Medicaid for Your Child When You Earn Too Much: Family of One Budgeting
Many families assume their child cannot get Medicaid because the household earns too much. For children who qualify for New York's Children's Waiver, that is not always true. The waiver allows Family of One budgeting, which looks at the child's own income instead of the family's.
What Family of One means
Medicaid normally counts the income of the whole household. Under Family of One budgeting, only the child's income is counted, plus the child's resources if the child is certified disabled. Most children have little or no income of their own, so this can make a child eligible for Medicaid even when the parents' income is high.
Which children it applies to
Family of One is tied to the Children's Waiver. Under the state's rules:
- Children with a serious emotional disturbance, and children who do not meet the standards for disability certification, have their Medicaid eligibility decided as a family of one.
- For children who are certified disabled, the parents' income is counted first. Family of One is used only if the child is not eligible that way.
- Medicaid under Family of One cannot be approved until the child has a place in the waiver.
In short, your child first has to qualify for the waiver. Our step-by-step guide to the Children's Waiver explains who qualifies.
How to ask for it
- Start the waiver eligibility check. If your child has no Medicaid, call C-YES at 1-833-861-4467. If your child already has Medicaid, a Health Home care manager does the check.
- Once your child is found eligible and has a waiver place, your local Medicaid office decides Medicaid using Family of One budgeting where it applies: HRA in New York City, or the county Department of Social Services on Long Island.
- In New York City, a child under 18 who has a waiver, or has been told they need long-term care services, can apply online through ACCESS HRA.
Questions to ask
- Does my child fit one of the waiver's target groups?
- Is my child certified disabled, and how does that change the budget?
- Is there room in the waiver for my child now?
Medicaid rules are detailed and every family is different, so treat this as a starting point and confirm the details with your care manager or Medicaid office.
We can help
Yeled Long Island's care managers can walk you through each step. Call (516) 900-6454 or make a referral.