|Release 68: Effective January 1, 2013|
Medical Assistance Programs -
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.
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.
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:
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);
|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.|
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.
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
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:
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:
People in the household group may be excluded from the MAF filing group as follows:
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:
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
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
Verify the following eligibility requirements for MAF:
|F||SEE SECTION A.1 (NC-A.1) OF THE NONCITIZENS CHAPTER FOR MORE INFORMATION ON VERIFICATION OF ALIEN STATUS.|
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
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
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.
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:
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:
The child support disregard is subtracted prior to the countable income test;
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.
|Adjusted Income||Countable Income|
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:
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.
Availability of Resources: 461-140-0020
Asset Transfer; General Information and Timelines: 461-140-0210
Resource Limits: 461-160-0015
The effective date for starting medical benefits for an eligible client is as follows:
In the MAF program when converting from HKC subsidy:
In the MAF program when not converting from an HKC (KCE) subsidy):
Retroactive eligibility effective dates
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