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138 (07/2026) Chapter 2:Eligibility • Section 2: Eligibility groups Note: The following individuals who are not otherwise eligible in a standard living situation are considered to be in their own household group (i.e. household group of one): • Individuals receiving or applying for home and community-based care or nursing facility care, • Individuals being evaluated under the ACS rules, • Individuals residing in 24-hour mental health residential care settings, and • Individuals applying for or receiving Employed Persons with Disabilities (EPD). HSD Household information is used to determine whose financial and non-financial information is considered and will be used to determine eligibility and who will receive benefits. This information establishes the household size and family size for each applicant. HSD medical programs only use household group. • Household group:

Š A household group consists of every individual whose information is considered for determining each medical applicant’s eligibility.

Š If a deceased individual still being claimed on a household member’s taxes and the year of death is within the year of evaluation, they should be included in the household group. • Family size is:

Š Used to compare to the income standards chart for the applicable program.

Š Equal to the household group for the OHP Bridge – Basic Health program. For all other HSD medical programs, if there is a pregnant individual in the household , the family size consists of all members of the household group and each unborn child of any pregnant members of the household group. When establishing eligibility for HSD medical programs, each applicant or beneficiary shall have their own Eligibility Determination Group (EDG) determined based on the EDG rules below. You can use the MAGI EDG Formation flow chart to assist you when determining an individual’s EDG. For individuals determined eligible based on the monthly income test and for the OHP Bridge – Basic Medicaid program: • Tax filer EDG: If individuals intend to file a federal income tax return and are not claimed as a tax dependent by another individual, their EDG consists of:

Š The tax filer

Š The tax filer’s spouse if: » Tax filing status is ‘Married Filing Jointly’; or » They live in the same household, regardless of tax filing status.

Š Individuals the tax filer claims as tax dependents • Tax dependent EDG: If individuals expect to be claimed as a tax dependent by a tax filer, their EDG:

Š Is the same as the tax filer that claims them as a dependent except when any of the below apply: » An individual is claimed as a tax dependent by someone other than a parent or spouse,