Medical Assistance Programs - E.  Medical Assistance to Families (MAF)

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The Medical Assistance to Families program provides medical assistance to people who are ineligible for MAA but are eligible for Medicaid using TANF (previously AFDC) program standards and methodologies that were in effect as of July 16, 1996.

1. Application Process

   The Application for Oregon Health Plan and Healthy Kids (OHA 7210), Oregon Health Plan (OHP) Standard Reservation List - OHP Application (OHA 7210R), Oregon Health Plan Application (online application) (OHA 7210W) or the Application for Services (MSC 415F) may be used.

   A new application may not be needed if the child is transitioning from another medical program or has joined a household currently receiving medical assistance or another program benefit such as SNAP.

   
   

2. Specific program requirements for MAF

   When a family or child becomes ineligible for or is denied MAA because of their household composition or income, determine eligibility for MAF medical assistance prior to converting to EXT or other OHP Plus medical program.

   To be eligible for MAF, a client must be a dependent child or a caretaker relative of a dependent child. However, a dependent child or caretaker relative cannot receive MAF while foster care payments are being made for the child.

   A dependent child must be under the age of 18, or 18 and regularly attending school full time.

   Definitions for Chapter 461: 461-001-0000
   Age Requirements for Clients to Receive Benefits: 461-120-0510
   Regular School Attendance: 461-120-0530

   Family members may be eligible for MAF when ineligible for MAA under the following situations:

   • Situation 1: If a blended (yours/mine/ours) family is ineligible for MAA because of income, resources or other program requirements, eligibility may exist by forming separate filing groups under MAF.

     For MAF, a blended family is one in which there is at least one child or unborn in common and the parents are unmarried. To fit in situation 1, there must also be at least one other child in the household from a prior relationship. If the only child is an unborn child in common, it is a situation 2 family (see below);

   • Situation 2: This situation is for a mother, father and their unborn child; there are no other children of these parents in the household, and the family is over income for MAA because of income from the father of the unborn child. If the father of the unborn child is not married to the mother and there are no other dependent children, the mother and the unborn child form a separate filing group. Deem the father's income to the mother (use the MAF Deeming Form (DHS 420A). (If the father of the unborn is also the father of another child in the household, consider situation 1.)

     Note:

     Do not begin MAF benefits until the calendar month before the month in which the due date falls. For both MAA and MAF, if the only child is an unborn child, there is no MAF eligibility for the pregnant woman until the month before the calendar month in which the due date falls.

   • Situation 3: A family is over income for MAA because of income from an ineligible noncitizen(s). The ineligible noncitizen(s) with income drops out of the filing group. Eligibility for MAF may exist by deeming (use the DHS 420A) the noncitizen(s) income to the MAF financial group.

     When deeming the noncitizen's income, deduct the adjusted income limit amount for the number of ineligible noncitizens who fall out of the filing group. The family may choose not to apply for MAF benefits for one or more ineligible noncitizens who have income. If the family so chooses, deduct the adjusted income limit amount for as many ineligible noncitizens with income who drop out of the filing group to make the balance of the filing group eligible for MAF benefits.

     For example, if there is an adult noncitizen and two noncitizen children who do not meet the alien status requirements but only the adult has income, you may choose to deduct the adjusted income limit for the adult only. The two noncitizen children may receive MAF CWM.

     In families with more than one ineligible noncitizen with income, it is possible to remove only one of the ineligible noncitizens from the filing group. For example, in a family with an ineligible noncitizen mother and an ineligible noncitizen father and one citizen child, if the father's income puts the need group over the MAA income standard, the father can be removed from the MAF filing group and his income deemed to the financial group, making the mother MAF CWM and the child MAF. Or, if more advantageous to the family, the mother and father can both be removed, and income from both parents deemed to the child if removing both parents will make the child MAF eligible.

   • Situation 4: A family is over income for MAA because of income from the spouse of a needy caretaker relative (the caretaker relative is not a parent). For MAF, the spouse with income is removed from the filing group of the needy caretaker relative and the dependent child. If the spouse has any dependent children not in common with the needy caretaker relative, they must be removed also. Deem the spouse's income to the MAF financial group (use the DHS 420A).
   • Situation 5: A family with self-employment income is over income for MAA. Eligibility for MAF may exist by deducting allowable costs of producing self-employment income.

   Filing Group; EXT, MAA, TANF: 461-110-0330
   Filing Group; MAF and SAC: 461-110-0340
   Specific Requirements; MAA, MAF, and TANF: 461-135-0070

   
   

3. Eligibility groups

   Household group (who is in the household?)

   A household consists of people who live in the same house, apartment, or other dwelling. A dwelling can contain more than one household if it is divided into separate living units, such as an apartment house, or if a landlord/tenant relationship exists. To have a valid landlord/tenant relationship, the landlord must live independently and bill the tenant for rent at fair market value. They may share bathroom and kitchen facilities, but only in a commercial room and/or board establishment.

   For homeless groups, the household is the people who consider themselves as living together.

   When people live in more than one household during a month, they are considered to be living in the household where they spend 51 percent or more of their time.

   Do not use a legal custody agreement to determine whether a child resides with the mother or the father. Instead, ask the parent where the child resided during the budget month. Be specific; you may need to ask questions about the particulars. For example, ask: Did the child reside with you on the first of the month? Where does the child live during the week?

   Once you have the answers, determine the number of days the child resided in each household and calculate the percentage.

   A person who leaves the household for short periods is considered to still be in the household if they intend to return. If they are gone for 30 continuous days or more, they are no longer in the household unless they must still be included under one of the following:

   • A parent gone because of employment while the other parent remains in the home. This includes people with jobs that customarily take them away from home, such as military service, truck driving or commercial fishing, and people looking for work;

   • A parent or caretaker relative for a maximum of 90 days when they are staying in a residential alcohol or drug treatment facility;

   • A person is receiving treatment in a general hospital and expected to return home. If they are not expected to return home, they remain in the household until they enter some other living arrangement, such as a nursing home;

   • A child gone for illness, social service, or educational reasons. They are no longer in the household if they are admitted to a Medicaid facility such as a nursing home or residential treatment facility for more than 30 days;

   • Children in foster care, if they are expected to return home within the next 30 days.

   Filing group (who must apply together?)

   The filing group is the people from the household group whose circumstances are considered in the eligibility determination process. The filing group includes people who must apply together because of their relationship to eligible people.

   When a household group member is in more than one filing group for the same program, the filing groups must be combined, unless specified otherwise in administrative rule.

   For MAF, the filing group must include a dependent child or unborn.

   People in the household group are included in the MAF filing group because of their relationship as follows:

   • Parents of the dependent child:
   • Each parent of an unborn child, as follows:
     • - The mother of an unborn;

     • - The father of an unborn if there is a dependent child in the filing group or if he is married to the mother of the unborn.

   • Siblings of the dependent child if the siblings meet the following nonfinancial eligibility requirements:
     • - Age - Under 18 years of age or age 18 and attending school full time;

     • - Living with a Caretaker Relative - The caretaker must be one of the following relatives to the sibling:
       1.    Any blood relative, including those of half-blood, and including first cousins, nephew, or nieces, and person of preceding generations as denoted by prefixes of grand, great-, or great-great;
       2.    Stepfather, stepmother, stepbrother, or stepsister;
       3.    A person who legally adopts the child and any person related to the person adopting the child, either naturally or through adoption.

     • - Citizen/Alien Status - The sibling must be a citizen of the U.S.; or be a citizen of Puerto Rico, Guam, the Virgin Islands or Saipan, Tinian, Rota or Pagan of the Northern Mariana Islands; or be a national from American Samoa or Swains Islands; or meet the alien status requirements for MAF.

     • - Deprivation. - The sibling must meet a deprivation requirement of the MAA program.

   • Needy caretaker relatives of the dependent child, their spouse and their dependent children.

   People in the household group may be excluded from the MAF filing group as follows:

   • In a two-parent household with common and uncommon children where the parents are not married, each parent may form their own filing group with their uncommon children;
   • A father of the unborn may be excluded from the MAF filing group if there are no other eligible dependent children in the filing group and he is not legally married to the mother of the unborn;
   • One or more ineligible noncitizens with income may be excluded from the MAF filing group;
   • The spouse and any dependent children of a needy caretaker relative may be excluded from the MAF filing group;
   • Exclude dependent children who have been or will be receiving foster care payments for more than 30 days;
   • A sibling of a dependent child may be excluded for the filing group if the sibling is receiving adoption assistance and counting the sibling's income reduces the filing group's benefits;
   • A dependent child is not included in the filing group if the dependent child is or will be receiving foster care payments for more than 30 days.

   Filing Group; Overview: 461-110-0310
   Filing Group; MAF and SAC: 461-110-0340

   Financial group (whose income and resources are counted?)

   The financial group is the filing group members whose income and resources count in determining eligibility and benefits.

   For MAF, the financial group includes all the people in the filing group except people receiving SSI benefits.

   Financial Group: 461-110-0530

   Need group (what income standard is used?)

   The need group consists of the people whose basic and special needs are used in determining eligibility. The number in the need group determines which income standard to use.

   For MAF, the need group includes all financial group members who meet all non-financial eligibility requirements except for the following:

   • Parents who are in foster care and for whom foster care payments are being made;
   • An unborn child.

   Need Group: 461-110-0630

   Benefit group (who receives benefits?)

   The benefit group is those people who receive benefits.

   For MAF, the benefit group includes all the need group members if the group meets the financial requirements.

   Benefit Group: 461-110-0750

   CAWEM

   Noncitizens who meet all the financial and nonfinancial requirements of another medical program (except OHP-CHP), except for their citizenship/alien status, are eligible for limited emergency medical assistance. The policy for forming eligibility determination groups for CAWEM is the same policy for the program the person would qualify for if they did meet the citizenship/alien status requirement.

   Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070

   
   

4. Verification

   Verify the following eligibility requirements for MAF:

   • Social Security number or an application for a number;

   • Citizenship. Acceptable evidence of citizenship must be provided for most MAF recipients who indicate they are U.S. citizens;

   • Alien status for persons who indicate they are not U.S. citizens but say they have legal immigration status;

     F	SEE SECTION A.1 (NC-A.1) OF THE NONCITIZENS CHAPTER FOR MORE INFORMATION ON VERIFICATION OF ALIEN STATUS.

   • American Indian/Alaska Native tribal membership or eligibility for benefits through an Indian Health Program;
   • Incapacity for deprivation based on incapacity. Other deprivation requirements as needed.

   When an Application Must Be Filed: 461-115-0050
   Verification; General: 461-115-0610
   Required Verification; BCCM, EXT, HKC, MAA, MAF, OHP, SAC: 461-115-0705

   
   

5. Budgeting

   For MAF, the initial budget month is the date of request (DOR) month. For the initial budget month, MAF uses actual income (that already received and what is anticipated to be received for the remainder of the budget month). For ongoing eligibility, MAF uses prospective budgeting and like MAA, is not certified. The eligibility worker is required to act on reported changes at any time during the MAF eligibility period, including changes reported on the DHS 945.

   In all SSP medical programs, when acting on reported changes, the day the change is reported is considered a DOR; treat the DOR month as the initial budget month when considering a different program.

   Example:

   A client reports a child has returned to the MAF filing group. Redetermine eligibility for the entire filing group using the month the change was reported as the budget month. If not eligible using the initial budget month for the child's medical eligibility, use any floating budget month that falls within 45 days from the DOR.

   Budgeting using the DHS 945

   The Medical Notice: It's time to renew your medical benefits (DHS 945) medical pend notice is mailed to SSP medical program clients. The DHS 945 establishes a DOR for medical and is used for SSP medical program redeterminations only.

   Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070
   OHP-OPU; Effective Dates for the Program: 461-135-1102

   
   

6. Financial eligibility for MAF

   Deeming

   For MAF situations 2, 3 and 4, income from the individual excluded from the filing group must be deemed back to the MAF financial group.

   The amount of income to deem back to the financial group if a person is excluded from the filing group for situations 2 and 3 is determined by deducting from that person's nonexcluded income.

   • The adjusted income standard in OAR 461-155-0030(2) for one person; and
   • The first $90 of earned income.

   These steps would be taken for each person whose income must be deemed to the MAF financial group. Deemed income is considered unearned income for the financial group.

   The amount of income to deem from the spouse of a needy caretaker relative to the MAF need group for situation 4 is as follows:

   • Deduct the following from the spouse's countable income;
     • - The needs of the spouse and their dependents living in the household, who are not in the benefit group, at the adjusted income standard; and

     • - The $90 earned income deduction.
   • Count any remaining income as unearned income to the financial group.

   Deemed Assets, Spouse of Nonparent Caretaker Relative; MAF: 461-145-0870
   Income of Ineligible Non-Citizens and Father of an Unborn; MAF: 461-160-0120

   Income deductions and exclusions

   Deductions are subtracted after the client has passed the countable income test.

   Exclusions are subtracted prior to the countable income test.

   Instead of allowing the TANF income deductions, use the following deductions and exclusions:

   • Exclude up to $50 of child support per dependent child or minor parent per financial group per month but not to exceed $200 per financial group per month. A filing group is only eligible for a $50 disregard of child support for the children who are receiving child support in the filing group. If only one child is receiving child support, other children in the filing group would not get the $50 disregard.

     The child support disregard is subtracted prior to the countable income test;

     Note:  See CS-H for more information about the child support pass-through and disregard, including examples.

   • For MAF situation 5, determine the amount of a self-employed person's countable earned income by reducing the amount of their gross sales or receipts by the amount of their costs of producing the income. See Section B of the Counting Client Assets chapter (CA-B) for allowed costs;
   • Once the amount of countable earned income is determined for any of the MAF situation financial groups (including countable self-employment income) allow the following deductions from each person's earned income:
     • - The first $120, plus one-third of the balance of their earned income; and

     • - A dependent care deduction up to $200 for each dependent under age 2, and $175 for each dependent age 2 and over. Costs may be incurred for hours worked, meal and commuting time, medical leave and work-related training.

   Earned Income Deductions and Order Applied; MAF and SAC: 461-160-0190
   Unearned Income Exclusion for Child and Spousal Support; MAF and SAC: 461-160-0200

   MAF income standards

   Countable income limit - This is the amount of countable income remaining after allowable exclusions.

   Adjusted income/payment standard - This is countable income minus deductions.

   Number in Need Group	Adjusted Income	Countable Income
   1 2 3 4 5 6 7 8 9 10 +1	$326   416   485   595   695   796   886   976 1,039 1,150 +110	$345   499   616   795   932 1,060 1,206 1,345 1,450 1,622 +172

   Income and Payment Standards; JOBS, MAA, MAF, REF, SAC, TANF: 461-155-0030
   How Income Affects Eligibility and Benefits; MAA, MAF, REF, SAC, SFPSS, TANF: 461-160-0100

   Resource limits and transfers

   For MAF the need group is not eligible for benefits if the financial group has countable resources equal to or greater than the need group resource limit.

   The resource limit for MAF is:

   • $10,000 for an MAF need group with at least one JOBS participant who is progressing in a case plan;
   • $10,000 for an MAF need group with at least one member who is working under a JOBS Plus agreement;
   • $2,500 for all other MAF need groups.

   To qualify for MAF benefits, a filing group must not have made a disqualifying transfer of their assets within the preceding three years. They must report any potentially disqualifying transfer at application, redetermination and when the transfer occurs. Making a disqualifying transfer of available assets will result in termination of benefits. When the client is ineligible for benefits because of a disqualifying transfer of assets, the client remains ineligible until the disqualification period ends or when the full equity rights in the asset are transferred back to the client or the client receives adequate compensation.

   Note:  A transfer of asset is only disqualifying if the client is an inpatient in a nursing facility or medical institution in which payment for the client is based on a level of care provided in a nursing facility.

   Availability of Resources: 461-140-0020
   Asset Transfer; General Information and Timelines: 461-140-0210
   Resource Limits: 461-160-0015

   
   

7. Effective dates; initial month medical benefits

   The effective date for starting medical benefits for an eligible client is as follows:

   In the MAF program when converting from HKC subsidy:

   • When converting an HKC subsidy client (KCE coding) to MAF, begin benefits the first of the month following the month that KCE eligibility ends. Enter a Compute action on the UCMS screen for the first of the next month. Change the medical start date on CMUP to the first of the next month.

   In the MAF program when not converting from an HKC (KCE) subsidy):

   • Unless converting from an HKC subsidy (see above), if the client meets all eligibility requirements on the date of request, begin medical effective the date of request;
   • If the client does not meet all eligibility requirements on the date of request, it is the first day following the date of request that all eligibility requirements are met. When floating the budget month, consider financial and nonfinancial eligibility requirements for the new budget month when determining eligibility.

   Retroactive eligibility effective dates

   • If a benefit group requests and is eligible for retroactive medical benefits, the earliest date they can be eligible is three months before the date of request. For example, if the benefit group requests benefits on July 10 and is found eligible for MAF, retro eligibility may also be considered for as far back as April 10;

   • After the earliest date is established, eligibility is determined on a month-by-month basis. The period starts on the earliest established date and ends on the date the benefit group requests benefits. For example, if the benefit group requests benefits on August 10, the earliest date is May 10. Eligibility is established separately for May 10 through May 31, June 1 through June 30, July 1 through July 31, and August 1 through August 9.

   Specific requirements; Retroactive Medical: 461-135-0875
   Effective Dates; Initial Month Medical Benefits: 461-180-0090
   Effective Dates; Retroactive Medical Benefits: 461-180-0140

   If the applicant is not eligible for MAF, review for EXT or OHP eligibility.

   Non-CAWEM MAF children may qualify for Continuous Eligibility for Medicaid if they lose eligibility for MAF prior to their next scheduled 12-month redetermination.

   Specific requirements; OHP: 461-135-1100