g. Applicability of Parent, Caretaker Relative, Guardian, or Family Caregiver Exclusion to Multiple Individuals in a Residence

Interested parties requested that we explain how the exclusion under section 1902(xx)(9)(A)(ii)(III) of the Act will apply in homes with multiple individuals who may be a parent, caretaker relative, guardian, or family caregiver. We considered limiting the exclusion to one person per residence or allowing multiple individuals who reside together to qualify for the exclusion. In Medicaid, there is no precedent for limiting the number of individuals who reside together and are eligible for an exclusion to the application of a policy (for example, cost sharing exemptions, outlined at § 447.56), as most existing exclusions/exceptions in Medicaid are established based on an individual's eligibility factors, not (like this exclusion) their relation to another individual. Further, the statutory language at section 1902(xx)(9)(A)(ii)(III) does not specify that to qualify as a specified excluded individual there must be a one-to-one ratio of the individual to the person receiving care. ( printed page 33370)

We also considered how FNS within USDA implements similar exemptions for SNAP work requirements. The time limit work requirement under SNAP exempts individuals who have someone under age 14 in their SNAP household. [ 54 ] In SNAP, a household is defined as everyone who lives together and purchases and prepares meals together. [ 55 ] Although the SNAP terminology for a household is slightly different from the Medicaid terminology we describe in this section, FNS does not limit these exemptions from SNAP work requirements to a single person in a household. Instead, the time limit exemption applies to everyone living in the SNAP household with someone 13 years of age and under. This approach does not require SNAP programs to determine if there are other caregivers caring for the same dependent child when determining exemptions from the time limit work requirement.

We acknowledge that multiple individuals who could qualify for this exclusion may reside together. Consistent with our interpretation of the statute and existing SNAP policy, we are promulgating at new § 435.554(c)(3)(ii) a policy that allows multiple parents, caretaker relatives, guardians, and/or family caregivers in a single residence to qualify for the exclusion, provided that they meet the definitions and criteria discussed in this section. CMS believes that this policy closely aligns with what is allowed under SNAP and is consistent with section 1902(xx) of the Act, while minimizing administrative burden for States and beneficiaries.