Family Healthcare (FAMIS) Manual

0905.012.10 Assistance Group (MAF)

IM-#6 January 11, 2000

The assistance group starts with the dependent children for whom MC+ healthcare coverage is requested. Next determine whether to consider income and needs of an individual(s) in a child’s household in an assistance group. A household includes those persons sharing common quarters and facilities as a unit, excluding boarders.

The ASSISTANCE GROUP is comprised of certain identified persons living together in the same household. MAF eligibility is based on those individuals’ needs. It MAY INCLUDE A NEEDY RELATED CARETAKER or LEGAL GUARDIAN living in the same home with the children. With respect to a SPOUSE, do not consider TEMPORARY separation expected to last less than six months (such as hospitalization, vocational training, etc.), as interrupting the continuity of living together for budgeting purposes. However, for separations on a CONTINUING BASIS (such as desertion; abandonment; confinement in a penal, medical, or mental institution; or living in a professional, practical, or domiciliary nursing or boarding home), budget the household and exclude the person separated from the family.

Consider any person or group of persons described below as an assistance group and consider their total needs and income in determining eligibility.

When a household contains both a parent and a non-parent caretaker relative or a parent and a legal GUARDIAN, the parent is always the caretaker payee for his/her child unless that parent is also an age eligible child.

NOTE: When a parent is also an age eligible child, see Minor Parent Assistance Group Provision for further information. (Section 0905.012.15 )

0905.012.10.05 Assistance Group Mandatory Persons Include:

The needs and income of the following persons living in the household must be included in the assistance group, unless they are a mandatory exclusion:

  • The dependent children (including legally adopted children) for whom coverage is requested.
  • Biological or adoptive parents of one or more of the eligible children.

If parents are actively exercising a joint physical custody arrangement, evaluate whether both parent’s income and needs should be included when determining the child’s eligibility.  If both parents are exercising care and control of the child, consider both parent’s income and needs.

NOTE:  The income and needs of parents who are ineligible aliens meeting the above criteria must be included even though not eligible for coverage.  The needs of a dependent child who is an ineligible alien, must be included even thought not eligible for coverage.

Include the needs and income of a parent sanctioned for failure to apply for or supply a Social Security Number in the assistance group. Show the parent on the IMU5 as a level of care “S” and with sanction reason of “N”.

A parent sanctioned for refusal to cooperate in establishing paternity or pursuing medical support is a mandatory member of the assistance group. The family size and need remain the same for the purpose of determining the children’s MAF eligibility, whether or not the parent cooperates. The parent will be shown on the IMU5 as Sanctioned (“S” loc) with sanction reason of “C” in field 13g2 since failure to cooperate will make the caretaker ineligible for MC+ healthcare coverage under MAF.

NOTE:  A pregnant women sanctioned on MAF for failure to cooperate may be eligible for MC+ for Pregnant Women.