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VA Medicaid Assistance Unit

Assistance Unit

The Medicaid assistance unit is the individual or family who applies for Medicaid and whose financial eligibility is determined. The rules for determining who is in an assistance unit are different for the different Medicaid Covered Groups.

This topic discusses a number of items. You can read the topic in sequence or jump to a specific section by following the links below:

·             Aged, Blind or Disabled (ABD) Covered Groups

o    Married ABD Individual

o    Unmarried ABD Individual Age 21 or older

o    ABD Child Age Less than 21

o    SSI Recipients

·             Families & Children Covered Groups

o    Family Unit

o    Budget Unit

Aged, Blind or Disabled (ABD) Covered Groups

Married ABD Individual

A married individual living with his/her spouse is always an ABD couple assistance unit (2 persons) for the resource-eligibility determination. (When WorkWORLD asks about assistance unit size, it means the size for determining income-eligibility, not resource-eligibility.)

For the income-eligibility determination, a married individual living with his/her spouse is an ABD couple assistance unit (2 persons) when:

·             The spouse is ABD and the spouse has applied for Medicaid; or

·             A Non-ABD spouse has deemable income. (Non-ABD means that the spouse either is not ABD or has not applied for Medicaid.)

Unmarried ABD Individual Age 21 or older

An unmarried ABD individual's assistance unit consists of one person -- the individual. The individual's child(ren) living with him or her are NOT included in the ABD individual's assistance unit, nor is any of the individual's resources or income allocated for the child(ren) when determining countable resources and countable income.

ABD Child Age Less than 21

The child's assistance unit is 1 person.

The parent(s) with whom the blind or disabled child under age 21 lives is legally responsible to support the child. However, the parent is not included in the child's assistance unit. The parent's resources and income are deemed available to the child.

SSI Recipients

Unless a recipient of Supplemental Security Income (SSI) owns an interest in real property contiguous to the home or undivided interest in heir property, or a former residence, a separate determination of resource eligibility is not made. If such resources are involved, then resource eligibility is determined for assistance units that are determined in accordance with the above rules.

However, an SSI recipient meets the Medicaid income eligibility requirements just by the fact that he/she receives an SSI payment, so a separate determination of income eligibility is not made.

Families & Children Covered Groups

The assistance unit for the Families & Children (F&C) covered groups is called the "Family Unit" or the "Budget Unit."

Family Unit

The Family Unit (FU) is the name for the assistance unit when determining eligibility for an F&C individual or family. The FU consists of the individuals in the household among whom legal responsibility for support exists. A parent or non-parent caretaker (caretaker-relative) can choose to exclude any child from the family unit by excluding the child from the Medicaid application.

The Family Unit must include the legally responsible relative(s) with whom the individual lives (parent for child under age 21 and spouse for spouse) unless the spouse or the parent receives SSI or a foster care/adoption subsidy payment. (Spouse refers to a person who would be defined as married to the individual under applicable state law. Parent refers to the natural or adoptive parent of the child.)

Multiple Family Units: DSS divides the household into multiple FUs when:

·      The household contains one or more individuals who apply for Medicaid but who are not a legally responsible relatives of the other individuals who have applied; or

·      The household contains a foster care child under age 21 who is placed in the home for a trial visit.

Each FU must contain only those individuals among whom legal responsibility for financial support exists. Therefore, caretaker-relatives of a dependent child are not in the same family unit as the dependent child for purposes of determining financial eligibility, even though their eligibility for LIFC Medicaid is based on the fact that there is a dependent child in the family.

The same is true for persons who are essential to the well-being (EWB) of a dependent child.

NOTE: Only one non-parent caretaker in a household can be eligible for Medicaid under the LIFC covered group. An individual cannot meet the caretaker-relative definition when the child's parent lives in the household.

Budget Unit

The Budget Unit is the term used for the assistance unit for F&C individuals in a family when specific circumstances exist. The Budget Unit is a sub-unit of the family unit. It contains some, but not all, members of the Family Unit.

The Family Unit must be further divided into Budget Units when the Family Unit does not meet the resource or income limit, and

·             The Family Unit contains a stepparent, an acknowledged father not married to the mother, a married Medicaid minor or a Medicaid minor parent in the home; or

·             A child in the Family Unit has resources or income of his/her own. In such cases, the number in the Budget Unit would be one, and the income of responsible parents would be deemed available to the child. (See F&C Parent-to-Child Deeming.)

See Also:

VA Medicaid Income Limits

VA Medicaid Resource Limits

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Chapter M05 of the Department of Social Services (DSS) Medicaid Manual.

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