The Medicaid Household Definition - Who's Included?

Medicaid provides essential medical benefits to low-income Americans who meet strict eligibility requirements. To qualify for this program, applicants must not exceed the income limits their state of residence sets for their household, so it’s important to understand how a household is defined.

Although the Medicaid household definition may vary by state, this article provides an overview of who’s included in a household and how to verify household members when applying for these government-funded benefits.

What Is a Medicaid Household?

For the purpose of defining an applicant’s income to assess their eligibility for benefits, a Medicaid household typically consists of the applicant plus their spouse and any dependents who are required to file tax returns. The number of members in a household is sometimes referred to as family size.

How Does Your Household Affect Your Eligibility for Medicaid?

Because Medicaid is designed to provide health care for low-income Americans, providing an accurate financial profile is a crucial part of qualifying for benefits. Your financial eligibility for Medicaid is measured using a tax-based methodology known as modified adjusted gross income (MAGI). This methodology uses U.S. tax definitions of household and income, so applicants know whose income to include in their households when applying.

To calculate MAGI, an applicant should add up the following income items for household members:

• The adjusted gross income on their federal tax return
• Nontaxable Social Security benefits
• Excluded foreign income
• Tax-exempt interest

Your household may also help determine which Medicaid rules apply to you, and the level of benefits you may receive from the program.

Who Should You Count as Part of Your Medicaid Household?

When applying for benefits, you should typically include the following individuals in your Medicaid household:

• Your spouse: If you are legally married, you must include your spouse in your Medicaid household. This applies to legal same-sex unions and legal spouses who reside at a different address.
  
  
• An unmarried domestic partner: If you claim your unmarried partner as a dependent on your tax return or you live and raise children together, you should generally include them as part of your household.
  
  
• Dependent children: Any dependent children who live with you, including adopted or foster kids, are considered part of your Medicaid household. If you share custody of dependent children with your spouse, you should only include them in your household if you declare them on your tax return.
  
  
• Other children you currently care for: If you care for children under the age of 21 who live in your home, they may be included as part of your household even if you don’t declare them on your taxes.
  
  
• Dependent parents and adult siblings: If you claim your parents or adult siblings as dependents when you file your tax return, you may include them in your household.
  
  
• Other dependent relatives: Grandparents, aunts, uncles and other relatives may be included in your household if you provide financial support for them and count them as dependents when filing tax returns.

Because familial relationships can be complex, it’s typically best to check the guidelines before determining who is included in the Medicaid household definition in your state. 

Who Isn’t Considered Part of Your Medicaid Household?

Individuals who aren’t considered part of your Medicaid household typically include:

• Roommates
• Long-term house guests
• Legally separated spouses
• Legally divorced spouses
• Boyfriends and girlfriends who aren’t tax dependents (unless you have children together)
• Shared-custody children who are claimed as dependents by an ex-spouse
• Unborn children

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Does the Medicaid Household Definition Vary by State?

Yes. depending on your state of residence, the Medicaid household definition may differ, so it’s important to review state-specific guidelines before applying for benefits. 

What Verification Will You Need for Household Members?

When applying for Medicaid, you may need to provide verification for members of your household. Depending on your relationship to each household member, you may be required to present one or more of the following items to verify their legal connection to you:

• Birth certificates
• Social Security cards
• A marriage certificate
• Custody agreements
• Other government identification.

Where Can You Find Additional Information on Medicaid Eligibility?

Additional information on eligibility criteria, including the Medicaid household definition for your state, is available through your county Medicaid office.