4311 Treatment of Assistance Plan

The assistance plan for all medical programs consists of those persons in the family group for whom assistance is requested and any excluded legally responsible person for those individuals.

The client may include or exclude any family group members for assistance purposes.

Except as noted below, eligibility shall generally be determined within a single assistance plan for those members who qualify under the same category of assistance. For example, if more than one member requests and is eligible for Medically Needy, a combined determination is required. This policy would also be applicable to members of a family who qualify for the same medical program but under different individual subtypes (i.e., OA, AB, or AD for Medically Needy). Once again, a combined determination of these individuals would be required.

Separate assistance plans shall be established in the following instances, which are not applicable to family medical programs:

Each SSI recipient (including 1619b recipients) shall have a separate plan as well as any child whose needs are met through foster care or adoption support payment.

Family group members who qualify under different medical programs (e.g., Medically Needy, Medicaid poverty level, etc.) shall have separate plans.

Each client in a long term care arrangement (including HCBS and PACE) shall have a separate plan.

Emancipated minors, minors determined to be able to act in their own behalf, and 18 year old children shall have separate assistance plans apart from their parents.

Any child (and his or her siblings) in the family who is not living with a legally responsible person (such as grandchildren, nieces, and nephews, etc.) shall have a separate assistance plan.