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1. Generally

3. Non-Financial Factors

A. Verifying Absence of Your Grandchild’s Parent

DHS policy on proof of a parent’s absence from the home has changed several times. Currently, policy says that the DHS case worker usually should take your word that the parent is not in your home. You do not have to prove the parent’s absence unless your statements are “questionable”  (for example, if the parent has given your address as his/her home). In the past, DHS workers had to insist on certain types of written proof that the parent was not in the home. Many case workers still are used to this policy and may automatically ask for written proof. Seek legal advice immediately if you are asked for verification that you cannot provide or if it is difficult for you to get.

B. School Attendance

If your grandchild is age 16 - 19, she or he must be attending high school (or equivalent vocational, technical, or other school) full time, or participating in a Work First program approved by DHS. If the grandchild is 18 or 19, she or he must be in high school.

C. Cooperation with Efforts to Obtain Child Support

You and your grandchild generally must cooperate in establishing paternity (if necessary) and seeking child support for the grandchild from the absent parents. This includes attending appointments, providing any known information about where the parent(s) live(s), etc. You do not have to cooperate if you can prove good cause. Good cause reasons for not cooperating to obtain support or prove paternity include: danger of serious harm to you or the grandchild, pending adoption proceeding, and some other reasons. Under welfare reform, if you do not cooperate in efforts to establish paternity and child support, without good cause, both you and your grandchild may become ineligible for FIP.

D. Work Requirements.—the “Work First Program”

Michigan has a “Work First” program, in which most adult recipients of FIP are required to participate. If you are over 65, care for disabled child receiving SSI, or you can prove that you are disabled or applying for SSI, you should be exempt. If you are denied an exemption for which you think you are entitled, request a hearing and seek legal help. If you are applying for FIP for yourself, in addition to assistance for your grandchild, the Work First rules require you to find work or do some type of approved employment-related activity for at least 30 hours per week. If there is a child under age 6 in the home, then you only have to participate 20 hours per week. Usually you meet these work-related activities by working at a job, participating in the “Work First” program, and job search. In many cases, some of your required hours may be met by participating in an educational or training activity that is approved in advance by the state agency. If you want more information about the education and training options, contact your DHS caseworker (if you are not in Work First) or your Work First caseworker. If you can’t get the information you need there, you can contact your local legal services office. Additional information and brochures are posted on-line at http://www.michiganlegalaid.org/.

Caregiver relatives who receive FIP must accept almost any offers you receive for new jobs or increases in work hours up to 40 hours per week. You will have to attend an orientation at a local “Work First Agency.” explaining these work requirements. If you apply for assistance for yourself, your FIP application may be denied if you do not attend orientation.

If you are working or attending DHS orientation or work programs, you may be eligible for child care and transportation assistance. Ask your Work First or DHS worker about these benefits. If you are required to attend work or training, but are denied help with necessary transportation or child care, seek legal advice.

If an adult group member fails to comply with work requirements, this may result in a complete loss of FIP for the entire group for a minimum of 30 days. There are steps the group can take to make sure that the loss of assistance does not last longer than 30 days. There are many changing and complicated rules that apply to the Work First program, so if you or a member of a household receive a notice that seems wrong, unfair, or confusing, you should definitely seek legal advice and help.

E. Citizenship or Immigration Status

You will be asked to verify that you and anyone else who is applying for assistance is a citizen. If anyone who is applying for assistance is not a citizen, you will be asked to provide papers showing how that person is here legally. In some cases, it may be necessary to show when the person immigrated to the United States or when they have been employed in the United States. If you not applying for assistance for someone (for example you are applying only for a child who was born in the U.S.) then you do not have to provide information or documents regarding anyone else’s citizenship. If you have questions related to your immigration status or how it may affect you or your grandchild’s eligibility for assistance, seek legal advice.

G. Vendor Payments and Deductions from FIP

You may choose to have DHS pay your rent or utilities directly, through “vendoring”. Having DHS pay your utility bills through vendoring may provide you with some protection from shutoffs during the winter months and help you to get additional energy assistance. In some very limited cases, you may be forced to have vendor payments. These exceptions are very narrow. Seek legal advice immediately if DHS sends all or part of your check to someone else without your permission. If you (or someone in your grandchild’s group) have been overpaid cash assistance in the past, DHS may reduce your ADC grant by a small amount to collect the overpaid amount. The collection process for overpayments under welfare reform has not been published. Seek legal advice if DHS attempts to reduce your FIP grant.

If a landlord has a court judgment against you (or someone in your grandchild’s group) for unpaid rent or damages to a rental property, DHS may send a small part of the FIP grant to the landlord, as payment on the judgment unless the house was not up to code. There are some confusing parts of this new rule. Seek legal advice if you receive notice that your grandchild’s FIP is being reduced to pay a landlord’s judgment. Also seek legal advice if a landlord sues you for money.

H. FOSTER CARE PAYMENTS

You may be able to receive Foster Care Payments if your grandchild is placed in your home by the Family Independence Agency, under a juvenile court order that makes DHS responsible for the grandchild. You will have to meet licensing requirements, including a background check, in order to qualify for Foster Care payments. Foster Care payments generally will be somewhat higher than regular FIP payments.

I. FOOD ASSISTANCE PROGRAM

The Michigan Department of Human Services [“DHS”] determines eligibility and issues food assistance benefits (previously called “Food Assistance ”) on an electronic benefits transfer (EBT) card called a “Bridge Card.” The Food Assistance benefits on your Bridge Card can be used at authorized grocery stores to purchase food. Seek legal advice if your grandchild is denied Food Assistance or has her Food Assistance reduced.

To receive Food Assistance, your grandchild (and other members of his/her group, as explained below) must meet both financial and non-financial eligibility rules. Your grandchild’s Food Assistance group will include you and your spouse, if you are acting as the grandchild’s parent. If your grandchild is your foster child, you may receive Food Assistance without having the child in your Food Assistance group; however, the grandchild
would not be able to receive Food Assistance separately from you. Depending on who is in the household, others may be included in the group, as well.

You and your grandchild may automatically be eligible for Food Assistance if everyone in your group is receiving either SSI or FIP. If you are not eligible under this rule, you will have to provide information showing that your group is financially needy.

Currently, your group’s financial need will be based on your housing expenses (up to a monthly maximum), child care costs, and certain other expenses, as well as your income and assets. If you are 60 years or older, or are receiving SSI, Social Security, or VA disability benefits, you should also claim a deduction for any medical expenses that are not paid for by insurance.

In determining Food Assistance eligibility and amounts, DHS deducts a portion of the group’s income ($128 - $165 based on household size) and 20% of any earned income. DHS also deducts any money that is used to pay child support for a child outside the home, or for the care of a dependent child or an infirm adult in the household.

Starting in mid-2000, many more higher income families with children began to qualify for Food Assistance because the state began to consider these families’ housing, child care, and child support expenses when the state determines whether the household will qualify.

In addition, many families who were previously denied because of the value of their car, are more likely to qualify. Households who were denied Food Assistance before the middle of 2000 due to income and assets may wish to reapply and see if they are eligible under these new rules. A toll free number (1-800-481-4989) and web site is now available that can help agencies and organizations estimate how many Food Assistance many types of households will receive. See www.foodstamphelp.org .

Legal immigrants seeking Food Assistance will have to provide information about their immigration status. This information will determine whether the legal immigrant will qualify for Food Assistance . All citizen members of an immigrant’s household may continue to qualify for Food Assistance , even if the immigrant does not. Undocumented members of the household will not be eligible for assistance, but citizens and documented members may be eligible, depending on the household’s financial circumstances. Any households that include immigrants are encouraged to call the Food and Nutrition Helpline 1-800-481-4989 for more specific
information. Help is available in Spanish, and other languages by request.

J. SUPPLEMENTAL SECURITY INCOME (SSI)

Supplemental Security Income (SSI) is a federal cash assistance program for elderly and disabled persons. SSI is run by the Social Security Administration. You can call 1-(800) 772- 1213 or visit your local Social Security office to begin the application process for SSI. There is an appeal process if your grandchild is denied assistance or assistance is reduced. Seek legal advice if you think you need to appeal a decision.

In order to receive SSI, your grandchild must be financially needy (low income, few assets). If his/her parent is living in the home, some of the parent’s income and assets will be “deemed” to the child. In determining countable income for assessing SSI eligibility, the Social Security Administration deducts $20 of income. For earnings from employment, the Social Security Administration will deduct the first $65 plus one half of the remainder. The SSI countable asset limit for an individual is $2,000.

If your grandchild receives SSI in a month, she or he cannot receive FIP for the same month. In some cases, however, you may be able to receive FIP as your grandchild’s caretaker, even if the grandchild is not eligible for FIP because the grandchild receives SSI. If you are the representative payee for your grandchild’s SSI benefits, you are required to use the SSI benefits in particular ways and may be required to keep records. You should be sure you understand and are willing to follow the rules about how you can use the child’s SSI before you agree to be the Representative Payee.

K. SOCIAL SECURITY BENEFITS

In some cases, your grandchild may be eligible to receive Social Security benefits on his/her parent’s earnings record, or your record, or perhaps even on the record of a step-parent or step-grandparent. Your grandchild does not need to prove financial need in order to receive Social Security, but will have to prove other factors, as summarized below.

There are many Social Security rules to allow a child to receive benefits under the record of a person who has died, or who has started to receive Social Security disability or retirement benefits. The Social Security Administration looks at the relationship between the child and the person on whose Social Security record the child wants to receive benefits. It also looks at whether that person was supporting the child, unless he or she is the person’s natural child. If your grandchild’s parent has worked and paid into the Social Security system, and the parent has died or become disabled, your grandchild may be able to receive Social Security on the parent’s record. If the grandchild’s parent is receiving Social Security disability benefits, or is dead and had worked while alive, contact the Social Security Administration to apply for benefits for your grandchild. If granted, the benefits generally will continue until the child is at the age of 18. If your grandchild becomes disabled before reaching age 22, the grandchild may continue to receive Social Security on the parent’s record.

In some cases, your grandchild may be eligible to receive Social Security benefits on your record when you become entitled to retirement or disability benefits, or die. If your grandchild’s parent is dead or disabled, and that parent was your child, and if you provide at least half of the financial support for your grandchild during the year before you begin receiving disability or retirement benefits, or you die, your grandchild may qualify for Social Security on your record.

Your grandchild can receive Social Security benefits on the record of an adopting parent who receives Social Security disability or retirement benefits, or who dies, if the adoption occurred before the grandchild turned the age of 18. A dependency test will be applied if the adoption occurred after the grandchild became an adult.

L. CHILD SUPPORT

As discussed above, if your grandchild is receiving any form of public assistance, you may have to cooperate in obtaining child support for your grandchild from his parents. Keep in mind that this requirement will be waived if there is good cause to not cooperate. This may be the case if seeking child support from the child’s parent may place you or the grandchild in danger.

If your grandchild is not receiving child support, the prosecuting attorney must assist you in obtaining child support for your grandchild if you are the legal guardian or if your grandchild is receiving public assistance, whether cash assistance, Food Assistance or Medicaid. If your grandchild is receiving public assistance, the child support specialists at your local DHS office should help you to arrange for a meeting with the prosecutor’s office. If your grandchild does not receive assistance, contact your prosecutor’s office directly, and ask to speak with the child support division.

Currently, the first $50 per month of child support payments, made in the previous month, should be sent to your grandchild while he or she is receiving FIP.

Meaningful access to health care for your grandchild will depend on both your ability to consent to medical treatment for the child, and your ability to arrange for payment for the medical services. This section discusses both consent to medical care and payment for care.

A. CONSENT TO MEDICAL CARE

In order to obtain medical care for your grandchild, you must have either written permission from the parent(s), or a court order appointing you as the child’s guardian. A written temporary authorization, signed by the parent in front of a notary public, will be accepted for up to six (6) months after it is signed. A kit with a temporary authorization for kinship care forms is available online at www.michiganlegalaid.org or from the Kinship Care Resource Center, 1-800-535-1218.

B. LIABILITY FOR MEDICAL BILLS

Consenting to medical care or being your grandchild’s guardian does not make you legally responsible for the grandchild’s medical bills. Carefully read any papers you are asked to sign when seeking medical care for your grandchild. A provider may ask you to guarantee payment of the bills. You are not legally required to agree to such conditions. In general, however, a medical provider may refuse to provide services without payment or a guarantee of payment. If you sign papers in which you agree to pay, you may be sued on any unpaid amount.
 
If your grandchild needs emergency medical care, and you are authorized to consent to medical treatment, hospital emergency rooms cannot turn your grandchild away in an emergency.

C. PAYMENT FOR MEDICAL CARE

Realistically, your grandchild will not be able to obtain health care unless s/he has some way to pay for it. In order to pay for your grandchild’s medical care, you may need to pursue both private and governmental insurance. This section provides an overview of the following options:

• Private insurance under a parent’s health insurance
• Private insurance under the grandparent’s (your) insurance
• Medicaid (Governmental Health Insurance) including the “Healthy Kids” program
• The MI-Child Program
• Other “Free” Medical Care Programs

Remember that each payment option may have good points and bad points. For example, more providers may be willing to treat your grandchild if s/he has private insurance, but the private insurance may have a high co-payment or deductible that your grandchild and you are unable to pay. Medicaid may provide more comprehensive coverage, but many providers do not accept Medicaid.

If your grandchild is covered under a private health insurance policy, Medicaid will not pay for medical care unless the private insurance has been billed and refuses to pay.

 
1. INSURANCE COVERAGE ON A PARENT’S INSURANCE

Your grandchild may be eligible for health insurance coverage through his/her parent’s insurance, even when the grandchild is not living with the parent. Employed parents may have free health insurance coverage available through their employer.

a. Medical Support Orders

If your grandchild’s parents will not voluntarily provide available health insurance, you may need to seek a court order. If a court has appointed you as your grandchild’s guardian, or if your grandchild is receiving public assistance (FIP or Medicaid), the prosecuting attorney in your county must help you obtain a court order for child support, including medical support. MSA 25.222(1a); MCL 552.451a. Under Michigan’s Child Support laws, the court must require a non-custodial parent to provide health insurance for the child if the parent has health care coverage available to them at a reasonable cost through their employment. MSA 25.222(2); MCL 552.452. It will be up to the court to decide what is a “reasonable cost”.

b. Obtaining Insurance Payments

Even if your grandchild has insurance coverage, you may have difficulty obtaining reimbursement for health care costs. Some insurance companies only accept requests for reimbursement from, or issue benefit checks to, the “subscriber”, who may be the child’s parent. The parent who is the subscriber may be unwilling to sign necessary forms or turn benefits checks over to you. A federal law was passed to solve this problem. It allows courts to enter a “Qualified Medical Child Support Order”, allowing the legal guardian or custodial parent of the child to deal directly with the health insurance company and obtain insurance payments directly.

If you believe you need this type of order, you should probably seek an attorney to help you obtain a Qualified Medical Child Support Order. In order to help your attorney provide the best possible representation to you and your grandchild, be sure to provide the attorney with any available information about the parent’s employment and insurance situation.

2. HEALTH INSURANCE ON THE GRANDPARENT’S POLICY

You or your spouse may have health care available through a current or previous employer, which may provide optional coverage for minor grandchildren living in the grandparent’s home. Contact your insurance agent or benefits representative to inquire about this possibility.

Medicaid is health insurance for low income children, families, and elderly or disabled persons. The state and federal governments combine funds to pay for Medicaid. In Michigan, Medicaid is administered by the Department of Community Health [“DCH”], in cooperation with the Family Independence Agency [“DHS”]. DCH handles the actual payments for medical care under the Medicaid program and decides how the program operates in Michigan. DHS processes Medicaid applications and decides whether or not an individual or family is eligible for Medicaid.
 
There are many different categories of Medicaid available to children in Michigan. The eligibility rules for each category are different, making it very confusing for everyone. Also, the rules change often, and Michigan has been asking the federal government if it can make major changes in its Medicaid program. As the rules change, information in this section may become obsolete.

If your grandchild was denied Medicaid several months or several years ago, you may want to reapply – in some cases, some people who were denied in the past may qualify now. If you or your grandchild was denied Medicaid in the past three months, you may want to seek legal advice to be sure no mistakes were made. It is easy for a case worker to make mistakes because the rules are so complicated. The child may also now be eligible for help through MIChild, an insurance program for children with somewhat higher incomes.

If you do not have health insurance yourself, and you are low income, you may be able to qualify for Medicaid because you have become the relative caretaker of a dependent child. See subsection b. 5, below.

 1. Applying for Medicaid

Medicaid applications are available at DHS offices, public health departments, and the billing or social work departments of many hospitals or other health care facilities. The application must be submitted to DHS, which then has 45 days to decide whether or not to approve it. DHS will ask for your grandchild’s birth certificate, Social Security number, and proof of your grandchild’s income and assets. DHS also will require you to cooperate with them if they seek a court order requiring one, or both of, your grandchild’s parents to help pay for medical bills or insurance.

You can request Medicaid, for up to three calendar months, before the month in which you apply. This retroactive Medicaid is important if there are unpaid, outstanding medical bills for your grandchild in those months.

2. Resolving Medicaid Problems

Decisions about your grandchild’s Medicaid -- including a decision that s/he is not eligible for Medicaid --can be appealed to a fair hearing. Seek legal advice if you receive a Medicaid denial or if Medicaid will not pay for particular services.

Questions about Medicaid eligibility or coverage may be available through the recipient hot line: 1-(800)638-6414. Questions about managed care (discussed in section 3 below) may be available through the managed care hotline: 1-(800)642-3195. Your grandchild’s DHS case worker may also be able to help.

3. Medicaid Managed Care

Many Medicaid recipients now receive health care through a “managed care” program. Each recipient is assigned either to a Qualified Health Plan (QHP) or a Health Maintenance Organization [“HMO”]. Some people, including children, who have very serious medical problems or disabilities may not have to enroll in a health plan, or may have a different health plan. If you are in this situation, you may want to get legal advice. If your grandchild has Medicaid, the name of the child’s QHP or HMO is printed on his/her Medicaid card. You have to use a doctor, or a program, that is in the managed care program. If your grandchild has significant medical problems and receives help through Children’s Special Health Services, then you will probably have a greater choice so your grandchild will still have access to specialists who treat your grandchild’s particular medical problems.

The health care provider who is named on your grandchild’s Medicaid card should assist you in getting all the health care that your grandchild needs. S/he should refer you to any specialized care that your grandchild needs. It is important to work with your grandchild’s primary provider, because Medicaid will only pay for health care that is approved in advance by that physician, clinic, or HMO. The primary provider must approve all tests, treatments, and prescriptions, including emergency care. Medicaid will not pay for medical care that has not been approved by the primary care provider.

The Department of Community Health will answer questions about managed care, including how to change the QHP/HMO that manages your grandchild’s medical care. The tollfree number to call for answers to your questions is: 1-(800)642-3195. If you have problems with your HMO or QHP, each plan is supposed to have a grievance procedure you can use. If you have problems getting Medicaid to pay for a service, you can request a hearing at DCH. In either case, it is a good idea to see if you can get help from a legal services office or other advocate.

4. Medicaid Covered Services and Transportation

Medicaid should cover all necessary medical care that is approved by the provider or HMO that manages your grandchild’s health care. Medicaid pays for doctors, hospitals, medical testing, prescriptions, and medical equipment such as wheelchairs.

Under federal law, the agencies that run Medicaid [DHS and DCH] also must assure your grandchild’s transportation to medical care appointments and to the pharmacy. Your HMO or QHP is required to help you with transportation to your medical providers as part of their plan.

If you receive Medicaid with a “spend down” [See Section b 3 ( c) below] or are not in an HMO / QHP for some other reason, you should contact your grandchild’s DHS caseworker to ask to apply for Medicaid transportation assistance. Be prepared to explain your transportation problems. If the caseworker approves transportation assistance, you will have to submit forms from the transportation provider and medical office to obtain payment. Seek legal advice if you are denied Medicaid transportation assistance.

5. Medicaid Health Screening for Children: Early Periodic Screening, Diagnosis and Testing [“EPSDT”]

Any child who receives Medicaid is entitled to health care screening and testing, preventive care, and full treatment of any condition that is diagnosed through the screening program, known as “EPSDT”. Under managed care, these services are supposed by provided by your QHP/HMO. To arrange for health screening and testing for your grandchild, contact your provider (your HMO or doctor). If you have questions, contact the local Department of Community Health. EPSDT pays for all routine, “well-child” check-ups, immunizations or vaccinations, etc. EPSDT is also supposed to help pay for treatment of most conditions identified in the screening, including dental work, eyeglasses, hearing aids, etc.

6. Prior Authorization

Most types of medical equipment and some types of care or treatment will have to be approved in advance by the Department of Community Health, as well as by your health plan. Your grandchild’s medical care provider should know when prior approval must be obtained from the Department of Community Health. You should seek legal advice immediately if your grandchild’s medical care provider states that Medicaid will not approve payment for a necessary test, treatment, or other medical care.

Medicaid recipients have the right to a fair hearing on the issue of whether Medicaid should pay for a particular service. However, the Department of Community Health does not provide a notice of denial to the recipient when Medicaid payment is not approved. You will have to rely on the medical care provider to inform you of the Medicaid agency’s decision. This may be not be legal. If you have questions, you should contact an attorney.

7. Dental and Vision Services

Medicaid no longer pays for most dental services, but children may be eligible for some dental care through the EPSDT program described above. Most optical care must be approved in advance by the Department of Community Health.

8. Medicaid as Payment in Full

Some medical care providers will not accept Medicaid. Others limit the number of Medicaid patients that they can treat. If your grandchild has Medicaid, you should ask if the provider will accept Medicaid as the insurance for your grandchild’s medical care, before receiving services.

 When a physician or other health care provider accepts your grandchild as a Medicaid patient, the provider must accept the Medicaid payment as payment in full. The physician must tell you in advance if a particular procedure or service will not be covered by Medicaid. Unless you agree in advance to have your grandchild receive a non-Medicaid-covered service, the provider should not bill for any part of the services your grandchild receives.

9. Retroactive Medicaid Coverage and Medical Bills Paid Before Medicaid Eligibility is Established

It may take several weeks to obtain a Medicaid card once you have applied. However, if you or your grandchild establish eligibility, you may receive Medicaid coverage for up to three calendar months before the month in which you apply. For example, if you apply for Medicaid on June 20, you may be able to get Medicaid coverage for March, April, and May, as well as June and future months. This is called retroactive Medicaid.

Once you receive the proof of Medicaid coverage (the Medicaid “card”), you must present it to the provider and request that they bill Medicaid. If you already have paid for the medical service, ask the provider (doctor, hospital, pharmacy, etc.) to reimburse you and bill Medicaid. Some providers will assist with this.

Currently, the Department of Community Health and the Department of Human Services do not provide direct reimbursement for medical bills that are paid while you are waiting for Medicaid to be approved, even if the services is covered under Medicaid and the patient has been found eligible for Medicaid for the date the service was provided. Courts in other states have decided that such reimbursement is required.

Seek legal advice if you have difficulty in obtaining Medicaid payment or reimbursement for bills that were incurred or paid before the agency issued the Medicaid card, but during the period that Medicaid eligibility is established.

This section explains some of the ways that your grandchild may be eligible for Medicaid. Each category of eligibility has different financial and non-financial rules. In addition, there are some rules that apply to all forms of Medicaid, such as a rule requiring Medicaid recipients to apply for other forms of assistance. The information below provides a general overview, and is not intended as a substitute for individualized legal advice.

1. Medicaid for Children Who Receive Family Independence Program (“FIP”) or Supplemental Security Income (“SSI”) Cash Assistance

If your grandchild receives cash assistance through Supplemental Security Income (“SSI”) program, she or he is automatically entitled to Medicaid health insurance coverage. If your grandchild receives FIP, she or he most likely will also qualify for Medicaid. If your child loses FIP because someone in her “FIP group” goes to work or earns more money, the child will still qualify for “Transitional Medicaid” (TMA) for 12 months thereafter, regardless of how much income the household has.

2. Medicaid for Children Receiving Foster Care Assistance or Adoption Assistance, and Department Wards

If you receive foster care payments (ADC-FC) or adoption assistance for your grandchild, or if a court has ordered that your grandchild be committed to, or placed with DHS, your grandchild is entitled to Medicaid coverage.

3. Medicaid for Other Low Income Children

Children who do not receive FIP or SSI cash assistance may be eligible for Medicaid if they have a low income under a Medicaid program for Low Income Families (“LIF Medicaid”). In determining whether your grandchild’s income is low enough for him or her to qualify for Medicaid, the Family Independence Agency [“DHS”] will only consider the income of the child, if his/her parent is not living in the home.4 Some Medicaid categories are based on income in comparison to a percentage of the federal poverty level, which is adjusted each year.

In order to obtain these types of Medicaid coverage for your grandchild, you must submit an application to the Department of Human Services and provide verification of eligibility factors such as income, residence, or citizenship/immigration status, etc. Information on the current poverty income levels mentioned in this section can be found on line at : http://www.mDHS.state.mi.us/olmweb/ex/prt/246.pdf . You will need the adobe acrobat reader program to view this document.

a. “Healthy Kids”

Children under the age of 18 are eligible for Medicaid if their group’s income is below 150% of the federal poverty guidelines. Children age 1 or younger can have income up to 185% of the federal poverty guidelines. There is no asset test for this category of Medicaid eligibility. This is a big help if the child has money in a savings account or other investments, but not a lot of regular monthly income.

If your grandchild’s monthly income is below the protected income level [“PIL”] for the county where s/he lives and s/he meets the asset test discussed above, s/he is eligible for full Medicaid coverage under this category.

 If the child’s income is over the Protected Income Level, s/he may still qualify for some Medicaid coverage under the “Spend-down” program, discussed below.

b. Spend-down Medicaid and Medicaid for Persons Under Age 21

To qualify for Medicaid as an individual under age 21, your grandchild must have both low income and limited assets. S/he also may qualify for Medicaid under this category with an income-based “spend-down”, which is a monthly deductible amount. If the parent is in the home, the parent’s income and assets will be considered in determining the child’s Medicaid eligibility.
 
Spend-down Medicaid is Medicaid with a monthly “spend-down” or deductible amount.

Spend-down Medicaid will only cover medical expenses which exceed the spend-down amount. The Protected Income Levels are published in DHS’s Program Reference Manual, which can be found on-line. Identify the “shelter area” where you live by going to Item 200 in the Program Reference Manual, Tables and Charts, located at www.mDHS.state.mi.us/olmweb/ex/prt/200.pdf

Use that information qualify for Medicaid without a spend-down. A child under age 21 or a caretaker relative (including grandparents) with income above the protected income level may qualify for spenddown Medicaid if the “Medicaid Group” has countable assets less than $2,000.

If you or your grandchild qualify for spend-down Medicaid, DHS will send a notice explaining that s/he will qualify for Medicaid in any month for which s/he submits verification that her medical expenses are equal to or more than her monthly “spend-down”. The amount of the spend-down will equal the countable income minus the spend-down amount.

For example, a 19 year old child receiving $600 per month in Social Security benefits and living in Genesee County in 1999, would have a spend-down of $192 [$600 - $408 PIL]. Medicaid coverage will begin only when the child has medical expenses of $192 in a month. For example, if the child goes to the doctor on June 2 and has a bill of $100, then fills a prescription that costs $50 on June 5, then goes to the hospital on June 10 and has a bill of $2,000, the child’s Medicaid coverage will begin on June 10, but the child will owe the first $42 of the hospital bill [$192 spend-down minus $150 total doctor and pharmacy bill]. Remember that the Protected Income Levels go up every year and be sure you are using the right ones for your county, family size.

 
4. Medicaid for Disabled Children

Home Care Child -- Michigan also has several additional Medicaid categories for children who have disabilities or special needs. Children who have medical problems that are so severe they require nursing home or hospital-type care, but who can be cared for less to find the protected income level based on your family size by looking at PRT 240, which can be found expensively at home, may qualify for Medicaid as a “Home Care Child”. The child must have countable assets less than $2,000 and countable monthly income less than $470. Income is determined according to SSI rules, which are discussed in section IV of the section on Financial Assistance.

Institutional Care -- If your grandchild has a developmental disability so severe that s/he requires nursing home or hospital-type care, s/he may be eligible for Medicaid under a special Medicaid program. The child’s disability status and special needs must be evaluated and certified by the local Community Mental Health agency to qualify under this Medicaid category.

Special Health Needs -- The Department of Community Health also operates a medical care program for Children with Special Health Care needs. Contact your local Health Department for more information.

Medicaid for Children who are Former SSI Recipients -- If your grandchild received SSI benefits on August 22, 1996, but lost them due to changes that the Social Security Administration made in the definitions of who is “disabled, ” your grandchild should still qualify for Medicaid if the Medicaid was stopped before February 1998. Your grandchild must be under age 18.

The MI-Child Program -- MI-Child provides insurance to children in families with countable incomes greater than 150% but less than 200% of the federal poverty level. $90 of earnings, some child care expenses, and child support will be disregarded from the monthly at: www.mDHS.state.mi.us/olmweb/ex/prt/240.pdf

There are no asset limits. If your grandchild receives health insurance through MIChild, you must join a qualified health plan, and pay a co-pay of $5 per month regardless of the number of children in your home who receive MI-Child. If your child receives any health insurance through a private insurance company, even there are high co-pays and deductibles, the child will not be eligible for MI-Child under current rules. You can obtain an application for MI-Child through at DHS , the Department of Community Health, and at other agencies. The child will be screened to see if he or she is eligible for Medicaid under the healthy kids program first, and if not, the child will be enrolled in MI-Child at the next enrollment month, i.e., May 1999, then each September and January thereafter. To find out more, call 1-888-988-6300.

A. Low Income Family Medicaid and Transitional Medicaid

Many grandparents can qualify for Medicaid by receiving Family Independence Program benefits themselves. If, however, they start working, their earned income may force them off the FIP-related Medicaid program. In that instance, they could qualify for either Low Income Family Medicaid (see section V –C -3–b-3 above on page 38) , which continues as long as the family is low income, or Transitional Medicaid, (see section V-C-3-b-1 on page 37) which provides Medicaid to the caregiver and minor children for 12 months regardless of the family
income.

NOTE: Many caregivers (and parents) are being improperly placed on time-limited transitional Medicaid rather than Low Income Family Medicaid. Any time a family loses FIP, DHS should be screening for both LIF and TMA Medicaid. Caregivers who are being placed on TMA rather than LIF, or who lose their TMA, should talk to a legal services advocate to see if they were improperly given TMA rather than LIF. Medicaid for Caretaker Relatives

As a grandparent caring for your grandchild in your home, you may qualify for Medicaid as a “Caretaker Relative”. Your eligibility will be based on your income (and that of your spouse, if s/he lives with you).6 If your income is too high for full Medicaid coverage, you may be able to receive Spend-down Medicaid as a caretaker relative. Fore information on the spenddown program, see section V-C-3-b –3-b on page 39, above.

In order for you to be a caretaker relative, your grandchild must be applying for, or receiving, Medicaid, and must be under 18 or an 18-year-old high school student expected to graduate before s/he turns 19.
If you apply for Medicaid, you do not have to apply for other public assistance programs.

B. Transitional Medicaid Plus

Michigan is now offering a health care program for working parents and caregivers who lose transitional Medicaid (TMA) after 12 months. Caregivers must join the program at least 40 days before their TMA ends. The caregiver must pay a monthly premium in full and on time each month to receive coverage. The premiums start at $50 per person per month and increase every 6 months to a maximum of $110 per month per person. For more information about the TMA Plus program see Issue Alert Number 00-05-01 which is posted on line at www.mplp.org.  If you live with your spouse and your grandchild, your asset limit for Medicaid purposes will be $3,000. Your “protected income level” is based on your group size and the county where you live.

A. Child Day Care Assistance

Many low and moderate income Caregivers can receive help from DHS to pay for workrelated child day care. DHS generally will not look at the income of caretaker relatives when deciding if a child is eligible for child day care. DHS sets a rate for payment based on the age of the child, the county where care is provided, and the type of care used (in-home day care aide, care in the home of a relative, or group daycare.) DHS will pay a certain percentage of this rate depending on how much income the group has. Charts showing the rates that are paid, and the percentage of those rates that DHS will pay (30 to 100% of the rates) are available in the DHS Program Reference Manual, Item 270. See http://www.mDHS.state.mi.us/olmweb/ex/prt/270.pdf.

A family of 3, for example, can receive up to $1990 in gross income in 2004 and still qualify for DHS to pay 30% of its approved rate toward child day care expenses. DHS will do a background check of your proposed provider and will only pay providers who are not listed with the child abuse and neglect registry. For more information on your rights related to the child day care program look at the public benefits resources at http://www.michiganlegalaid.org/

B. Employment Support Services

If you are employed or looking for work, DHS or your local Work First Agency may be able to help you with certain expenses that you must pay in order to accept a job or continue working at job. Depending on how the employment support services program is structured in your community, these may include car repairs, help toward a once-in-a-lifetime car purchase, special equipment or uniforms required only for your job (and not simply nice dress clothes).

You may also be able to receive temporarily help with transportation to work, e.g. bus passes. You will be required to attend an “orientation” meeting, usually at the local Work First Agency. If you are receiving cash assistance (FIP benefits) you will generally ask for these “Employment Support Services” through your Work First caseworker (if you have one) or your DHS caseworker if you don’t have a Work First caseworker, or if there is an emergency. If you are not receiving cash assistance benefits, you would apply for help through the “Non-Cash Recipient” or NCR program, directly at the Work First agency. The precise types of help that are available in the NCR program vary from county to county. In addition, the rules about these programs changes often. More information on the ESS and NCR program are available in the issue alerts posted at www.mplp.org.

This article appears courtesy of the Center for Civil Justice.