Income Guidelines for Children without Private Health Insurance

To determine if a child without private health insurance may be eligible for medical assistance, follow the steps outlined below:

Step 1: Begin with the monthly gross income (income before deductions) from employment/self-employment of each parent/stepparent living in the home of the child for whom medical assistance is being requested. NOTE: If the child's parent(s)/stepparents are not living in the home, a separate household may be established for the child. NOTE: If step 1 is less than $0, enter $0.

Step 2: Add gross monthly income from non-employment (i.e. child support, Social Security, BIA General Assistance) of each child for whom medical assistance is being requested and of the child's parent(s)/stepparent(s) living in the home.

Step 3: Subtract the following income deductions:

• $50 of child support received
• Any court-ordered child support a parent/stepparent living in the household pays to another household monthly
• Any child care paid monthly so a parent/stepparent living in the household can work

Step 4: The amount remaining is the adjusted income. Compare the adjusted income to the chart below. If the household's adjusted income is at or below the amount for family size, the child may be eligible for medical assistance. NOTE: Family size includes the parent(s)/stepparent and children (under age 19) living in the home.

WORKSHEET:

Compare your adjusted income from Step 5 to the chart below:

NOTES:

• If a member of your family receives SSI DO NOT include him/her in the family size and DO NOT count his/her income.
• Earnings of child(ren) under age 19 are not counted if the child lives with a parent or other adult caretaker.
• Most student loans or grants are not counted as income.
• A fifth paycheck of the month, if paid weekly, or a third paycheck, if paid every other week, is NOT counted.