Department of Human Services: Chapter 1: Sections 1.4 thru 1.5

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IMA POLICY MANUAL
PART IV: NON-FINANCIAL ELIGIBILITY REQUIREMENTS

CHAPTER 1: GROUP COMPOSITION

OPTIONAL GROUP MEMBERS 1.4

The SSR should designate or create the group(s) in the manner most beneficial to the applicants (that is, in the manner that allows as many applicants as possible to be eligible), including optional members where helpful.

Example

Mrs. Payne lives with her two children, Robert and Mary, and her husband. Mr. Payne is neither Robert nor Mary’s father. Mr. Payne works and earns $45,000 per year. Mrs. Payne works and earns $15,000 per year, and neither Robert nor Mary receive any child support or other benefits.

Create an assistance unit consisting of Robert and Mary and evaluate their Medicaid eligibility based on the AR program type. If they are ineligible, evaluate their Medicaid eligibility based on the AX program type. Do not include Mrs. Payne in the assistance unit (but code her as “IP”, so her own income is counted). If she is included, Mr. Payne’s income will be deemed available to the assistance unit because spousal income is always deemed available to a spouse applying for Medicaid for him/herself. Step-parent income, however, is not deemed to step-children if the natural/adoptive parent is not in the assistance unit. Therefore, when determining the children's Medicaid eligibility, only Mrs. Payne’s income will be deemed available to Robert and Mary if Mrs. Payne chooses not to be included in the assistance unit.

AR: Children under 21, parents and/or step-parents living with children under 21, and caretakers of children under 21 (in households in which the parents are absent) may be included in the assistance unit with the child. Related and unrelated caretakers of minor children may be included in the group.

If a child lives in a joint or shared custody situation (that is, child lives with his/her mother two weeks each month and his/her father the other two weeks), only one parent may be in the group. The income and resources of the parent included in the group (or applying on behalf of the child) is included. Only actual income received by the child from the other parent is counted.

Foster care parents are not included in the assistance unit.

Step-siblings and children-in-common may be included in the group if they so elect.

The parent(s) of a parenting minor may be included in the group if it is to the benefit of the household. Similarly, the parent(s) of a pregnant minor may be included in the group. However, SSR shall exclude the parent(s) of a pregnant or parenting minor at their own request or at the request of the minor. If the parents are excluded, their income and resources are not counted, even provisionally.

An essential person (see Section 1.6: Essential Person in this Chapter) of a dependent child has the option of being included in the assistance unit. Also, a caretaker relative has the option of being included in the assistance unit, but s/he may only be included if a parent is not in the home.

AX: See AR. Note that although the AR program serves children until they turn 21, the AX program serves children only until they turn 19. Children under 19, parents and/or step-parents living with children under 19, and caretakers of children under 19 eligible for Medicaid (in households in which the parents are absent) who are otherwise eligible may be included in the assistance unit. Other types of persons that can be included in the AR group can likewise be included in an AX group.

SR: There are no optional group members.

QM: See SR.

TANF

There are two types of optional group members:

A caretaker relative (see Section 5.6: Caretaker in this Part).
A child of a TANF child.

These individuals may be included or excluded from the group depending on whichever is advantageous to the group. The caretaker relative must request that s/he be included.

There are no optional group members, though a caretaker can be included in the MA unit as is described above.

N/A

EXCLUDED PERSONS 1.5

Fugitive Felon and Probation or Parole Violators 1.5.1

ALL

Assistance will be denied to any person who is fleeing to avoid prosecution, custody, or confinement after conviction under the laws of the place from which the individual flees for a crime or an attempt to commit a crime which is a felony under the laws of the jurisdiction from which the individual flees; or who is violating a condition of probation or parole imposed under federal, state, or D.C. law. A fleeing felon is usually determined by the existence of an outstanding warrant for the individuals’s arrest; the individual is assumed to be fleeing as of the date the warrant is issued.

For an individual to be considered fleeing, that individual must be acting with the intent to avoid prosecution. For cases where a warrant has been issued, the individual must have knowledge that a warrant has been issued for his arrest in order to be considered “fleeing”. Once an individual has knowledge of the warrant, either by having received the warrant personally, or by being advised of its existence by the SSR, s/he is technically at that time, “fleeing”. In the case where the SSR determines during the application processing time frame that an applicant has a warrant out for his/her arrests, the SSR must verify with the applicant whether s/he has knowledge of the warrant. The applicant should also be given an opportunity to submit documentation that the warrant has been satisfied. This policy does not apply to individuals who have been granted a pardon from the President of the United States with respect to the above conduct.

In compliance with the District’s existing policy on safeguarding customer confidentiality, the Department is required to cooperate with federal, state, and D.C. law enforcement authorities by honoring their request for information on persons who are believed to have committed a felony.

At each application and review, the SSR must inform the customer of the program provisions regarding fleeing felons and probation and parole violators.

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