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West Virginia Income Maintenance Manual Chapter 3

West Virginia Income Maintenance Manual Page 53 Chapter 3 Eligibility Determination Groups

IF YES: Test against the three exceptions below. If the answer to any of these exceptions is ‘yes’, then the applicant’s MAGI household size must be calculated using STEP 3. 1. The applicant is claimed as a dependent by someone other than a spouse or parent. 2. The applicant is a child under 19 who lives with both parents, but both parents do not expect to file taxes jointly. 3. The applicant is a child under 19 who is claimed as a tax dependent to a non-custodial parent(s). If none of these exceptions are true, then the applicant’s Medicaid household consists of the applicant, the tax filer claiming him as a dependent, this could be two people filing jointly, any other dependents in the tax filer’s household, and the applicant’s spouse if they reside together. This is known as the tax dependent rule. STEP 3: IF THE APPLICANT IS NOT A TAX FILER, IS NOT CLAIMED AS A TAX DEPENDENT OR MEETS ONE OF THE EXCEPTIONS IN STEP 2: The Medicaid household consists of the applicant and the following individuals as long as they reside with the applicant: • The applicant’s spouse; • The applicant’s child(ren) under age 19; • For applicants under 19, their parents, and their siblings who are also under 19. This is known as the non-filer rule. STEP 4: CASES WHERE APPLICANT CANNOT REASONABLY ESTABLISH TAX DEPENDENT STATUS If an applicant/tax filer cannot reasonably establish that reported household members will be tax dependents of the applicant for the tax year in which Medicaid is sought, the inclusion of such individual in the MAGI household of the tax filer is determined using rules in STEP 3. NOTE: For the purpose of this exception, the custodial parent is established based on physical custody specified in a court order or binding separation, divorce, or custody agreement. If there is no such order or agreement or it is unavailable, or in the event of a shared custody agreement, the custodial parent is the one with whom the applicant spends most nights.