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MAC Income Requirements - Iowa

Consider the income of everyone in the household according to FMAP policy, except do not consider:

·           Income of a child voluntarily excluded from the eligibility determination because the child’s excess income creates ineligibility.

·           Income of persons who are receiving FMAP benefits when establishing MAC eligibility for persons not in the FMAP eligible group.

·           Any income that has been diverted to the FMAP eligible group in determining the countable income.

·           The FIP grant.

Exclude the needs, income, and resources of SSI recipients in the household when determining eligibility.

Exclude from the household size stepparents who have no children of their own and no common children.

Follow FMAP policy when establishing household size, including the following:

·           Count an unborn child (or children) as if born and living with the mother. The pregnancy must be verified.

·           Apply Medicaid policies regarding exclusion of certain household members.

The needs of a minor parent whose self-supporting parents’ income creates ineligibility for the minor parent and the minor’s child may be voluntarily excluded from the eligibility determination for the minor child. When the income of the minor parent and the minor’s child exceeds FMAP limits but do not exceed MAC Income Limits, the child may be eligible.

Examples:

1. Child A (age 6) and Child B (age 14) live with Aunt V. Child A receives $600 per month from a trust fund established by a relative. Child B receives $800 per month from the same trust fund. This creates ineligibility for Child A and Child B under the MAC coverage group because their combined unearned income exceeds 133% of the poverty level for a two-member household.

Aunt V may exclude either Child A or Child B from the eligibility determination in order to gain eligibility for the other child. The excluded child cannot receive Medicaid under any other coverage group. If Aunt V chooses not to exclude either child, examine Medically Needy eligibility for the entire household.

2. Mr. and Mrs. D live with Child E (age 17) and Child E’s daughter, Child F (age 2). Child E applies for FIP and Medicaid for herself and Child F. However, the income of Mr. and Mrs. D, her self-supporting parents, combined with her own earned income, creates FIP and FMAP ineligibility for Child E and Child F.

Child E may voluntarily exclude the income of Mr. and Mrs. D and, therefore, her own needs from the eligibility determination for Child F.

Child F would be Medicaid-eligible under the MAC coverage group if the countable income of Child E and Child F (minus applicable deductions) exceeds the FMAP limit for one person but is less than 133% of poverty for one person.

Since the self-supporting parents are responsible for Child E’s needs, none of Child E’s income can be diverted to meet her own needs. Child E is not eligible for Medicaid under any other coverage group.

3. Same household composition as in Example 2, above. Child E applies for FIP and Medicaid for herself and Child F. However, the resources of Mr. and Mrs. D, her self-supporting parents, combined with the resources of Child E and Child F, create FIP ineligibility for Child E and Child F.

In determining Medicaid eligibility for Child E and Child F, resources of all household members, including those of Mr. and Mrs. D, are disregarded.

Child E and Child F are determined Medicaid-eligible under FMAP, if all other eligibility factors are met.

Legal reference: 441 IAC 75.1(28)"a" and "e"

See Also:

·           MAC Income Limits

·           MAC Resource Limits

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter F, Coverage Groups, Mothers and Children (MAC) Program

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