Transcript Coding Household Members
Household Composition
What’s Changing For Medicaid?
•
Classic Medicaid
–The financial eligibility rules for these programs are not subject to the new MAGI methodology rules.
•
MAGI-based Medicaid
– Refers to individuals who are relatable to Medicaid/CHIP that includes family, Apple Health for Kids, pregnant women, or the newly eligible adults between the age of 19 up to 65. • Does not relate to classic Medicaid groups. HealthPlanFinder will get you to the right place •
Washington Apple Health (WAH) –
all Medicaid programs. the new brand name for 2
Household Calculation is also applied to Subsidies
• Calculated differently than Medicaid 3
Are you confused/Anxious?
• • It will be ok!
What you need to know – Definitions of filing status – Why family members may have differing eligibility – Importance of telling the Exchange of any change in household or income as it occurs – Very general understanding of household calculations.
4
What you don’t need to know
• • • How the Exchange calculates every family composition situation Tax law Answers to clients questions about how they should file taxes 5
Key Takeaways
• • Households for premium credits and Medicaid will not necessarily match people’s actual living situation Household rules could split families into different coverage programs (subsidies or Medicaid) 6
Why
• • Medicaid and premium subsidies are calculated by income and family size. Medicaid and premium subsidies define who is in a family differently.
7
Why Household Size and Composition Matter
• • Necessary to convert income to a federal poverty level (FPL) standard Who is in the household determines whose income counts in determining eligibility 8
Total Number of Family Members, parents and children
Your whole family qualifies for free coverage
Gross Month Family Income Self-employed? Use net income
Your child qualifies for free coverage Your child qualifies for coverage costing up to $30 a month
Your whole family qualifies for a subsidy or tax credit 1 2 3 4 5 More members?
$1322 $1784 $2246 $2708 $3171 Add $463 for each additional person $1915 $2585 $3255 $3925 $4595 Add $670 for each additional person $2874 $3879 $4884 $5889 $6894 Add $1,005 for each additional person
$3832 $5172 $6512 $7852 $9192 Add $1,340 for each additional person
9
New Medicaid Household Composition
• An assistance unit is comprised of those household members who must be looked at together due to income, age or tax-filing status in order to determine the household size. • Household size determines the income standard we use to determine an individual household member’s eligibility. • MAGI assistance rules can be found in Washington Administrative Code 182-506-0010 effective October 1, 2013. • Although income of other household members may be used in determining the household’s income eligibility and size for an assistance unit, each individual in the family unit will have their own Medicaid determination. 10
Key Components
• • • • There are several key components required to create assistance units such as: A individual’s tax filing status; How household members are related to each other; Their age; and If a woman in the household is pregnant *
*
If there is a pregnant woman in the household, the assistance unit (or units) she is included in, is increased by one count for each unborn child. 11
Households for Premium Tax Credits Household = individuals for whom a taxpayer claims a deduction for a personal exemption Household for Medicaid Household = Individuals living under one roof Don’t worry – the HealthPlanFinder will sort this out! 12
Terms you need to know 1. Head of Household You can claim the Head of Household filing status on your tax return if you are unmarried at the end of the year, have cared for a closely-related dependent for over half the year, and paid more than half the cost of maintaining a home for yourself and your dependent or dependents 2. Dependent see next slide 3. Filer files taxes 4. Non-filer does not file taxes 5. Married filing single 6. Married filing jointly
The term you chose will be the one your client filed on his or her taxes
13
Definitions
Tax Filer:
A tax filer is an individual who files taxes and is not claimed as a tax dependent by another tax filer.
Tax Dependent:
A tax dependent is an Individual who is claimed as tax a dependent by another person who is a tax filer.
Non-Filer/Non-tax dependent:
A non-filer/non-tax dependent is an individual who does not file a tax return and who is also not claimed as a tax dependent by another tax payer.
14
15
16
Even though Washington Healthplanfinder will establish the assistance units, it will be helpful for individuals who assist families in the application process to understand the assistance unit rules so that they can: • Confirm that the system results are correct and no error was made in the data entry; and • Explain why some household members received different results 17
On the “Primary Applicant’s Taxes” screen in the Washington Healthplanfinder, the following questions are asked: • The tax-filing status of the primary applicant; and • How they filed for the past tax year; how they plan to file in the current tax year; and how they plan to file in the next year. The information gathered on this screen will establish assistance units for determining eligibility.
18
WA Healthplanfinder will collect the following information about: • Other household members; • Their current/future tax filing status; • Relationship to the primary applicant; • If they live in the same home; • Demographics, age, SSN, race, etc.
19
20
Drop Down Choices for Health Plan Finder 21
There are 3 Rules that determine who must be included in an assistance unit .
Rule #1 The individual (tax filer) must expect to file taxes for: • Themselves; • Their spouse living with them; • All individuals expected to be claimed as a tax dependent regardless of age 22
Single Adult Not Claimed as a Tax Dependent
23
Coding Household Members Name Name Applicant for Medicaid
Jon
Filing Status to select in Healthplanfinder
Individual/Head of Household 24
Rule #2 The individual answered
NO
taxes (tax dependent): to Rule #1 – they do not plan to file • Does the individual expect to be claimed as a tax dependent by someone else?
o If
no
: They are a non-filer and must go onto Rule #3 o If
yes
: The basic rule is that their household is exactly the same as the tax filer that claims them, but there are some exceptions.
25
Rule #2 Exceptions
1. A child under age 19 living with parents who do not file a joint tax return 2. A child under age 19 who expects to be claimed by a non-custodial parent 3. A child under the age of 19 who lives with both parents and the parents are not married to each other 4. The individual expects to be claimed as a tax dependent by someone other than a spouse or parent 26
Rule #2 Exceptions
If one of the exceptions applies to the tax dependent, then the individual is treated as a non-filer and the assistance unit is determined according to Rule #3 27
Married Parents with a Common Child
• Bob and Suzie are married and file taxes jointly with their child in common, Tommy • Bob and Suzie claim Tommy as their tax dependent 28
Coding Household Members Name Applicant for Medicaid
Bob
Name
Suzie
Name
Tommy
Filing Status to select in Healthplanfin der
Married filing jointly Married filing jointly Tax dependent 29
Single Adult Claimed as a Tax Dependent
• Jon is an unmarried 20 year old residing in his parent’s home • Parents claim Jon as a tax dependent 30
Coding Household Members Applicant for Medicaid Name
Jon
Name Filing Status to select in Healthplanfinder
Tax dependent 31
Married Parents with a Child not in Common
• Steve and Donna are married and file taxes jointly • Donna’s child, Jonny (10), from a previous relationship, lives with them • Steve and Donna claim Jonny, as their tax dependent 32
Coding Household Members Name Applicant for Medicaid
Steve
Name
Donna
Name
Jonny
Filing Status to select in Healthplanfin der
Married filing jointly Married filing jointly Tax dependent 33
Rule # 3 If the individual answered
no
#2
BUT
to rule #1,
no
to rule #2 or,
yes
to rule an exception applies, the individual is considered a NON FILER.
A non filer’s assistance unit includes: • The individual • Their spouse • Their children under age 19 • If the applicant is under age 19, include their parents and siblings under age 19 34
•
Single Mom with Children
Ann is a single parent and is not filing taxes • Ann has two children, Drew (12) and Annabelle (7) • Drew’s father claims him as his tax dependent but Drew is currently living with his mother, Ann 35
Coding Household Members Applicant for Medicaid Name
Ann
Name
Drew
Name
Annabelle
Filing Status to select in Healthplanfinder
Non-filer Tax dependent Non-filer 36
Let’s stop here and discuss how to implement this with a client 1. How might you explain the results to a family when the child is eligible for Medicaid (CHIP), the mom is eligible for a subsidy, and the dad is not eligible for a subsidy?
2. How might you answer questions such as “should I claim my child next year on my taxes or have his dad do so?” or “ should I file separately from my spouse instead of together?” 37
Questions End here.
38
Exception Examples
E x a m p l e s o f h o w e a c h o f t h e f o u r e x c e p t i o n s a p p l y w h e n d e t e r m i n i n g w h o t o i n c l u d e i n t h e a s s i s t a n c e u n i t 39
Exception Examples Exception 1:
• “A child under the age of 19 living with parents that do not file a joint tax return” 40
Exception 1: Married Parents with a Child in Common Filing Taxes Separately
• Brad and Julie are married with child in common, Jesse (1) • Brad and Julie file taxes separately • Brad claims child, Jesse, as his tax dependent 41
Coding Household Members Applicant for Medicaid Name
Brad
Name
Julie
Name
Jesse
Filing Status to select in Healthplanfinder
Individual or head of household Individual or head of household Tax dependent 42
Exception Examples Exception 2
“A child under the age of 19 who expects to be claimed by a non-custodial parent” 43
Exception 2: Non-Custodial Parent Claims Child as Tax Dependent
• Ryan and Kari are married with a child in common, Austin, and Kari’s child, Monica, from a previous relationship • Ryan and Kari file taxes jointly and claim their child, Austin, as their tax dependent • Monica’s father (non-custodial parent) claims her as his tax dependent 44
Coding Household Members Applicant for Medicaid Name
Ryan
Name
Kari
Name
Austin
Name
Monica
Filing status to Select in Healthplanfinder
Married filing jointly Married filing jointly Tax dependent Tax dependent by someone outside of the HH 45
Exception 2: Child Claimed as a Tax Dependent of a Non-Custodial Parent
• Kevin files taxes and lives with his daughter, Jane (18) • Jane is claimed as a tax dependent by her mother, Ann, who does not live in Kevin and Jane’s home • Kevin applies for medical for himself and child Jane 46
Coding Household Members Applicant for Medicaid Name
Kevin
Name
Jane
Filing Status to select in WA Healthplanfinder
Individual or head of household Tax dependent of an individual outside the HH 47
Exception Examples Exception 3
“A child under the age of 19 who lives with both parents and the parents are not married to each other” 48
Exception 3: Unmarried Parents with a Child in common
• Chris and Carrie are unmarried with a common child, Bertha (3) • Chris and Carrie file taxes separately • Chris claims child, Bertha, as his tax dependent 49
Coding Household Members Applicant for Medicaid Name
Chris
Name
Carrie
Name
Bertha
Filing Status to select in WA Healthplanfinder
Individual or head of household Individual or Tax head of household dependent 50
Exception 3: Unmarried Parents with Child in Common and Uncommon
• Ron and Lucy are unmarried with a child in common, Frankie (7) and a child from a previous relationship. Sara (13) is Ron’s child from a previous relationship. • Ron and Lucy files taxes separately • Ron claims both children, Frankie and Sara, as his tax dependents 51
Coding Household Members Applicant for Medicaid Name
Ron
Name
Lucy
Name
Frankie
Name
Sara
Filing Status to Select in Healthplanfinder
Individual Individual or head of or head of household household Tax dependent Tax dependent 52
Exception Examples Exception 4
“The individual expects to be claimed as a tax dependent by someone other than a spouse or parent” 53
Exception 4: Grandparents Claim Grandchild as a Tax Dependent
• Grandpa, Grandma and grandchild, Melissa (16), live together • Grandpa claims Grandma and grandchild, Melissa, as his tax dependents 54
Coding Household Members Applicant for Medicaid Name Name
Grandpa Grandma
Name
Melissa
Filing Status to Select in Healthplanfinder
Married filing jointly Married filing jointly Tax dependent 55
Exercises
56
Single Adult Not Claimed as a Tax Dependent
• Theresa is an unmarried 24 year old residing in her parent’s home • Parents do not claim Theresa as a tax dependent and she will file her own taxes this year without any dependents
Applicant for Health Care Coverage Theresa Included in Applicant’s Household Theresa
57
Coding Household Members Name
Applicant for Health Care Coverage Theresa Name Filing Status to select in WA Healthplanfinder Individual/Head of Household 58
Married Couple No Dependents
• Dan and Jennifer are married and file taxes jointly • Dan and Jennifer do not have any dependents
Applicant for Health Care Coverage Dan Included in Applicant’s Household Jennifer Dan Jennifer
59
Coding Household Members
Applicant for Health Care Coverage Filing Status to select in WA Healthplanfinder Name Dan Name Jennifer Married filing jointly Married filing jointly 60
Married Parents with a Common Child
• Dan and Jennifer are married and file taxes jointly with their child in common, Kim who is a minor child.
• Dan and Jennifer claim Kim as their tax dependent
Applicant for Health Care Coverage Dan Included in Applicant’s Household Dan Jennifer Jennifer Kim Kim
61
Coding Household Members
Name Name Name Applicant for Health Care Coverage Filing Status to select in WA Healthplanfinder Dan Married filing jointly Jennifer Married filing jointly Kim Tax dependent 62
Single Adult Claimed as a Tax Dependent
• Kim is an unmarried 19 year old residing in parent’s home • Parents claim Kim as a tax dependent Applicant for Health Care Coverage Kim Included in Applicant’s Household Kim 63
Coding Household Members
Name Applicant for Health Care Coverage Kim Filing Status to select in WA Healthplanfinder Tax Dependent Name 64
Parents with Children
• Daniel and Gabriela are married and are not filing taxes • Daniel and Gabriela have two children at home, Sofia, who is a minor and Jessie who is 19 years old.
Applicant for Health Care Coverage
Daniel
Included in Applicant’s Household
Daniel Gabriela Gabriela Sofia Sofia Jessie Jessie 65
Coding Household Members
Applicant for Health Care Coverage
Name
Daniel
Name Name
Gabriela Sofia Applicant for Health Care Coverage
Name
Jessie Filing Status to select in WA Healthplanfinder Non filer Non-filer Non-filer Filing Status to select in WA r Healthplanfinde Non filer 66
Married Parents with a Child in Common Filing Taxes Separately
• Daniel and Gabriela are married and have a minor child, Sofia in common • Daniel and Gabriela file separately • Daniel is claiming child Sofia as his tax dependent
Applicant for Health Care Coverage Daniel Included in Applicant’s Household Daniel Gabriela Gabriela Sofia Sofia
67
Coding Household Members Applicant for Health Care Coverage Name
Daniel
Filing Status to select in WA Healthplanfinder Name
Gabriela
Name
Sofia Individual or head of household Individual or head of household Tax dependent 68
Non-Custodial Parent Claims Child as Tax Dependent
• Jason and Amanda are married with a child in common, Jared, and Amanda’s child, Sonia, from a previous relationship • Jason and Amanda file taxes jointly and claim their child, Jared, as their tax dependent • Sonia’s father (non-custodial parent) claims her as his tax dependent
Applicant for Health Care Coverage Jason Included in Applicant’s Household Jason Amanda Amanda Jared Jared Sonia Sonia
69
Coding Household Members Applicant for Health Care Coverage Name
Jason
Name Name
Amanda Jared
Filing Status to select in WA Healthplanfinder Name
Sonia Married filing jointly Married filing jointly Tax Tax dependent dependent 70
Child Claimed as a Tax Dependent of a Non-Custodial Parent
• Gloria files taxes and lives with her son, Michael (18) • Michael is claimed as a tax dependent by his father, Devin, who does not live in Gloria and Michael’s home • Gloria applies for medical for her and son Michael
Applicant for Health Care Coverage Gloria Included in Applicant’s Household Gloria Michael Michael
71
Coding Household Members Applicant for Health Insurance Care Name
Gloria
Filing Status to select in WA Healthplanfinder
Individual or head of household
Name
Michael Tax dependent 72
Unmarried Parents with a Child in common
• Sean and Kelly are unmarried with a child in common, Molly (3) • Sean and Kelly file taxes separately • Kelly claims child, Molly as her tax dependent
Applicant for Health Care Coverage Sean Included in Applicant’s Household Sean Kelly Kelly Molly Molly
73
Coding Household Members Applicant for Health Care Coverage Filing Status to select in WA Healthplanfinder Name
Sean
Name
Kelly
Name
Molly Individual or Individual or Tax head of Head of dependent household household 74
Parents unmarried, with Child in Common and Child Not in Common
• Karl and Amy are unmarried with a common child, Corey (5) and Brenda (16) Karl’s child from a previous relationship • Karl and Amy files taxes separately • Karl claims both Corey and Brenda, as his tax dependents Applicant for Health Care Coverage Karl Included in Applicant’s Household Karl Amy Amy Corey Corey Brenda Brenda 75
Coding Household Members Applicant for Health Care Coverage Filing Status to select in WA Healthplanfinder Name
Karl Individual
Name
Amy Individual or head of or head of household household
Name
Corey Tax dependent
Name
Brenda Tax dependent 76
Non-parent or spouse claim Tax Dependent
• Tamara and her husband Darryl have Tamara’s sister Krisanne (15) living with them • Darryl and Tamara file jointly and claim Krisanne as their tax dependent Applicant for Health Care Coverage Darryl Included in Applicant’s Household Darryl Tamara Tamara Krisanne Krisanne 77
Coding Household Members Name Name Applicant for Health Care Coverage
Darryl Tamara
Filing Status to select in WA Healthplanfinder
Married filing jointly Married filing jointly
Name
Krisanne Tax dependent 78
Questions?
Melissa Rivera Eligibility Policy & Service Delivery Office of Medicaid, Medicare, Eligibility & Policy [email protected]
360-725-1713 79