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OHP Program Manual

C. Eligibility Groups

Effective 4/1/11

1. Household Group

The household group is the people who live together with or without benefit of a dwelling. For homeless people, the household group is the people who consider themselves living together. A dwelling can contain more than one household if it is divided into separate living units, such as an apartment house, or if a landlord/tenant relationship exists.

When people live in more than one household during a month, they are considered to be living in the household where they spend 51% or more of their time.

A person who leaves the household for short periods is considered to still be in the household if they intend to return. People gone from the household for 30 days or more are no longer part of the household, except for the following:


2. Filing Group

The filing group is the people in the household group whose circumstances are considered in the eligibility determination process. A household group member of any age must be in their own filing group if they are not required to be in a filing group with other household group members.

The following people living in the household must be included the same filing group:

A caretaker relative (defined in 461-001-0000) has the option of forming a separate filing group for children living in the household who are not their own children, or including the children in the caretaker relative’s filing group.

Each person in the household who is applying for OHP, regardless of their age, who is not required or allowed to be included in the filing group with other people, must be an individual filing group.

A child receiving OHP benefits with his or her parents must apply separately upon reaching age 19 if he or she wants to continue to qualify for medical assistance.

The following people are assumed to be eligible for OHP:

Filing Group: 461-110-0400
Assumed Eligibles: 461-135-0010

3. Financial Group

The financial group is the filing group members whose income and resources count in determining eligibility and benefits. The financial group for OHP consists of all the people in the filing group (including those receiving SSI benefits), except caretaker relatives (other than parents) who choose not to be included in the need group.


4. Need Group

The need group is the people whose basic and special needs are used in determining eligibility. For OHP, the need group consists of all the people in the financial group. For pregnant females, include the unborn child(ren).


5. Benefit Group

For people not assumed eligible (461-135-0010), the benefit group consists of the people from the need group requesting benefits who:

  • Meet all nonfinancial eligibility requirements;
  • Have resources below the resource limit; and
  • Have income below the Income Limits/Payment Standards.

For people assumed eligible, the benefit group consists of the people who are in the benefit group of the program used to assume eligibility.



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