section 3220) • QMB/QDW/SLMB Assistance Groups (MED 4) (Section 3230).

The program-specific sections will discuss policy on composition of the assistance groups.

3205.00.00 ASSISTANCE GROUP DEFINITION

The assistance group (AG) is an individual or group of individuals whose income, resources, needs, and/or expenses are considered together in the eligibility determination for an assistance category.

For categories of assistance subject to the modified adjusted gross income (MAGI) methodology for income and household size, the AG determination is aligned with tax filing rules, in accordance with the requirements laid out in the Affordable Care Act (ACA) of 2010.

For categories of assistance not subject to MAGI methodology, the AG determination is based upon relationship and living arrangement. Within the AG for non-MAGI categories of assistance, individuals may be participating or nonparticipating members, depending upon each program's eligibility requirements.

Participating members are individuals for whom eligibility for a benefit is considered. Nonparticipating members are those individuals whose needs, income, expenses and/or resources are considered in determining the eligibility and benefit level of the participating members, but who are not eligible for benefit consideration on their own behalf. Household members who are not, according to specific program regulations, eligible for membership in the AG as participants or non-participants, are excluded from consideration in the eligibility determination; as such, they are also excluded from any requirement to provide personal demographic or financial information to the agency.1 Please refer to IHCPPM 2404.00.00.

Non-applicant/recipient household members who are mandatory non-participating members are not required to provide a Social Security Number (SSN), however they are required to provide any applicable financial and/or non-financial information needed to determine eligibility for applicant/recipient or other mandatory participating AG member (based off tax dependent relationship for MAGI groups and AG for non-MAGI households. For example,) mandatory non- participating AG members are not required to provide their SSN, but are required to provide proof of their income to determine their child’s eligibility.