Household composition

Revised April 27, 2016

Purpose: To explain the rules and worker responsibilities regarding the establishment of medical assistance units (MAU), for one or more family members whose eligibility for health care coverage is determined separately or together based on type of Apple Health program, relationship, and financial responsibility.

WAC 182-506-0010 Medical assistance units for MAGI-based programs.

Effective April 3, 2016

This section applies to applicants or recipients whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income methodology under WAC 182-503-0510 and 182-509-0300.

  1. General medical assistance unit (MAU) rules.
    1. The rules in this section describe how the medicaid agency must determine who is in an applicant's or recipient's MAU.
    2. Each person will have an individualized MAU and may have different eligibility results than other people on the same application.
    3. The countable income used to determine a person's eligibility is the sum of the countable income of everyone in the person's MAU.
  2. Rules regardless of tax filing status.
    1. If a married couple resides together, the agency must include both people in each other's MAU regardless of tax filing status.
    2. If a member of the MAU is pregnant, the number of people in the MAU increases by one for each unborn child.
    3. A deceased person does not count in the MAU of other applicants or recipients except in the month the person died.
  3. Children residing in an institution under chapter 182-514 WAC. An applicant or recipient is the only person in the MAU if the applicant or recipient: 
    1. Has resided in a medical institution, institution for mental diseases (IMD), or inpatient psychiatric facility for thirty consecutive days; or
    2. Based on an assessment by the department of social and health services, is likely to reside in a medical institution, IMD, or inpatient
      psychiatric facility for thirty consecutive days.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-506-0012 Determining a person's medical assistance unit.

​Effective April 3, 2016

This section applies to people whose financial eligibility for Washington apple health coverage is based on modified adjusted gross income
methodology.

  1. Determining a tax filer's medical assistance unit (MAU).
    1. A tax filer is a person who:
      1. Expects to file a federal income tax return; and
      2. Does not expect to be claimed as a tax dependent on a federal income tax return.
    2. If the applicant or recipient is a tax filer, the following people constitute the applicant's or recipient's MAU:
      1. The tax filer;
      2. The tax filer's spouse, if residing with the tax filer; and
      3. Everyone the tax filer expects to claim as a tax dependent.
  2. Determining a tax dependent's MAU.
    1. A tax dependent is a person who expects to be claimed as a tax dependent on a tax filer's federal income tax return.
    2. If the applicant or recipient is a tax dependent:
      1. The following people constitute the tax dependent's MAU unless the tax dependent meets one of the exceptions in (b)(ii) of this
        subsection:
        1. The tax dependent;
        2. The tax dependent's spouse, if living with the tax dependent;
        3. The tax filer who claims the tax dependent;
        4. The spouse of the tax filer who claims the tax dependent, if living with the tax filer; and
        5. All tax dependents claimed by the tax filer.
      2. A tax dependent who meets one of the exceptions below is treated as a nonfiler under subsection (3) of this section:
        1. A tax dependent who is neither the spouse nor the child of the tax filer;
        2. A child under age nineteen who resides with both parents and
          those parents do not file a joint tax return; or
        3. The tax dependent expects to be claimed by a noncustodial parent.
  3. Determining a nonfiler's MAU.
    1. A nonfiler is a person who does not expect to file a federal income tax return and either:
      1. Does not expect to be claimed as a dependent; or
      2. Meets one of the exceptions listed in subsection (2)(b)(ii) of this section.
    2. If the applicant or recipient is a nonfiler, the nonfiler and the following people constitute the applicant's or recipient's MAU,
      but only if residing with the nonfiler:
      1. The nonfiler's spouse;
      2. The nonfiler's children under age nineteen; and
      3. If the nonfiler is under age nineteen, the nonfiler's parents and the nonfiler's siblings under age nineteen.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

(2)(b)(ii)(B) Clarified: A child being claimed as a tax dependent by a custodial parent who is living with both parents who are not married to each other would fall under this exception. (2)(b)(ii)(B) Clarified: The tax dependent expecting to be claimed by a noncustodial parent only applies to a child under age 19. Adult children over age 18 are not included in this exception. Household Defined: Medicaid households are based on a person’s family and tax relationships, as well as living arrangements. MAU Defined: MAU stands for “Medicaid assistance unit.” It refers to the individuals who are counted together when determining Medicaid eligibility. Each individual has his or her own MAU. This means different members of a household might all have different MAUs. Parent, child, and sibling relationships include biological, adopted, and step.

The Importance of MAU:

Knowing an individual’s MAU allows us to determine two key facts:

  1. The appropriate FPL standard; and
  2. Whose income to count when determining if the MAU's combined countable income is under the appropriate FPL standard.

Noncustodial and Custodial Parent:

The term noncustodial and custodial parent(s) only applies to a child under age 19. If there is no court order or binding agreement establishing physical custody controls, the custodial parent is the parent with whom the child spends the most nights.

College Students:

College students, including those age 19 or older, are treated as any other tax filer, tax dependent, or non-filer according to the rules under WAC 182-506-0010. If they are a tax dependent, they should list themselves in Healthplanfinder as “tax dependent of someone on the application.” Healthplanfinder will prompt the tax dependent (college student) to enter the information for the tax filer(s) and other dependents.

Tax Filing Status:

Tax filing status should be entered as it is or is expected to be for the corresponding year of eligibility.

For example, if a married couple separates but still plans to file Married Filing Jointly for the current year, they would enter their tax filing status as Married Filing Jointly and indicate that their spouse is not living in the home. If their tax filing status is expected to be different for the following year, they would enter their expected tax filing status for the corresponding year.

Examples: Example 1: Jason applies for himself, his wife, Ashley, and their two children, 8 year old Paul and 6 year old Emma. Jason and Ashley plan to file a joint return claiming both their children as dependents.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size
Jason Tax Filer Jason, Ashley, and their tax dependents, Paul and Emma 4
Ashley Tax Filer Ashley, Jason, and their tax dependents, Paul and Emma 4
Paul Tax Dependent Paul, the tax payers, Jason and Emma, and their other tax dependent, Emma 4
Emma Tax Dependent Emma, the tax payers, Jason and Ashley, and their other tax dependent, Paul 4

Results: Jason and Ashley are tax filers, so Tax Filer rules apply to them. Paul and Emma are tax dependents for whom none of the exemptions listed under tax dependents apply, so tax dependent rules apply to them. The result is that for all four individuals, the MAU includes the tax payers and their two dependents.

Example 2: The scenario is the same as in Example 1, except that neither Jason nor Ashley expects to file taxes.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size
Jason Non-Filer Jason, his spouse, Ashley, and their children, Paul and Emma 4
Ashley Non-Filer Ashley, her spouse, Jason, and their children, Paul and Emma 4
Paul Non-Filer Paul, his parents Jason and Ashley, and his sibling Emma 4
Emma Non-Filer Emma, her parents, Jason and Ashley, and her sibling, Paul 4

Results: Since no one in the example is a tax filer or dependent, non-filer rules apply. Spouses, parents and siblings for children under age 19 are considered for each individual. In examples 1 and 2, the same four family members are in each individual's MAU regardless of whether tax filer or non-filer rules are used.

Example 3: Carol, age 60, applies for herself and her grandson, Cody, age 12. She states that she will file taxes and claim her grandson as a dependent.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size
Carol Tax Filer Carol and her dependent, Cody 2
Cody Non-Filer Cody 1

Results: Since Carol is a tax filer, her MAU includes herself and her grandson who is her tax dependent. Cody is a tax dependent who is claimed by a person who is not his parent or spouse (tax dependent, exception 1), therefore non-filer rules apply for him and he has an MAU of one.

Example 4: Nick, age 30, lives with his son Alex, age 8, his girlfriend Shari, age 31, and their daughter in common, Joan, 1 year. Nick applies for himself and Alex. Nick does not expect to file taxes or be claimed as a tax dependent. Shari applies for herself and Joan. Shari is a tax filer and plans to claim Joan and Alex as her dependents.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size:
Nick Non-Filer Nick and his children, Alex and Joan 3
Alex Non-Filer Alex, his father Nick, and sibling Joan 3
Shari Tax-Filer Shari and her dependents, Alex and Joan 3
Joan Non-Filer Joan, her parents Nick and Shari, and sibling Alex 4

Results: Since Nick is a non-filer, use non-filer rules. His MAU includes himself and his 2 children. Alex is a tax dependent who is claimed by Shari. Since Shari is not his parent (tax dependent, exception 1), non-filer rules apply for Alex. His MAU includes himself, his father, and his sibling. Shari is a tax payer, so her MAU includes herself and her 2 dependents. Joan is a tax dependent who is claimed by one parent, but lives with both parents who are not married so they do not file a joint tax return (tax dependent, exception 2). Non-filer rules apply for Joan, so her MAU includes herself, both parents and her sibling.

Example 5: Sarah, age 19, applies for herself and her younger brother John, age 9. She states that she is a tax filer and will claim John as a dependent. Sara is pregnant and is expecting twins.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size:
Sarah Tax Filer Sarah + 2 unborn, and John 4
John Non-Filer John 1

Results: Since Sara is a tax filer, her MAU includes herself, her brother who is her tax dependent, and her 2 unborn. John is a tax dependent who is claimed by a person who is not his parent or spouse (tax dependent, exception 1), therefore non-filer rules apply to him and he has an MAU of one.

Example 6: Jim and Jill, both age 30 are divorced with a child in common, Kyle, age 6, who lives with Jill but is claimed as a tax dependent by Jim. Jill is a tax filer and applies for herself and Kyle. Jim, who lives in a different town, applies separately for himself.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size:
Jim Tax Filer Jim and his tax dependent, Kyle 2
Jill Tax Filer Jill 1
Kyle Non-Filer Kyle and his mother, Jill 2

Results: Even though Kyle does not live with Jim he would still be included in Jim’s MAU since he is claimed as a tax dependent. Jill is also a tax filer and she would include herself but not her son as he is being claimed by Jim who lives outside the home. Kyle is a tax dependent who is claimed by a noncustodial parent (tax dependent, exception 3) so non-filer rules apply to him. Under non-filer rules, an individual under age 19 includes his parent(s) in his MAU if living with them.

Example 7: The scenario is the same as Example 6 except Jill does not file a tax return.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size:
Jim Tax Filer Jim and his tax dependent, Kyle 2
Jill Non-Filer Jill and Kyle 2
Kyle Non-Filer Kyle and his mother, Jill 2

Results: Even though Kyle does not live with Jim he would still be included in Jim’s MAU since he is claimed as a tax dependent. Since Jill is a non-filer and is not claimed by another person non-filer rules apply. She has an MAU of 2, her and her son, Kyle. Kyle is a tax dependent who is claimed by a noncustodial parent (tax dependent, exception 3) so non-filer rules apply to him.

Example 8: Natalia, age 45, lives with her daughter, Catalina, age 18 and her granddaughter Mia, age 1. Natalia files taxes and claims both her daughter, Catalina and granddaughter, Mia. Natalia applies for herself and her daughter Catalina. Catalina applies separately for her daughter, Mia.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer Rule: Who to include: MAU size
Natalia Tax Filer Natalia, and her tax dependents Catalina and Mia 3
Catalina Tax Dependent Catalina, her mother Natalia, and her daughter, Mia 3
Mia Non-Filer Mia and her mother, Catalina 2

Results: Since Natalia is a tax filer, use tax filer rules. Her MAU includes herself and her two tax dependents, Catalina and Mia. Catalina is a tax dependent and she doesn’t meet any of the exceptions so her MAU is exactly like the tax filer claiming her: Catalina, Natalia, and Mia. Mia is a tax dependent claimed by Natalia. Since Natalia is not her parent (tax dependent, exception 1), non-filer rules apply for Mia. Her MAU included her mother and herself.

Example 9: Carlos applies for himself, his spouse, Sebastian, and their 17 year old niece, Ana. Carlos and Sebastian file a joint tax return and claim their 20 year old son, Rafael, who is away at college, and Ana. Rafael applies separately.

Determine MAU for: Tax Filer, Tax Dependent, or Non-Filer: Who to include: MAU size:
Carlos Tax Filer Carlos, Sebastian, Rafael, and Ana 4
Sebastian Tax Filer Sebastian, Carlos, Rafael, and Ana 4
Rafael Tax Dependent: Must apply for Medicaid on his own since he is age 20 Rafael, Carlos, Sebastian, and Ana 4
Ana Non-Filer Ana 1

Results: Carlos and Sebastian are tax filers claiming Rafael and Ana as tax dependents so their MAUs would include themselves, their spouse and both tax dependents. Rafael is away at college and his parents expect to claim him. He is a tax dependent and doesn’t meet any of the exceptions so his MAU is the same as the tax filer claiming him: Rafael, his parents, and his cousin, Ana. Non-filer rules apply to Ana since she is being claimed by someone other than a spouse or parent (exception 1). Her MAU would only include herself.

Worker Responsibilities

  1. Make sure to include on the application:
    1. All relatives living in the home (including unmarried parents of children in common)
    2. All parents who do not have custody but are claiming a child in the home as a tax dependent
    3. Anyone else not living in the home who is claiming someone in the home as a tax dependent
  2. For each individual on the application, make sure to confirm the following:
    1. Tax filing status,
    2. Relationships with every other individual, and
    3. Whether the individual lives in or outside the home.

Note: To avoid processing errors, verify the accuracy of each individual's name, date of birth, social security number (if applicable).

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