4311 Treatment of Assistance Plan - The assistance plan for all medical programs consists of those persons in the family group for whom assistance is requested and any excluded legally responsible person for those individuals.
The client may include or exclude any family group members for assistance purposes.
Except as noted below, eligibility shall generally be determined within a single assistance plan for those members who qualify under the same category of assistance. For example, if more than one member requests and is eligible for MS, a combined determination is required. This policy would also be applicable to members of a family who qualify for the same medical program but under different individual subtypes (i.e., OA, AB, or AD for MS). Once again, a combined determination of these individuals would be required. For purposes of this provision, the Medicaid poverty level and Title 21 programs shall be viewed as the same category of assistance and a combined determination would be applicable.
Separate assistance plans shall be established in the following instances:
Each
SSI recipient (including 1619b recipients) shall have a separate plan
as well as any child whose needs are met through foster care or adoption
support payment.
Family
group members who qualify under different medical programs (e.g.,
MS, Medicaid poverty level, etc.) shall have separate plans.
Each
client in a long term care arrangement (including HCBS and PACE) shall
have a separate plan. However, a member of an MA CM plan who also
receives HCBS or PACE services in the community, may remain part of
the MA CM plan as an excluded/disqualified individual (DI) if a separate
assistance plan would result in ineligibility for one or more household
members.
Emancipated
minors, minors determined to be able to act in their own behalf, and
18 year old children shall have separate assistance plans apart from
their parents.
Any
child (and his or her siblings) in the family who is not living with
a legally responsible person (such as grandchildren, nieces and nephews,
etc.) shall have a separate assistance plan.
If the only children for whom assistance is requested are stepsiblings or have no blood relation, a separate plan is required as only the income of each child's parent can be considered. Otherwise, where all siblings (excluding unborn siblings) are blood related or adoptive brothers and sisters, a single plan shall be applicable if they qualify under the same category of assistance. This would include family arrangements in which assistance is requested for the non-mutual children of a husband and wife and a mutual child.
4312 Additional Assistance Planning Provisions - The following additional principles are applicable for assistance planning purposes: