Medicaid 101: The Basics

Transcription

1 Medicaid 101: The Basics Madison Hardee, JD Staff Attorney, Legal Services of Southern Piedmont Pam Silberman, JD, DrPH Professor of the Practice, Department of Health Policy and Management, UNC Gillings School of Global Public Health 1

2 Agenda Medicaid and NC Health Choice eligibility Citizenship, immigration status, and residency requirements Eligibly categories Income eligibility Resources/assets tests Medicaid and the Marketplace Appeals ** Additional information on Medicaid covered services, Medicaid Network and delivery system, and more detailed information on Medicaid eligibility available at end of slide deck 2

3 Agenda Medicaid and NC Health Choice eligibility Citizenship, immigration status, and residency requirements Eligibility categories Income eligibility Resources/assets tests Medicaid and the Marketplace Appeals ** Additional information on Medicaid covered services, Medicaid Network and delivery system, and more detailed information on Medicaid eligibility available at end of slide deck 3

4 Basic Concepts: Medicaid, NC Health Choice, Medicare Medicaid is a governmental financed health insurance entitlement program that is jointly financed and administered between the federal and state government. It provides health insurance to some lowincome people. North Carolina Health Choice (NCHC) is a jointly financed health insurance program for certain low-income children (<age 19) who do not qualify for Medicaid. Medicare is a federally financed health insurance entitlement program that covers most older adults (age 65 or older) and some people with disabilities 4

5 Medicaid Eligibility People need to meet certain eligibility criteria to qualify for Medicaid in North Carolina: Citizenship or a qualified alien Residency Type of person (eligible category) Income Some people also need to have resources (assets) below a certain asset limit 5

6 NC Medicaid Income Eligibility (2014) (Percent of Federal Poverty Level, based on new MAGI income levels) 196% NC Health Choice Medicaid 210% 211% Currently, childless, nondisabled, non-elderly adults can not qualify for Medicaid 133% 47% 100% 100% Because of categorical restrictions, Medicaid only covers 30% of low-income adults in North Carolina (eg, incomes 100% FPL) CMS. State Medicaid and CHIP Income Eligibility Standards Effective January 1, Calculations for parents based on a family of three. Note: 100% of the federal poverty levels (FPL) (2014) = $11,670/yr. (1 person), $15,730 (2 people), $19,790 (3 people), $23,850 (4 people). Note: Children are covered by Medicaid up to 138% (which is the 133% ACA limits plus the 5% income disregard. The disregard is not reflected in this chart. 6

7 Medicaid Expansion Under the ACA The ACA gave states the option of expanding Medicaid to cover more low-income uninsured The expansion option eliminates the categorical eligibility requirements so it would provide coverage to childless adults who are not disabled or elderly if they have incomes below 133% FPL* Medicaid expansion would have potentially covered 560,000** in North Carolina North Carolina has chosen not to expand Medicaid at this time * There is a 5% income disregard, effectively making the upper income 138% FPL. **Based on a 2012 analysis by the NC Division of Medical Assistance and the NC Institute of Medicine. 7

8 Citizenship or Qualified Alien To qualify for Medicaid, a person must be a citizen or a qualified alien Citizens include people who were born in the United States or to US parents, as well as those who have been naturalized Qualified aliens include, but is not limited to people lawfully admitted for permanent residence (LPR),active duty military, refugees, asylees, battered child or spouse, conditional entrant Most qualified immigrants must be in the country for at least five years before they can start receiving Medicaid Some immigrants are exempt from the 5 year bar, including certain refugees and asylees, pregnant women and children, active duty military Must have a social security number or have applied for one 8

9 Mixed Status Families Individuals who are ineligible for health coverage due to immigration status can still help other eligible members of their family apply for Medicaid or the Marketplace. If an individual is not applying for coverage for themselves, they are not required to provide social security of document numbers. For anyone in household not applying for coverage, can leave SSN blank. 9

10 Residency In order to meet NC Medicaid state residency requirements, an individual must be domiciled in NC with the intention to remain here permanently or for an indefinite period or show that he/ she entered NC to seek employment or with a job commitment. 10

11 Eligible categories In North Carolina, Medicaid only covers certain types of people, including: Pregnant woman Child under age 21 Parents of dependent children Disabled (meet SSA disability definition) Elderly (65 or older) Women who have been diagnosed with breast or cervical cancer through a Breast and Cervical Cancer screening program There are other, more limited programs, for specific populations Family planning 11

12 Categories that receive automatic Medicaid coverage Certain people automatically receive Medicaid because they are getting other federal benefits. This includes: Older adults or people with disabilities who are receiving Supplemental Security Income (SSI) payments Note: SSI is not the same as Social Security disability or retirement payments Both Social Security and SSI are administered through the Social Security Administration, but SSI is for low-income people. Social Security income or disability payments are based on past contributions into the Social Security system Note: Families who are requesting Temporary Assistance to Needy Families (TANF or Work First ) payments (this is what most people refer to as welfare) can apply for Medicaid on same application. In most cases, if eligible for TANF, will also be eligible for Medicaid. 12

13 Eligible Categories People who do not fall into one of the eligible categories can not qualify for Medicaid, regardless of their income Example: adults who are homeless and living on the street do not qualify for Medicaid unless they meet Social Security disability standards, are age 65 or older, have children under the age of 19 living with them, or are pregnant Medicaid is not a program for all low-income people, just some lowincome people who meet the categorical, income, and (for some people) asset requirements. Note: If North Carolina had chosen to expand Medicaid, there would no longer be categorical eligibility requirements. That means that childless, nondisabled adults would qualify if their income was below 133% FPL. 13

14 Income Eligibility Income eligibility varies by type of eligible category. For example: Medicaid for pregnant women: 196% FPL Children: 0-5: 210% FPL (Medicaid) 6-18: 133% FPL (Medicaid) 133% FPL-211% FPL (NC Health Choice) Elderly and Disabled: 100% FPL Income eligibility for parents of dependent children not based on a fixed percentage of the FPL. It is generally less than half (50%) of the FPL. Note: Some individuals with higher incomes may qualify with a deductible under the medically needy program (discussed later) 14

15 Asset/ Resource test There is no asset test for pregnant women, children, or parents/family coverage (unless applying as medically needy) There is an asset test for the elderly, disabled, medically needy, or anyone applying for long-term care The asset limit is generally $2,000 for an individual and $3,000 for a couple (or family if applying as medically needy). Assets include money in the bank, stocks and bonds, more than one car, IRAs, pensions, etc. It does not include a person s home, the household belongings, the land where their house sits, one car, or the cash value of life insurance (if the total face value is not more than $10,000). 15

16 Overview of Eligible Medicaid Categories Category Pregnant Women Child under age 6 Child 6-18 Parent of child under 19 Eligible as soon as pregnancy verified. Self attestation for pregnancy is allowed. Income Income at or below 196% FPL (Note: include pregnant woman and unborn child(ren) plus any other family members in the household unit) Eligible for Medicaid Income at or below 210% FPL Eligible for Medicaid or NC Health Choice Medicaid: Income at or below 133% FPL NC Health Choice: Income between % FPL Asset test None None None None Parent or caretaker relative eligible if child <18 living with them Income less than ~50% FPL (income level varies by size of family) Note: Chart does not include all Medicaid eligibility categories such as Health Care for the Working Disabled, Medicare Savings Programs or Medically needy

17 Overview of Eligible Medicaid Categories Category People with Disabilities Elderly Breast and Cervical Cancer Meets the Social Security disability standards [1] Income Income at or below 100% FPL Asset test $2,000 in countable assets for an individual $3,000 for a couple 65 or older Women who have been diagnosed by a Breast and Cervical Cancer program as having cancer [2] Income at or below 100% FPL $2,000 (ind.) $3,000 (couple) Income at or below 250% FPL No asset test Family Planning Program [3] Men, women, and children of all ages Parental income will be considered for children (Cannot currently be on Medicaid) Income at or below 195% FPL No asset test [1] Social Security disability definition is having a physical or mental impairment that prevents a person from engaging in substantial gainful activity and which is expected to last 12 months or end in death. [2] Women are only eligible for BCCM if they have been diagnosed with breast or cervical cancer through a Breast and Cervical Cancer screening program generally through local health departments. Thus, it is important to refer patients to BCCCP if there is an abnormal screening or diagnostic test (before cancer is diagnosed). [3] Family planning coverage generally only provides coverage for family planning services (not abortions).

18 Medically Needy Program North Carolina provides coverage to some categorically eligible individuals with incomes in excess of mandatory limits. Individuals/families must incur medical bills equaling difference between their countable income and medically needy income limits (deductible or spend-down ). Note: Medically needy is not a separate eligibility category. Person still must be pregnant, child, parent/caretaker relative of dependent children, elderly or disabled. Medically needy program only helps people with excess income qualify. 18

19 Medicaid Medically Needy Calculations Example: Elderly individual with $1,042 countable monthly income in North Carolina $1,042 - countable monthly income medically needy income limits $800 - monthly spend-down or deductible x 6 - calculated on six month basis $ month deductible Unless monthly income is low enough to qualify automatically, Medicaid operates as a catastrophic health insurance program for individuals with large medical expenses 19

20 Agenda Medicaid and NC Health Choice eligibility Citizenship, immigration status, and residency requirements Eligible categories Income eligibility Resources/assets tests Medicaid and the Marketplace Appeals ** Additional information on Medicaid covered services, Medicaid Network and delivery system, and more detailed information on Medicaid eligibility available at end of slide deck 20

21 Household (HH) Unit MAGI Medicaid vs. Marketplace For Marketplace, HH size = Tax filing unit For MAGI Medicaid, Individual-based determination Members of a family could have different household sizes The household (HH) is not always the same as the tax filing unit When there may be differences in HH size: Pregnant women counted as 2 people (or more if multiple births) Tax dependent who is not a child or spouse Child claimed as tax dependent by non-custodial parent Child living with both parents who are unmarried 21

22 Household Size Examples Family of 4: 2 unmarried parents, 2 dependent child, all live together Medicaid Marketplace Mom 1 1 Dad 3 3 Child Child Family of 3: Parents divorced. Child lives with his mom, but dad claims him as a dependent Medicaid Marketplace Mom 1 1 Dad 2 2 Child 2 (in Mom s HH) 2 (In dad s HH) 22

23 Medicaid Is it Minimum Essential Coverage (MEC)? In some cases, yes: Medicaid for the Blind or Disabled Medicaid for the Aged (65+) Medicaid for Families/ Children NC Health Choice Breast and Cervical Cancer Medicaid (BCCM) Medically needy (after deductible) In some cases, no: Family Planning Medicaid Medically Needy (before deductible) Medicaid for Pregnant Women* Why this matters: Tax Penalty and Special Enrollment Periods 23

24 Marketplace State Application Transfer How it s supposed to work: No wrong door In practice, consumers will benefit by starting in the right place Faster way to access the coverage that is right for the individual Consumer has clear understanding of who is reviewing application Where to start? See Flowchart. For potentially Medicaid-eligible, can refer to local Department of Social Services or a navigator. Navigator referrals call

25 Medicaid-related questions on healthcare.gov Is consumer a US citizen or US national? Has consumer lived in the US since 1996? Do any of these people below have a physical disability or mental health condition that limits their ability to work, attend school, or take care of their daily needs? See Do any of these people need help with the activities of daily living through personal assistance services, a nursing home, or other medical facility? 25

26 Medicaid-related questions on healthcare.gov Does consumer live with one or more children under age 19 and is she the main person taking care of that child or children? Were any of these people found not eligible to get Medicaid and Children's Health Insurance Program (CHIP) since November 15, 2014? Are any of these people pregnant? 26

27 Children: Example Mom and 7 yo daughter. HH income is $30k (190% FPL) Both apply in Marketplace for coverage. Mom is eligible to enroll but daughter is sent to State for an NC Health Choice determination. Mom is upset that daughter can t enroll in Marketplace and wants to forget the whole thing. What to do? Advise mom to contact DSS or navigator to expedite daughter s NCHC approval Explain benefits of NC Health Choice 27

28 People with Disabilities: Example Mr. Lee is a 56 year old carpenter. He was injured about a year ago, hurting his back. He has been offered several small carpentry jobs since then, but each time his back has started hurting and he has been unable to continue. At most, he has earned between $500-$600/month in odd jobs. Mr. Lee exhausted his meager savings and has no other assets. What to do? Advise Mr. Lee to apply for Medicaid Advise Mr. Lee to also apply for Social Security Disability Advise to appeal if denied for Medicaid or Social Security 28

29 Immigrants: Example Patel and Mira, 75 yrs old, moved to the US to be closer to their son (but not claimed as dependents). They have been LPRs for 7 years but have not worked since arriving. Not eligible for Premium free Medicare due to no work history Only income is Patel s retirement pension pension of $800/ mo. What to do? Apply for Medicaid What if they were only LPRs for 3 years? Apply in Marketplace 29

30 Elderly Medicare Recipient: Example Tina is a 70 year old woman. Her only income is a Social Security Check of $1100 per month. She has Medicare parts A, B and D, but says that the premium and co-payments are too expensive What to do? Advise to apply for Medicaid. May qualify for premium assistance (MQB/LIS) 30

31 Agenda Medicaid and NC Health Choice eligibility Citizenship, immigration status, and residency requirements Eligible categories Income eligibility Resources/assets tests Medicaid and the Marketplace Appeals ** Additional information on Medicaid covered services, Medicaid Network and delivery system, and more detailed information on Medicaid eligibility available at end of slide deck 31

32 What can be appealed? Medicaid/ NC Health Choice (NCHC) o o Eligibility for Medicaid/ NCHC Services for Recipients Marketplace o o o o o Eligibility to buy a Marketplace plan The amount of Advanced Payment Tax Credit (APTC) The level of Cost Sharing Reduction (CSR) Eligibility for a Special Enrollment Period Eligibility for an exemption from the individual responsibility requirement 32

33 When and how to appeal Medicaid/ NCHC o o Appeal deadline depends on type of denial. Best to appeal as soon as possible. In most cases, consumer can request appeal by phone, fax or mail. Marketplace o o Must appeal within 90 days of date of determination Form must be mailed. It cannot be submitted by phone or online this year. Appeal request form in English Appeal request form in Spanish 33

34 Referrals for Legal Assistance Pisgah Legal Services: Buncombe, Henderson, Madison, Polk, Rutherford, and Transylvania Counties Legal Services of Southern Piedmont: Mecklenburg County Legal Aid of NC: All 100 Counties 34

35 Questions? 35

36 Addendum Medicaid covered services and out of pocket costs Medicaid network and delivery system More detailed Medicaid eligibility information 36

37 Covered Services Traditional (comprehensive) Medicaid program: States are required to cover certain services in their Medicaid program (mandatory services) States have the option of covering other services (optional services) Special Medicaid programs: Medicaid for Pregnant women: Same benefit package, but may require prior approval on some services and no copays Family planning services: people are generally limited to family planning services only Medicare Savings: Medicaid helps pay for some (or all) of Medicare cost sharing, but does not provide coverage for other services that Medicare does not cover 37

38 Mandatory Medicaid Services Hospitals (inpatient, outpatient) Physician services Nursing facility (NF) services for individuals aged 21 or older Home health care for persons eligible for nursing facility services Family planning services and supplies Rural health clinic services Laboratory and x-ray services Pediatric and family nurse practitioner services Federally qualified health center (community, migrant health centers) Nurse-midwife services EPSDT services for children under 21 Medically necessary transportation 38

39 Some Optional Services Prescription drugs Rehabilitation and other therapies Prosthetic devices, eyeglasses, durable medical equipment Dental services and dentures (limited for adults) Inpatient psychiatric services in dedicated psychiatric hospitals for children under age 21 or older adults (65 or older) Home and community based care to certain persons with chronic impairments Personal care services Intermediate care facilities for people with intellectual disabilities (ICF/IDs) Hospice services 39

40 NC Health Choice Services NC Health Choice covers many of the same services covered by Medicaid, including: Well-child checkups Prescription drugs Doctors visits Hospital care Lab tests Vision and hearing care Dental services Mental health Therapies 40

41 Out-of-Pocket Costs: Medicaid Medicaid: For most groups, there are no premiums, deductibles or coinsurance in the Medicaid program Copayments are allowed for certain people and for certain types of services, but copayments must be nominal (generally $3 or less) Copayments are not allowed for services provided to pregnant women, children, or people in nursing facilities; and not allowed for family planning services Exception: For Healthcare for the Working Disabled, there may be an annual fee or premiums based on income Above 150 FPL: Must pay annual enrollment fee Above 200 FPL: Annual enrollment fee + monthly premium 41

42 Out-of-Pocket Costs: NC Health Choice* Annual fee: Families with incomes above 150% FPL must pay an annual fee of $50 for one child or $100 for two or more children There is no deductible in NC Health Choice Copayments: Families may need to pay copayments of- $2-$10 for prescription drugs (depending on whether generics are available) $5 for doctor s visits or outpatient hospital visits $10-$25 for nonemergency visits to the emergency department *Children in families with incomes at or below 150% FPL do not pay the annual fee and pay lower copayments (eg, $1/$3 prescription drugs, no copay for office visits, and $10 for nonemergency visits to the ED). Children with higher family incomes pay enrollment fee and higher copays. 42

43 Addendum Medicaid covered services and out of pocket costs Medicaid network and delivery system More detailed Medicaid eligibility information 43

44 Community Care of North Carolina (CCNC)/Carolina Access Medicaid links recipients to a primary care home Medicaid and NC Health Choice recipients must select a primary care provider (if not, auto assigned) Primary care provider (PCP) can be the person s doctor, nurse practitioner, or physician assistant The PCP works with the patient to manage the patient s care. The PCP generally must approve any non-emergency care the patient needs. Example: Ms. Smith has uncontrolled diabetes and needs a consultation with an endocrinologist. Her primary care provider must authorize (approve) the referral to the endocrinologist. 44

45 Community Care of North Carolina/Carolina Access Most primary care practices are part of a larger CCNC network* There are 14 CCNC networks covering the state The network each includes primary care providers, hospitals, DSS, local health departments, local management entities/managed care organizations, and other health professionals who work together to care for the Medicaid population In addition, the network hires care managers to help work with people who have complex health problems to help them better manage their health condition Note: There are some providers who are not part of CCNC but are part of a prior program called Carolina Access. These providers can also serve as primary care medical homes, and must help manage the patient s care. However, they are not linked into the broader CCNC networks and do not have access to care management services. 45

46 Addendum Medicaid covered services and out of pocket costs Medicaid network and delivery system More detailed Medicaid eligibility information 46

47 Pregnant Women Category: A woman is categorically eligible for Medicaid once her pregnancy is medically verified Income: To qualify, her income must also be at or below 196% of the federal poverty limits (FPL) In determining income eligibility, you count the pregnant woman and her unborn children in the calculation (plus any other family members in the household unit Assets: There is no asset test for pregnant women 47

48 Children Category: Children are categorically eligible for Medicaid or NC Health Choice (the state s Child Health Insurance Program) Income: The determination of whether a child is covered by Medicaid or NC Health Choice is based on the age of the child and the family income Children under age 6 are eligible for Medicaid if their family income is less than or equal to 210% FPL Children ages 6 through 18 may be eligible for Medicaid or NC Health Choice Children with family incomes less than or equal to 133% FPL are eligible for Medicaid Children with incomes between % FPL are eligible for NC Health Choice Note: Some children in the household may be covered by Medicaid and others by NC Health Choice 48

49 Children (19, 20) Young adults, ages 19 and 20, may be eligible for Medicaid if their incomes are less than approximately 50% FPL Parent s income will count if child lives with and/or dependent on parent Assets: There is no asset test for children (unless the child is applying on the basis of disability) 49

50 Caregiver of Dependent Children Category: Parents or caretaker relatives (grandparents, aunts/uncles) may also be categorically eligible for Medicaid if: They have a dependent children under age 19 living with them Spouse of caregiver also covered Income: Eligibility for parents or caretaker relatives is generally limited to adults with incomes less than ~50% FPL Assets: There is no asset test for parents or caretaker relatives 50

51 People with Disabilities Category: People can also qualify for Medicaid if they are disabled (meeting the Social Security disability definition) SSA disability definition: Having a physical or mental impairment that prevents a person from engaging in substantial gainful activity, and which is expected to last 12 months or end in death Income: People with disabilities can qualify for Medicaid for people with disabilities (MAD) if their countable income is no more than 100% FPL. o Note: There are different income and asset rules for people who are in adult care homes or nursing facilities. If working disabled, can qualify with income above 100 FPL. Assets: There is an asset test for the elderly and disabled. People who are applying for Medicaid on the basis of disability cannot have more than: $2,000 in countable assets (for an individual) $3,000 in countable assets for a couple 51

52 Elderly Category: People can qualify for Medicaid if they are age 65 or older Income: Older adults can qualify if their family income is no more than 100% FPL Assets: There is an asset test for the elderly and disabled. People who are applying for Medicaid on the basis of disability cannot have more than: $2,000 in countable assets (for an individual) $3,000 in countable assets for a couple 52

53 Medicare Savings Programs Medicaid helps pay for some or all of the Medicare premiums, deductibles, co-insurance, and copays for elderly and disabled people who are receiving Medicare and who do not qualify for traditional Medicaid coverage. Note: The Medicare Savings program coverage is not the same as comprehensive Medicaid. It does not provide coverage for services, such as dental or vision, that Medicaid covers for people with full Medicaid coverage. The Medicare Savings program only provides coverage for some or all of the Medicare out-of-pocket costs. May qualify if income is below 135% FPL Note: If income below 100% FPL, can be dual-eligible for full Medicaid benefits in addition to Medicare 53

54 Medicare Savings Programs* Qualified Medicare Beneficiary (QMB) Income: $993/mo. (ind.) or $1,331/mo. (couple) Resources: $7,160 (ind.) or $10,750 (couple) Covers: Medicare Part A and B premiums, deductibles, coinsurance, copays Specified Low-Income Medicare Beneficiary (SLMB) Income: $1,187/$1,593 Resources: $7,160/$10,750 Covers: Part B premiums only Qualifying Individual (QI program) Income: $1,333/$1,790 Assets: $7,160/$10,750 Covers: Part B premiums only Qualified Disabled and Working Individuals (QDWI) Income: $3,975/$5,329 Assets: $4,000/$6,000 Covers: Part A premiums only * These are 2014 income limits. Income limits will be increased later in 2015 after new federal poverty limits released. Income limits changed every year. 54

55 Breast and Cervical Cancer Category: women who have been diagnosed by a breast and cervical cancer program as having breast or cervical cancer Note: to quality, the woman must have been diagnosed by a Breast and Cervical Cancer CCC Program (generally offered through health departments). Thus, women with abnormal screening or diagnostic tests should be referred to the BCCCP program for a diagnosis. Income: At or below 250% FPL. Resource test: None. 55

56 Family Planning Program Category: Covers children, women, and men (no age limits) The person will not qualify if they are currently receiving other Medicaid coverage (because other Medicaid coverage categories also cover family planning services) Income: At or below 195% FPL Assets: No asset test (Note: only provides coverage for family planning services) 56

57 Medicaid Monthly Income Limits (2014) Family Size Medicaid for Children 0-5 (210% FPL) Medicaid Children 6-18 (133% FPL) NC Health Choice Children 6-18 Medicaid for Parents of Children <19 (or children 19, 20) Medicaid for Pregnant Women (196% FPL) Breast and Cervical Cancer Program (250% FPL) Family Planning Services (195% FPL) 1 $2,043 $1,294 $1,295-$2,052 $434 $2,431 $1,896 2 $2,753 $1,744 $1,745-$2,766 $569 $2,570 $3,277 $2,556 3 $3,463 $2,194 $2,195-$3,480 $667 $3,233 $4,123 $3,216 4 $4,174 $2,644 $2,645-$4,194 $744 $3,896 $4,969 $3,876 5 $4,885 $3,094 $3,095-$4,908 $824 $4,559 $5,815 $4,535 * Income rules will change every April 57

58 Medicaid Monthly Income Limits (2014) Family Size Elderly and Disabled (100% FPL) Medicare Savings Programs 1 $993 $1,333 $242 2 $1,331 $1,790 $317 3 $367 4 $400 5 $433 Medically Needy Income Limits * Income rules will change every April 58

59 Income Eligibility Income is calculated differently for different categories of eligibles: MAGI Medicaid Programs for pregnant women, children and parents Almost all earned income is counted SSI, Work First, Child support, Veteran s benefits, workers comp NOT included 5% FPL disregard (different than marketplace) Income of tax dependents excluded unless dependent expected to be required to file tax return Traditional Medicaid Programs for the elderly, disabled and medically needy $20 general income exclusion $65 earned income exclusion Half of remaining earned income disregarded. Income of tax dependents included Includes some income that MAGI considers exempt Special rules for what family income is counted 59

60 MAGI Medicaid Household configurations Expect to file tax return and not claimed as dependent by another HH includes: Taxpayer and those expected to be claimed as tax dependents Expect to be claimed as a dependent HH includes: Taxpayer and those expected to be claimed as a dependent Not filing taxes and not claimed as a dependent HH includes: If adult is applicant: Individual, spouse, and children (including adopted & stepchildren) If child is applicant: Individual, parent, siblings (including stepparents and halfsiblings) Treated as not filing taxes: 1. Child expected to be claimed as a tax dependent by non-custodial parent 2. Child lives with both parents, is expected to be claimed by one, and child s parents do not expect to file jointly 3. Tax dependent is not a child or spouse of the taxpayer If not possible to establish tax dependency, use nonfiler rules Spouses living together are in same HH, regardless of filing status. Married couples filing jointly are in same HH even if living apart. 60