Household composition
To explain the rules and worker responsibilities regarding the establishment of medical assistance units (MAU), for one or more family members whose eligibility for health care coverage is determined separately or together based on type of Apple Health program, relationship, and financial responsibility.
-
WAC 182-506-0010 Medical assistance units for MAGI-based programs.
-
WAC 182-506-0010 Medical assistance units for MAGI-based programs.
Effective April 3, 2016
This section applies to applicants or recipients whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology under WAC 182-503-0510 and 182-509-0300.
- General medical assistance unit (MAU) rules.
- The rules in this section describe how the medicaid agency must determine who is in an applicant's or recipient's MAU.
- Each person will have an individualized MAU and may have different eligibility results than other people on the same application.
- The countable income used to determine a person's eligibility is the sum of the countable income of everyone in the person's MAU.
- Rules regardless of tax filing status.
- If a married couple resides together, the agency must include both people in each other's MAU regardless of tax filing status.
- If a member of the MAU is pregnant, the number of people in the MAU increases by one for each unborn child.
- A deceased person does not count in the MAU of other applicants or recipients except in the month the person died.
- Children residing in an institution under chapter 182-514 WAC. An applicant or recipient is the only person in the MAU if the applicant or recipient:
- Has resided in a medical institution, institution for mental diseases (IMD), or inpatient psychiatric facility for thirty consecutive days; or
- Based on an assessment by the department of social and health services, is likely to reside in a medical institution, IMD, or inpatient
psychiatric facility for thirty consecutive days.
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
- General medical assistance unit (MAU) rules.
-
WAC 182-506-0012 Determining a person's medical assistance unit.
-
WAC 182-506-0012 Determining a person's medical assistance unit.
Effective April 3, 2016
This section applies to people whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income
methodology.- Determining a tax filer's medical assistance unit (MAU).
- A tax filer is a person who:
- Expects to file a federal income tax return; and
- Does not expect to be claimed as a tax dependent on a federal income tax return.
- If the applicant or recipient is a tax filer, the following people constitute the applicant's or recipient's MAU:
- The tax filer;
- The tax filer's spouse, if residing with the tax filer; and
- Everyone the tax filer expects to claim as a tax dependent.
- A tax filer is a person who:
- Determining a tax dependent's MAU.
- A tax dependent is a person who expects to be claimed as a tax dependent on a tax filer's federal income tax return.
- If the applicant or recipient is a tax dependent:
- The following people constitute the tax dependent's MAU unless the tax dependent meets one of the exceptions in (b)(ii) of this
subsection:- The tax dependent;
- The tax dependent's spouse, if living with the tax dependent;
- The tax filer who claims the tax dependent;
- The spouse of the tax filer who claims the tax dependent, if living with the tax filer; and
- All tax dependents claimed by the tax filer.
- A tax dependent who meets one of the exceptions below is treated as a nonfiler under subsection (3) of this section:
- A tax dependent who is neither the spouse nor the child of the tax filer;
- A child under age nineteen who resides with both parents and
those parents do not file a joint tax return; or - The tax dependent expects to be claimed by a noncustodial parent.
- The following people constitute the tax dependent's MAU unless the tax dependent meets one of the exceptions in (b)(ii) of this
- Determining a nonfiler's MAU.
- A nonfiler is a person who does not expect to file a federal income tax return and either:
- Does not expect to be claimed as a dependent; or
- Meets one of the exceptions listed in subsection (2)(b)(ii) of this section.
- If the applicant or recipient is a nonfiler, the nonfiler and the following people constitute the applicant's or recipient's MAU,
but only if residing with the nonfiler:- The nonfiler's spouse;
- The nonfiler's children under age nineteen; and
- If the nonfiler is under age nineteen, the nonfiler's parents and the nonfiler's siblings under age nineteen.
- A nonfiler is a person who does not expect to file a federal income tax return and either:
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
- Determining a tax filer's medical assistance unit (MAU).
Worker Responsibilities
- Make sure to include on the application:
- All relatives living in the home (including unmarried parents of children in common)
- All parents who do not have custody but are claiming a child in the home as a tax dependent
- Anyone else not living in the home who is claiming someone in the home as a tax dependent
- For each individual on the application, make sure to confirm the following:
- Tax filing status,
- Relationships with every other individual, and
- Whether the individual lives in or outside the home.
Note: To avoid processing errors, verify the accuracy of each individual's name, date of birth, social security number (if applicable).