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477-000-009
REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID ELIGIBILITY 477-000-009 – Examples: Budgeting Procedures Example 1 – Employed Single Parent and One Child: The household consists of Mom, a single parent with one 9-year-old child, Mom’s earned income is $800/month. The child passes at 133% FPL, so she is eligible. Mom fails Parent/Caretaker for a household size of 2, or $704. Mom has a medical need and is budgeted under the MNIL for two, or $392. Mom’s Share of Cost would be $308/month ($800 minus $100 earned income disregard minus $392). If insured, the child’s income standard would be 133% FPL for two. Because the earned income is less than 133% FPL for two, the child would still be eligible if insured. Example 2 – Ineligible Parents with Three Children: The family consists of two parents, both employed, and three children, ages 12, 5, and 6 months. The parents are requesting Medicaid only for their children. The earned income is $3,200/month. If the children are insured, the income level for the 12-year-old is 133% FPL for five, so this child is over his income level. The income level for the 5-year-old is 145% FPL for five, so this child and the 6-month-old (who would be budgeted at 162% FPL) are both eligible. If uninsured, the 12-year-old child would be eligible for CHIP at 213% FPL. If insured, the 12-year-old child is not reviewed for eligibility with a Share of Cost as a medical need does not exist. Example 3 – Disabled Dad, Mom and Three Children: The family consists of a disabled Dad who receives $1,200 SSA Disability/month, Mom who is unemployed and three children, ages 14, 6, and 3. Each of the children receives $275 SSA due to Dad’s disability.
The income for the father is $1,200 (Dad’s SSA) - $20 general ABD disregard = $1,180. The income for the other household members is $1,200 (Dad’s SSA). To determine Dad’s eligibility at 100% FPL for five, we’d only use Dad’s SSA of $1,180. Dad is therefore eligible as ABD/OMB. Note: A child’s income is never counted in a disabled parent’s budget. Mom’s eligibility is based on Parent/Caretaker relative (P/CR) guidelines plus the 5% FPL disregard. Mom’s income is $1,200. The P/CR income limit for a unit size of five is $1,375, so she is eligible for Medicaid.