Personal tools

Issue Alert - 03-09-09

Document Actions

Sep 30, 2003

Issue Summary:

PEM 536 - New FIA policy has been issued in an effort to comply with a federal court order regarding the calculation of Group 2 Caretaker Relative Medicaid eligibility for non-parent caretaker relatives (kinship caregivers), such as grandparents who are raising their grandchildren. <br>The new policy is poorly written and does not properly explain how to determine Medicaid eligibility for adults who are parenting their own minor children as well as the minor children of a close relative.

Persons Affected:

Relatives who are raising children under the age of 18 who are not their own children.



What's Happening?

FIA has issued a new policy for its Program Eligibility Manual (PEM), which is intended to comply with the federal court order. The new policy is in PEM 536. Unfortunately, the new policy contains confusing language and does not provide clear instructions for handling cases in which an adult is acting as the parent for minor children who are close relatives. (Such as an adult who is raising his or her niece and nephew, or sibling, or grandchild.) THE NEW POLICY PROVIDES AN INACCURATE DEFINITION OF A "CARETAKER DEPENDENT". PEM 536 page 1 mistakenly says that a "Caretaker DEPENDENT" is "a relative acting as parent to a minor, unmarried child under the age of 18." In fact, the definition provided is the definition of a "Caretaker RELATIVE." A caretaker DEPENDENT is a the unmarried, minor child that is being parented by a close relative. THE NEW POLICY FAILS TO CLEARLY EXPLAIN HOW TO PRO-RATE INCOME OF AN ADULT WHO IS RAISING BOTH HIS OR HER OWN CHILDREN AND THE CHILDREN OF A CLOSE RELATIVE.When a parent's eligibility for Group 2 Caretaker Relative Medicaid is determined, the parent's income is pro-rated to account for the needs of the parent's spouse and children who are living in the parent's home. Using this methodology, FIA takes into account the fact that some of the adult's income is used to meet the needs of the children in the home and therefore should not be considered in determinining the adult's ability to pay for his or her own medical care.Under the federal court order, a portion of the adult's income also must be disregarded to take into account the needs of the other, related children that the adult is parenting. Unfortunately, under the new PEM 536, the policy does not clearly provide that if the adult is acting as a parent for a minor child who is closely related but is not his or her own child, only a pro-rated amount of the adult's income will be counted when determining his or her income eligibility for Medicaid under the Group 2 Caretaker Relative category. This means that the new policy does not comply with the federal court order.

What Should Advocates Do?

Screen low income clients to determine whether they have Medicaid coverage.Advise low income caretaker relatives (kinship caregivers) to apply for Medicaid if they need health care coverage. Advise caretaker relatives who have a Medicaid "spend-down" (deductible) to contact FIA and request that their spend-down be re-calculated under the federal court order and L Letter 03-039. Refer caretaker relatives with questions or problems to the Center for Civil Justice (contact information at the top of this Alert.) Caretaker Relatives in Genesee County should be referred to the Genesee County HELPline: (810) 238-8053.

What Should Clients Do?

Apply for Medicaid if you are a low income parent or caretaker relative.Ask FIA to recalculate your Medicaid spenddown if you are a caretaker relative (adult raising an umarried, minor child who is a close relative) and have been assigned a Medicaid spenddown in or after February 2003.Contact the Center for Civil Justice if you are a caretaker relative and have questions or problems regarding Group 2 Caretaker Relative Medicaid. See the contact information at the top of the Alert.If you live in Genesee County, contact the HELPline at (810) 238-8053.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp website ( or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.