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COMBINED MEDICAID 202-1 Adding or Removing Household Members

Supersedes: FMA 202-1 (01/01/07); FMA 202-2 (01/01/06) Reference: 42 CFR 435.916; ARM 37.82.101, .204, .205, .704 Overview: The assistance unit’s eligibility must be redetermined if a required filing unit member moves into or out of the household. Medicaid coverage is effective the first of the month in which the new member’s presence is discovered/reported, and they are determined eligible. NOTE: The new member may receive up to three months retro Medicaid coverage from the month of discovery/report, provided ALL eligibility factors are met. It may be necessary to open a separate case to process eligibility for the months the individual was not physically present in the current household. NOTE: HMK does not allow retroactive coverage. If the presence of the new member(s) is reported to or discovered by the agency, redetermine the assistance unit’s eligibility by including the needs, income, and resources of all required filing unit members, including the new member(s). If a filing/assistance unit member leaves the household, the individual’s needs must be removed from the case. When redetermining eligibility, use the income standard based on the current number of household members. The income and resources of a disqualified individual must be counted, but the disqualified individual will not be included in the household size. VERIFICATION: The new member (or responsible adult) needs to provide sufficient verification of income, resources, citizenship/alien status, identity and relationship. HMK: Citizenship and identity are the only verifications required to add another child to the household. Reasonable opportunity applies. NEW MEMBER START DATE: When the new member’s presence is reported or discovered, and they are determined eligible, proceed as follows: • NEWBORN: START DATE for eligibility is the first day of the month in which the child was born if mom was receiving Medicaid at the time of birth. • EXISTING HOUSEHOLD MEMBER: The existing member’s START DATE would be the date the individual is required to be included in the filing unit. • REQUIRED MEMBER NEW TO THE HOUSEHOLD: START DATE is the first of the month in which it was discovered/reported he or she entered the household.