002 Household Composition

(A) Determination of Household Composition. MassHealth determines household size at the individual member level. MassHealth determines household composition in two ways. (1) MassHealth Modified Adjusted Gross Income (MAGI) Household Composition. MassHealth uses the MassHealth MAGI household composition rules to determine member eligibility for the following benefits: (a) MassHealth Standard, as described in 130 CMR 505.002(B), (C), (D), (F), and (G); (b) MassHealth CommonHealth, as described in 130 CMR 505.004(F) and (G); (c) MassHealth CarePlus, as described in 130 CMR 505.008: MassHealth CarePlus; (d) MassHealth Family Assistance, as described in 130 CMR 505.005(B) through (E); (e) MassHealth Limited, as described at 130 CMR 505.006: MassHealth Limited; and (f) Children’s Medical Security Plan (CMSP), as described in 130 CMR 522.004: Children’s Medical Security Plan (CMSP). (2) MassHealth Disabled Adult Household. MassHealth uses the MassHealth Disabled Adult household composition rules to determine member eligibility for the following benefits: (a) MassHealth Standard, as described in 130 CMR 505.002(E): Disabled Adults; (b) MassHealth CommonHealth, as described in 130 CMR 505.004(B) through (E); and (c) MassHealth Family Assistance, as described in 130 CMR 505.005(F): Eligibility Requirement for Disabled Adults Who Are Qualified Noncitizens Barred, Nonqualified Individuals Lawfully Present, and Nonqualified PRUCOLs with Modified Adjusted Gross Income of the MassHealth Disabled Adult Household at or below 100% of the Federal Poverty Level. (B) MassHealth MAGI Household Composition. (1) Taxpayers Not Claimed as a Tax Dependent on Their Federal Income Taxes. For an individual who expects to file a tax return for the taxable year in which the initial determination or renewal of eligibility is being made and who is not claimed as a tax dependent by another taxpayer, the household consists of (a) the taxpayer, including their spouse, if the taxpayers are married and filing jointly regardless of whether they are living together; (b) the taxpayer’s spouse, if living with them regardless of filing status; (c) all persons the taxpayer expects to claim as tax dependents; and (d) if any individual described in 130 CMR 506.002(B)(1)(a) through (c) is pregnant, the number of expected children. (2) Individuals Claimed as a Tax Dependent on Federal Income Taxes. (a) For an individual who expects to be claimed as a tax dependent by another taxpayer for the taxable year in which the initial determination or renewal of eligibility is being made and who does not otherwise meet the Medicaid exception rules as described in 130 CMR 506.002(B)(2)(b)1., 2., or 3., the household consists of 1. the individual; 2. the individual’s spouse, if living with them; 3. the taxpayer(s) claiming the individual as a tax dependent; 4. any of the taxpayer’s tax dependents; and 5. if any individual described in 130 CMR 506.002(B)(2)(a)1. through 4. is pregnant, the number of expected children. (b) Medicaid Exceptions. Household size must be determined in accordance with non- tax filer rules for any of the following individuals: 1. individuals other than the spouse or natural, adopted, or stepchild who expect to be claimed as a tax dependent by the tax payer; 2. individuals younger than 19 years old who expect to be claimed by one parent as a tax dependent and are living with both natural, adopted or stepparents, but whose natural, adopted, or stepparents do not expect to file a joint tax return; 3. individuals younger than 19 years old who expect to be claimed as a tax dependent by a noncustodial parent. For the purpose of determining custody, the MassHealth agency uses a court order or binding separation, divorce, or custody agreement establishing physical custody controls or, if there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights. (3) Individuals Who Do Not File a Federal Tax Return and Are Not Claimed as a Tax Dependent on a Federal Tax Return. For an individual who does not expect to file a federal tax return and who does not expect to be claimed as a tax dependent on a federal tax return or when any of the exceptions described at 130 CMR 506.002(B)(2)(b)1., 2., or 3. apply, the household consists of (a) the individual; (b) the individual’s spouse if living with them; (c) the individual’s natural, adopted, and stepchildren younger than 19 years old if living with them; (d) for individuals younger than 19 years old, the individual’s natural, adoptive, or stepparents and natural, adoptive, or stepsiblings younger than 19 years old if living with them; and (e) if any individual described in 130 CMR 506.002(B)(3)(a) through (d) is pregnant, the number of expected children. (C) MassHealth Disabled Adult Household. The household consists of (1) the individual; (2) the individual’s spouse if living with them; (3) the individual’s natural, adopted, and stepchildren younger than 19 years old if living with them; and (4) if any individual described in 130 CMR 506.002(C)(1), (2) or (3) is pregnant, the number of expected children.