What’s the issue?
Income of caretakers should not be included when determining a child’s eligibility.
If household income is below the MCHP ceiling
If the household income is below the Maryland Children’s Health Program (MCHP) ceiling, you can create the household, establish relationships, answer “yes” to the caregiver relative question and enter income. Under these circumstances, the HBX eligibility rules engine will determine the child’s eligibility correctly because the household income is within the MCHP threshold, so it doesn’t matter whether or not the caretaker’s income is counted.
If household income is above the MCHP ceiling
If the income is above the MCHP ceiling, HBX may incorrectly find the child ineligible for coverage unless you apply one of two work-arounds. The first option is to not enter the caretaker’s income. This gives an accurate eligibility determination, because no income is counted for eligibility, but may become a problem when it comes to verifications. Entering zero if the caretaker actually has income will likely trigger a VCL, and the VCL worker will often fail the VCL because the attestation will not match the electronic resource return or any proffered document. It sometimes helps to mark “Caretaker relative case, caretaker relative income not included” in the comments section of the worker portal to help the VCL worker understand, but if the worker does not read the comments or understand caretaker relative rules, the VCL will fail and coverage for the child will be delayed.
Another work-around many navigators and caseworkers have used successfully is to create the household; establish relationships; answer the “Caregiver relative” question “no,” and then enter the caretaker’s income correctly. This seems to provide an accurate eligibility determination. We think the programming error is that when one answers “yes” to the question, the system doesn’t recognize the child as an exception group. Answering “no” to the question forces HBX to produce the correct eligibility determination based on relationships rather than income. Again, it is always best practice to notate the caretaker relative status in the comments section.
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