Simulation of Medicaid and SCHIP Eligibility: Implications of Findings From 10 States. Final Report.. D. Family Composition Rules


The most challenging and complex rules are those pertaining to family composition. These rules are important because they affect whose income is counted in the unit and the poverty threshold against which family income is measured. Medicaid and SCHIP programs are allowed to establish their own rules for determining family size. Typically family size is determined by the dependent child and his or her natural or adoptive parents and any blood-related or adoptive siblings living in the same household. But programs employ numerous exceptions or special provisions regarding minor parents, pregnant women, multigeneration households, stepparents and stepsiblings, SSI recipients, and certain aliens. As a result, family size may differ across different programs.

The most striking finding is that TANF and Medicaid programs (including M-SCHIP) continue to use complex rules that are based on old AFDC standards, while S-SCHIP programs may use simpler rules. S-SCHIP programs in Colorado, Florida, New Jersey, and New York count everyone who lives with the applicant child; that is, they do not include or exclude household members based on their relationship to the applicant child. This is an important finding because it implies that, in several states, S-SCHIP programs count Supplemental Security Income (SSI) beneficiaries and SSI benefit payments, which Medicaid programs do not.18 Also, S-SCHIP programs may count other types of individuals such as stepparents and grandparents (as well as their income) when they are not counted by Medicaid programs or only at the discretion of the applicant or under certain circumstances. Finally, it is fairly common for programs (Medicaid and SCHIP) to count unborn children in determining the family size on which most income or poverty thresholds are based.