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REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006

 BILL is not expected to file taxes, nor does he expect to be claimed as a tax dependent by his grandmother, Alice.  Because Bill is not married, he has no children, he does not live with his parents, and no one in the household is pregnant, Bill's household consists of himself only.  BILL’S MEDICAID/CHIP HOUSEHOLD = Bill

2. DETERMINE THE MEDICAID/CHIP HOUSEHOLD INCOME FOR EACH HOUSEHOLD.

 BILL’S MEDICAID/CHIP HOUSEHOLD = Bill

 Bill is not the child or expected tax dependent of another member of his household.  Although Bill is a child, his Social Security Survivor benefits DO count as income.  Bill collects $500/month, so his MAGI-based income = $500/month.  This household income equates to 52% FPL* for a household size of 1.  BILL’S MEDICAID/CHIP HOUSEHOLD INCOME = 52% FPL.

3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.

 ALICE:  Because Alice is age 65 or older, her eligibility for Medicaid will be based on ABD standards, in which tax filing requirements do not apply. Her eligibility will be determined using non-MAGI ABD based methodology, with necessary information gathered on an ABD supplemental form.

 BILL:  Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL.  With a Medicaid/CHIP household income of 52% FPL, Bill is eligible for Medicaid. If Bill had not been eligible for Medicaid, he may have been eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard.

SIMPLIFIED EXAMPLE 3 – KELLY & STANLEY’S FAMILY

Kelly is a 45-year-old woman applying for coverage for herself, her 47-year-old partner Stanley, her 15-year-old son Isaac, Stanley’s 14-year-old son Trent, and Stanley and Kelly’s 2-year-old son Jacob. Kelly claims Isaac as a tax dependent. Stanley claims Trent and Jacob as tax dependents. No one in the household is blind or disabled. No one in the household is pregnant. No one in the household has health insurance.

Relevant Information:  Kelly earns $1,500/month ($18,000/year)  Stanley earns $2,500/month ($30,000/year)  There are no other sources of income