60.12 Households that include individuals who are not lawfully present93

In general. If one or more individuals for whom a tax filer is allowed a deduction under § 151 of the Code are not lawfully present (see § 17.01(g) for definition of lawfully present), the percentage a tax filer's household income bears to the FPL for the tax filer's family size for purposes of determining the applicable percentage under § 60.07 is determined by excluding individuals who are not lawfully present from family size and by 87 An example to illustrate the rules of this subsection can be found at 26 CFR § 1.36B-3(h)(2). 88 26 CFR § 1.36B-3(j). 89 See § 36B(b)(3)(D) of the Code. 90 Examples to illustrate the rules of this subsection can be found at 26 CFR § 1.36B-3(j)(3). 91 26 CFR § 1.36B-3(k). 92 An example to illustrate the rules of this subsection can be found at 26 CFR § 1.36B-3(k)(3). 93 26 CFR § 1.36B-3(l). Eligibility-and-Enrollment Procedures Part 7 – Page 39 (Sec.61.00, Sub.0) determining household income in accordance with paragraph (b) of this subsection. (b) Revised household income computation Statutory method. For purposes of (a) of this subsection, household income is equal to the product of the tax filer's household income (determined without regard to this paragraph (b)) and a fraction: (i) The numerator of which is the FPL for the tax filer's family size determined by excluding individuals who are not lawfully present; and (ii) The denominator of which is the FPL for the tax filer's family size determined by including individuals who are not lawfully present. Comparable method. The IRS Commissioner may describe a comparable method in additional published guidance.94 Timely determination of eligibility95 (01/15/2019, GCR 18-064) In general AHS strives to complete eligibility determinations for health-benefits programs and QHP enrollment promptly and without undue delay. The amount of time needed to complete such determinations will necessarily vary, depending on such factors as: (i) The capabilities and cost of generally-available systems and technologies; (ii) The general availability of electronic data matching and ease of connections to electronic sources of authoritative information to determine and verify eligibility; and (iii) The needs of an individual, including: Individual preferences for mode of application (such as through an internet Website, telephone, mail, in-person, or other commonly available electronic means); and The relative complexity of adjudicating the eligibility determination based on household, income or other relevant information. An eligibility determination is complete once AHS sends written notice of decision to the individual. (b) Real-time determination of eligibility. When an individual files a complete, accurate and web-based application and relevant data can be fully verified through the use of available electronic means, an individual can expect a real-time or near-real-time eligibility determination. 94 See § 601.601(d)(2) of chapter one of the Code. 95 42 CFR § 435.912; 45 CFR § 155.310(e). Eligibility-and-Enrollment Procedures Part 7 – Page 40 (Sec.62.00, Sub.0) (c) Normal maximum time for determining eligibility.96 In cases involving such factors as described in paragraph (a) of this section, eligibility determinations may require additional time to complete. In any event, a decision on a health-benefits application will be made as soon as possible, but no later than: 90 days after the application date, if the application is based on a person’s disability; or 45 days after the application date for any other health-benefits application. (d) Extenuating circumstances. A determination may take longer in unusual situations, such as: An individual delays providing needed verification or other information; An examining physician delays sending a necessary report; or An unexpected emergency or administrative problem outside the control of AHS delays action on applications. (e) Notice of timeliness standards. Individuals will be informed of the timeliness standards set forth in this section. Interviews (01/01/2025, GCR 24-077) An in-person interview will not be required as part of the application process for a determination of Medicaid eligibility.97 Individual choice (01/15/2017, GCR 16-100) Choice of Medicaid category.98 If an individual would be eligible under more than one Medicaid category, the individual may choose to have eligibility determined for the category of the individual’s choosing. (b) Choice to determine eligibility for health-benefits programs.99 An individual may request only an eligibility determination for enrollment in a QHP without APTC or CSR. However, if the individual is requesting an eligibility determination for a health-benefits program, the individual may not request an eligibility determination for less than all of the health-benefits programs. For example, if an individual seeks a subsidy to help pay for the cost of QHP coverage, they may not limit their application to APTC or CSR. Rather, they must likewise submit to a determination of eligibility for Medicaid. Premiums (10/01/2021, GCR 20-004) 96 42 CFR § 435.912(c)(3). 97 42 CFR § 435.907(d)(2). 98 42 CFR § 435.404. 99 45 CFR § 155.310(b). Eligibility-and-Enrollment Procedures Part 7 – Page 41 (Sec.64.00, Sub.64.01)