DETERMINING NON-FINANCIAL ELIGIBILITY 4.3

Unless otherwise indicated, non-financial eligibility requirements for the Alliance program correspond to those of AR Medicaid (see Part IV, Non-financial Eligibility). Non-financial eligibility requirements must be verified.

Group Composition 4.3.1

The assistance unit must consist of the person requesting assistance and certain relatives and caretakers of children who live with the person, if these individuals wish to receive assistance. Relatives/caretakers who do not want to apply for benefits for themselves are never required to be included in the assistance unit, though their income and resources may be considered when determining the applicant’s eligibility. Groups that include children must follow the rules for the AR program. Groups in which no child is included (or included provisionally) must follow the rules of the SR program.

An Alliance unit may consist of any of the following:

• a single individual;
• an individual and his/her spouse, including a common-law spouse;
• a parent and his/her child(ren);
• a related or unrelated caretaker and the child and child’s siblings under his/her care; or
• a pregnant woman and her unborn child(ren).

In addition, at the group’s option, the following persons may be included in groups that include a child:

• a stepparent,
• step-siblings,
• an essential person, and
• parents of a parenting minor.

While parents residing in the home with a dependent child do not have to be included in the assistance unit, parents living in the home with a dependent child are provisionally included for the purpose of determining financial eligibility. If an individual resides in the same home as his/her spouse, the spouse must be provisionally included in any case that includes that individual.

The following individuals must be excluded from any Alliance unit:

• persons eligible for Medicaid,
• persons receiving Medicare Part A or Part B benefits,
• fugitive felons,
• probation or parole violators,
• persons penalized for misrepresenting their residence to receive assistance in two or more states,
• persons who refuse to provide information needed to determine their eligibility, and
• persons included in another medical assistance unit.

In addition, the following individuals may be excluded

• a child that the applicant/recipient has asked to excluded,
• a parent whose needs are met by his/her spouse who is not a natural or adoptive parent of the dependent child and who chooses to be excluded, and
• a parent under age 21 who chooses to be excluded because his/her needs are met by his/her parents with whom s/he resides

Residency  4.3.2

To be eligible for program benefits, a person must be a presently living in the District of Columbia voluntarily and not for a temporary purpose and have no current intention of moving out of the District. See Part IV: Chapter 2, Non-Financial Eligibility Requirements: Residency, for additional information on establishing and verifying residency eligibility. 

Social Security Number  4.3.3

The applicant/recipient must provide a Social Security Number (SSN) for each member of the group, who has one. Application for and verification of SSNs is not required.

Age/School Attendance  4.3.4

There are no age restrictions for receipt of benefits, but children under age 21 and adults 65 or older should be evaluated for federal Medicaid eligibility, prior to approval of Alliance benefits.

School attendance is not required.

Living with a Relative  4.3.5

There is no requirement that a child live with a relative to receive Alliance benefits. However, the child must be under the care of the person applying on his/her behalf, unless the person applying is acting as the authorized representative of the caretaker. See Part IV: Chapter 5, Non-Financial Eligibility Requirements: Living with a Relative, for additional information.

Citizenship/Alienage  4.3.6