KFMAM Manual - 11/22/2009

02000

                                                                                                  04000

03000: Assistance Planning -

03100 Assistance Planning for Medical Programs -

3110 - This section sets forth the assistance planning guidelines regarding persons who are in independent living arrangements. Persons in independent living are those who live in their own homes (renting, living with friends or relatives, homeless, etc.) or who live in room and board situations or specialized living arrangements. It does not apply to persons in the home-and community-based services (HCBS) program.

Specialized living arrangements are defined as non-medical living arrangements which are publicly funded or funded by not-for-profit agencies and/or organizations which provide living arrangements for individuals or families having an identified physical, mental, or social condition that requires an element of care or supervision. This would include but is not limited to alcohol or drug abuse facilities licensed or certified by ADAS, living arrangements sponsored by community mental health centers or similar agencies, shelters for battered women, temporary shelters for the homeless, and other non-medical residential care facilities.

3111 Assistance Planning - Assistance planning relates to the consideration of certain individuals living together as a family group. A family group is defined as the client and all individuals living together in which there is a legal and/or a caretaker relationship. (See KEESM Appendix T-6 regarding the definition of a caretaker and a legally responsible relative, 2140 for temporary absences, and 2069 for paternity.)

For MA CM, the assistance plan shall be based on TAF rules (see KEESM 4100) with a few exceptions. Persons excluded from the TAF assistance plan per KEESM 4113 because of a labor dispute, cash fraud conviction, time-limited assistance, fugitive felon or drug felon provisions are potentially eligible for Medicaid and are included in the MA CM plan. Persons excluded from MACM due to ineligibility shall be included in the MACM household size. These excluded individuals are also eligible for earned income deductions per 6221

For all other programs the assistance plan shall consist of those persons in the family group for whom assistance is requested and any excluded legally responsible person.

3112 Treatment of Assistance Plan - As noted earlier, the assistance plan for all medical programs other than MA CM (e.g., Medicaid Poverty Level and HealthWave) shall consist of those persons in the family group for whom assistance is requested and any excluded legally responsible person for those individuals. A stepparent shall be excluded from the assistance plan if assistance is requested only for his or her stepchild. For pregnant women, the assistance plan shall consist of the woman, the unborn child, and the father of the unborn child if living together. In addition, if the pregnant woman is a minor, the assistance plan must include the parents if living together. For children in the Medicaid poverty level or HealthWave program, if assistance is requested for a child who is ineligible due to failure to meet eligibility criteria (citizenship, insurance, etc.), the child shall still be included in the assistance plan. This does not include children who fail to meet age criteria, who have entered an institution or jail, or who are eligible for HCBS, SSI, TAF, foster care, or adoption support assistance. If the family fails to cooperate in providing information necessary to determine a child’s eligibility, he or she would be excluded from the plan. The income, resources (if applicable), and medical expenses of all persons in the plan shall be considered and their needs reflected in the applicable income and resource standard.

The client may include or exclude any family group members for assistance purposes.

Except as noted below, eligibility shall generally be determined within a single assistance plan for those members who qualify under the same category of assistance. For example, if more than one member requests and is eligible for MS, a combined determination is required. This policy would also be applicable to members of a family who qualify for the same medical program but under different individual subtypes (i.e., MP, N2, N3, N4, T5, T6, or T7). Once again, a combined determination of these individuals would be required. For purposes of this provision, the Medicaid poverty level and HealthWave programs shall be viewed as the same category of assistance and a combined determination would be applicable.

Separate assistance plans shall be established in the following instances:

3112.01 - Each SSI recipient (including 1619b recipients) shall have a separate plan as well as any child whose needs are met through foster care or adoption support payment.

3112.02 - Family group members who qualify under different medical programs (e.g., Medicaid poverty level, etc.) shall have separate plans except for family groups where some children qualify for the Medicaid poverty level program and some for HealthWave as noted above.

3112.03 - Each client in a long term care arrangement shall have a separate plan.

3112.04 - Emancipated minors, minors determined to be able to act in their own behalf, and 18 year old children shall have separate assistance plans.

3112.05 - Any child (and his or her siblings) in the family who is not living with a legally responsible person (such as grandchildren, nieces and nephews, etc.) shall have a separate assistance plan.

3112.06 - If the only children for whom assistance is requested are step siblings or have no blood relation, a separate plan is required as only the income of each child's parent can be considered. Otherwise, where all siblings (excluding unborn siblings) are blood related or adoptive brothers and sisters, a single plan shall be applicable if they qualify under the same category of assistance. This would include family arrangements in which assistance is requested for the non-mutual children of a husband and wife and a mutual child.

03120 Additional Assistance Planning -

03121 Additional Assistance Planning Provisions - The following additional principles are applicable for assistance planning purposes:

3121.01 - The caretaker can qualify for medical benefits under the MA CM program.

3121.02 - A common-law marriage establishes legal responsibility provided the parties: have the legal capacity to enter into a marriage (meets the age criteria and is not already married to another individual); consider themselves presently married; and hold each other out as husband and wife to the public. The "Statement of Common-Law Marriage" form in KEESM Appendix section P-5 may be used to document this relationship. However, when completion of the form is requested, negative action for failure to complete it shall not be taken unless the marriage relationship affects the determination of eligibility or benefit amount.

3121.03 - Any individual who does not have the legal responsibility to support a person in need is not required to do so. When such individual in the household, including an SSI recipient, voluntarily and regularly contributes cash to the applicant/recipient toward household expenses (including his maintenance needs), the net amount of income realized by the household shall be considered. To determine the net amount of income to be counted, the difference in the PIL including the individual and the PIL excluding the individual shall be deducted from the gross amount of the contribution.