ARTICLE 19

 

SECTION 4

_________

 

SECTION 1931(B) MFBU COMPOSITION AND SNEEDE RULES

 

 

1.        GENERAL RULES FOR 1931B MFBU COMPOSITION

 

A.       The MFBU for 1931b is the basic unit of persons considered in determining an individual’s or family’s eligibility. Sneede is applicable to a 1931b determination. Person’s eligible for 1931b have a zero SOC. Persons eligible for 1931b are not included in the Maintenance Need for the MN/MI Programs. Examples of various budget scenarios are included at the end of this section in MPG Appendix 19-4-B.

 

B.       All persons in the family who are living in the home and who are not already receiving a cash grant, e.g., Supplemental Security Income (SSI), CalWORKs, or In-Home Supportive Services (IHSS), are evaluated for 1931b in the same MFBU regardless of whether or not they have linkage. Persons who are considered to be receiving Public Assistance (PA) or other PA are not in the MFBU except for those receiving Four-Month Continuing and Transitional Medi-Cal benefits. A family member who is ABD and living in LTC is not considered to be living in the home, nor is he/she included in the MFBU.

 

 

 

 

MEPM

8G

 

 

 

 

C.       If some persons in the household are receiving CalWORKs, the remaining family members, who are not eligible for CalWORKs or choose not to receive CalWORKs, are considered to be eligible for 1931b without a separate determination as long as there is linkage through AFDC deprivation. These people must still meet other Medi-Cal Program requirements. Some examples are:

 

1)      People who are sanctioned from CalWORKs, such as those who do not cooperate with work requirements, fleeing felons, the parent of an unborn who is not eligible for CalWORKs until the child is born, but whose income is counted in the CalWORKs determination, or those who have reached their time limits.

 

2)      People who are not eligible to receive CalWORKs benefits because they do not have satisfactory immigration status. These people are eligible to restricted 1931b benefits.

 

 

The exceptions to this rule are: persons who do not meet the age requirements of a child (they are not under 18 or not enrolled in school and expected to graduate prior to age 19), or a non-needy caretaker relative who was not financially eligible as a CalWORKs applicant or recipient and whose income and resources were not counted when determining the CalWORKs case. These individuals cannot be assumed to be eligible for 1931b without a determination.

 

 


D.       Those persons who are in the same MFBU with other family members, but are 1931b ineligible because they do not have linkage or who are found to be ineligible after a Sneede determination should be evaluated for the MN, MI or Percent Programs, if otherwise eligible.

 

E.       There must be at least one AFDC deprived child living in the home receiving zero SOC Medi-Cal, i.e., 1931b, SSI, MN, MI, Public Assistance, Deemed Eligibility, Continuous Eligibility for Children or Percent Programs.

 

F.       An unborn may be used to increase the 1931b family size prior to the last four months of pregnancy, regardless of whether the unborn is deprived, if there are other deprived children in the family who are otherwise eligible.

 

 

MEM

PROC.

8G-2

 

 

ACWDL 03-49

G.       If the only deprived child is an unborn in the last four months of pregnancy and the mother is being evaluated for 1931b, the spouse or unmarried father is an ineligible member of the 1931b MFBU and is not eligible for 1931b until the birth of the unborn. The father should be evaluated for the MN Program. Continued Eligibility and Sneede rules apply. The unmarried father may choose to opt out if he wishes.

 

H.       A child 18, 19, or 20 years old who is living in the home with a senior parent and other siblings, and is considered an “adult” under 1931b rules, is an ineligible member of the 1931b MFBU. However, the adult child who is living in the home of the senior parent is an excluded MFBU member in his/her parent’s case if the adult child:

·         is a parent of a deprived child; and

·         could apply for 1931b in a separate case regardless of whether the adult child’s own and his/her child’s income or property are under the 1931b limits.

 

In effect, a married or unmarried adult child between ages 18 to 21 who is not eligible for 1931b in his/her parent’s case and has 1931b linkage in a separate case, but is not eligible for 1931b due to income or property, is an excluded member of the senior parents’ MFBU.

 

I.         The stepparent may choose to apply as an essential person for 1931b if his/her spouse has a deprived child and the spouse wishes to apply, regardless of whether or not he/she has non-deprived children. (This is different from the MN Program, which only allows a stepparent with no children of his/her own in the home to be linked by a spouse who is incapacitated.) The stepparent’s income must be counted if his/her spouse is requesting Medi-Cal. The stepparent may opt out of 1931b or the MN Program if only his spouse’s separate children are applying for benefits. See the special property rules requirement described under Sneede property in MPG Article 19, Section 3, Item 9.

 

 

 

 

 

 

 

MEM

PROC.

8G-4


J.        The 1931b MFBU rules for a non-parent caretaker are similar to those of the MN Program. See MPG Appendix 19-4-C for MFBU scenarios involving caretaker relatives:

 

1)      A caretaker relative is not required to be in the MFBU if they are not requesting benefits for themselves.

 

2)      A caretaker relative is linked to the related child because the parent is absent from the home or for Section 1931(b) purposes only, the parent lives in the home, but has no care and control.

 

3)      Only siblings and half-siblings are in the same MFBU.

 

4)      Only one caretaker relative may be linked to a child. If there is more than one child in the household and they are not siblings, each caretaker may be linked to a different child. The caretakers would be in separate budget units with their related child.

 

 


5)      If the caretaker relative is pregnant, aged, blind, or disabled etc., he/she need not be included with the related child; however, he/she must be linked to a deprived child to be eligible for the Section 1931(b) program.

 

6)      A caretaker relative with his/her own deprived child and a related child may choose to be linked to either his/her own child or the related child.

 

7)      If an MFBU, which contains a caretaker relative and related children, has excess property or a share of cost, follow existing Sneede/Gamma procedures in Article 8F. Caretaker relatives are not responsible for their related children and do not allocate to them. The related children receive a full income limit or maintenance need amount rather than a prorated amount.

 

8)      A caretaker relative who is eligible for Section 1931(b) with a related child is not in the MFBU with other household members who are not eligible for Section 1931(b) unless the caretaker’s spouse, other parent, or children are being evaluated for the Percent programs.

 

 


9)      A caretaker relative who is not eligible for Section 1931(b) and is eligible for the Medically Needy (MN) program with a related child is also in the MFBU as an ineligible member with an MN spouse or other MN parent and would be an ineligible member of the MI budget if he/she has his/her own MI children.

 

10)    In households where there is an MFBU which contains a caretaker relative and related children and the spouse or children of the caretaker either do not wish Medi-Cal or receive public assistance (PA) or other PA and do not appear in any MFBU, no income or property allocation is made to either the spouse or the caretaker’s own children by the caretaker or vice versa. If the spouses have joint checking accounts or savings, assume ½ is community property unless it is separate.

 

11)    If the caretaker relative is in two MFBUs, consider the caretaker relative’s full income in both and allow his/her medical expenses to be used to meet the share of cost in both MFBUs.

 

The caretaker relative may be any relation by blood, marriage or adoption as long as he/she is within the fifth degree of kinship to the dependent child (this description is the same as for the MN Program). See MPG Appendix 19-4-A for a chart to assist in determining the degree of relatedness. Verification includes most types of legal documents as well as records from church, insurance policies, school, medical, or social services agencies. The following factors may be considered when determining whether the caretaker has care and control when the child is living in the home with a caretaker relative:

 

 


·         Deciding where the child attends school or child care

·         Dealing with the school on educational decisions and problems

·         Controlling participation in extracurricular and recreational activities

·         Arranging medical and dental services

·         Claiming the child as a tax dependant

·         Purchasing and maintaining the child’s clothing

 

Exception: An exception to the 1931b MFBU rules for caretaker relatives is if the non-parent relative is the caretaker of a child and the adult parent of that child is also living in the home. This is permitted under 1931b rules even though MN rules do not permit the caretaker relative to be aided when the parent is also living in the home. If an adult parent does not have care and control of his /her child (but his/her parental rights have not been terminated) and he/she is living with a caretaker relative of the adult parent’s child such as a grandparent who does have care and control, all persons are included in the MFBU if the caretaker wishes to be aided.

 

 

K.       The minor (see definition of a child, MPG 19-1-3) parent who is living in the home of his/her parent must either be deprived or may request aid only for himself/herself and his/her deprived child to be aided under 1931b. In either case, the senior parent’s income and property are counted and he/she must apply for the minor until the minor is an adult. If the minor is pregnant, there is one case/MFBU in the senior parent’s name. The deprived pregnant minor is an eligible member in the MFBU with her unborn, parents and siblings. The senior parent with no care and control of a minor is an ineligible member of the 1931b MFBU and must be evaluated for the MN Program in an MFBU of one.

 

If the minor parent has no other siblings in the household to provide linkage for the senior parent, the senior parent must have care and control of both the minor and the minor parent’s child if the senior parent wishes to be aided under 1931b. If these conditions are not met, the senior parent is an ineligible person on the minor parent’s MFBU for 1931b The case will be in the senior parent’s name. If these conditions are met, there are two MFBUs for 1931b (similar to the treatment of the minor parent and the senior parent under the MN rules):

 

The senior parent is in the first case/MFBU with the minor parent. The case will be in the senior parent’s name. The minor parent is an ineligible member with his/her child in the second case/MFBU in the minor parent’s name with a separate case number. As in the MN Program, the senior parent’s income/property is never used to determine the eligibility for the minor parent’s child. If the senior parent’s income/property makes the minor parent ineligible, only the infant is eligible in the second MFBU. The senior parent and the minor parent may be eligible for the MN or Percent Programs if they are not eligible for 1931b. NOTE: Under this scenario, where the minor has care and control of herself/himself and/or the infant, the senior parent’s income and property is not counted when the minor reaches age 18 regardless of whether or not he/she is enrolled in school and expected to graduate before age 19.

 

If there are siblings in the home, the senior parent, siblings and the minor parent are in the first MFBU. Care and control is not an issue due to CalWORKs mandatory inclusion rules. Sneede rules apply if the siblings or the minor has income. The minor mother is an ineligible member of the second MFBU with her infant.

 

1931b rules for married minor children and their spouses living with the senior parents are similar to the MFBU used for the MN Program except that a minor under the MN/MI Program is a person under 21. There may be separate MFBUs depending on who wishes to be aided.

 

 

L.        A deprived child must live with either a parent or caretaker relative to be eligible for 1931b.

 

 

2.        SNEEDE REQUIREMENTS

 

A.       General Rules

 

The requirements of the Sneede lawsuit, which limits responsibility to spouse for spouse and parent for child, apply to 1931b. This means that if a family is determined ineligible for 1931b rules because of excess property or failure to meet the income test, Sneede provisions apply if there is a Sneede class member. If only the parent is eligible for 1931b after Sneede is applied, there must be at least one deprived child who is eligible for another Medi-Cal Program with a zero SOC in order for the parent to be eligible for 1931b. Generally, the same Sneede methodology used in the regular Medi-Cal Program is followed under 1931b except for the following:

 

 

The parental needs allowance for the applicant and recipient alternative B budgets is the FPL limit for one person. The parental needs allowance for recipient alternative A is the 1931b limit for one minus $1. The actual dollar amounts may change annually or when the FPL limit changes.

 

Each alternative A Sneede member may receive the full $240 and ½ deduction, if applicable. Each alternative B Sneede member may receive the full $240 deduction up to the amount of his or her disability-based income, if applicable. Each alternative B Sneede member may receive the $90 deduction up to the amount of his or her earned income. The Sneede budget worksheet for the recipient alternative A is 14-65 HHSA and for the applicant/recipient alternative B budget, the worksheet is 14-66 HHSA.

 

 

 

 

 

 

 


ACWDL 02-44


B.       Allocating Income Outside the 1931b MFBU

 

1)      1931b ineligible spouses with no other children (such as a father of an unborn where there are no born children) may deduct all of their income if they are being determined as eligible or ineligible members of the MFBU for the MN Program and their income was used to make their spouse eligible for 1931b. Unmarried parents are not responsible relatives to each other and may not deduct any income.

 

 

NOTE: Instances where one spouse is ineligible are rare because spouses are in the same Mini Budget Unit (MBU) and will pass or fail the income and property test together. Furthermore, the stepparent can choose to be an essential person. However, the spouse may not have linkage when the pregnant woman has no other deprived children and is in her last four months of her pregnancy because the father is not eligible under the 1931b Program until the deprived child is born.

 

Unmarried parents may not deduct any allocation to the unmarried parent of their mutual child; therefore, unmarried parents usually pass the 1931b income limit test unless they have separate children who are in the same budget unit.

 

 

2)      A parent who is not eligible for 1931b may deduct the amount of their parental allocation to each child if that child is 1931b eligible when the parent is being determined for the other Medi-Cal Programs as an eligible or ineligible member.

 

3)      No income or Sneede allocation from any eligible 1931b person is carried over to a family member who did not pass the 1931b income test.

 

4)      If only a child(ren) and/or spouse is Section 1931(b) eligible using either the Alternative A or B allocations by a parent or spouse, the parent or spouse may deduct the larger of either Alternative A or B allocations when determining his/her MN determination.

 

5)      If the allocations from a parent or spouse using either alternative A or B could be used to make a child or spouse eligible for 1931b, the parent or spouse may deduct the larger of either alternative A or B allocations.

 

6)      Children who do not pass 1931b after a Sneede determination, or do not meet the age limitations or deprivation requirements, may not deduct any of their income from the MN/MI budget used in the 1931b determination because they are not responsible relatives. The children must use their income again, if any, when they are determined for the MN or MI Programs. As noted in item 3) above, no allocations from the parent in 1931b are carried over to the children who do not pass 1931b. However, if a parent is determined 1931b ineligible, that income not used to make other family members eligible to 1931b is used again in the MN/MI budget.

 

 

 

 

 

 

 

 


MEM

PROC.

8G-5


3.        PERCENT PROGRAMS

 

Follow the regular MFBU composition and income rules as described in MPG Article 5, Section 2 when determining eligibility for the Percent Programs for persons who:

 

·        did not pass 1931b;

·        did not qualify for the MN/MI Program with no SOC after Sneede rules were applied; or

·        have no deprivation and are being evaluated for the Percent Programs.

 

Include the income from all responsible persons and compare the net nonexempt income to the income limit for the entire family size. Follow the usual 1931b exceptions, which are:

 

A.       if the stepparent is opting out of either 1931b or the MN Program because the only spouse’s separate children wish to be aided, or

 

B.       if the unmarried father does not wish to be aided with the unmarried mother and her separate child and the only non-deprived mutual child is the unborn.

 

The people in items A and B above were not part of the original 1931b or MN MFBU and are not included in the family size, nor is their income counted when determining Percent Program eligibility.

 

 


APPENDIX 19-4-A

 

CHART FOR DETERMINING RELATEDNESS OF CARETAKER RELATIVES

 

1)    The caretaker relative also includes the spouse or former spouse of the relatives listed above.

 

2)    The caretaker relative also includes the adoptive parents and their relatives as listed above.

Great Great

Great

Grandparent

Great Great

Grandparent

Great Great

Aunt

Great Grandparent

Great Great

Uncle

 

Great Aunt

 

Great Uncle

 

Grandparent

 

Stepmother

 

Stepfather

 

Aunt

 

Parent

 

Uncle

 

1st Cousin

1st Cousin

Once-removed

 

1st Cousin

1st Cousin

Once-removed

AFDC

Child

 

Sister

 

Half sister

 

Stepsister

 

Brother

 

Half brother

 

Stepbrother

 

Niece/Nephew

 

Niece/Nephew

NOTE: All persons listed on this chart are shown in their relationship to the Medi-Cal child. For example, persons listed as “first cousins” are first cousins to the Medi-Cal child.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



APPENDIX 19-4-B

 

 

In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 1: Some Family Members Receive CalWORKs (No budget example provided)

 

Father and two children age 6 and 8 are receiving Medi-Cal through CalWORKs. Mother is not eligible for CalWORKs because she does not meet the other CalWORKs requirements such as work, citizenship or time limits. Oldest child is not eligible for CalWORKs because he is age 20.

 

                                                 (FBU AA)                  (FBU 02)

CalWORKs                           1931(b)                      MN/MI

 

Father                                                Mother                        20-Year-Old

Child #1                              <20-Year-Old>

Child #2

 

There is no income or property determination required for the mother because she is presumed eligible for Section 1931(b) because the other family members are receiving CalWORKs. The 20-year-old is only shown in her budget unit to be consistent with the other examples, but no actual computation is required. The 20-year-old is in his own budget unit for the MN/MI because he is not eligible for Section 1931(b) because he is over the age limit. No income or property from other family members is used to determine his eligibility.

 


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 2: Family Members Who are Not Eligible for Section 1931(b) Due to Age (No budget example provided)

 

A father and two children ages six and eight were receiving CalWORKs. His spouse was not eligible for CalWORKs because she did not participate in the CalWORKs work requirements and was receiving Medi-Cal under the Section 1931(b) Program. The oldest child was not eligible for CalWORKs because he is age 20. The father and the two younger children have now been terminated from CalWORKs because of an increase in earnings from employment. Reevaluate the entire family for Section 1931(b). As of March 1, 2000 all are considered recipients, even if the 20-year-old was not receiving CalWORKs or Section 1931(b) in the first month of eligibility.

 

(FBU AA)                               (FBU 02)

1931(b)                                  MN/MI

 

Father                                                20-year-old

Child #1 ($)

Child #2

Mom

<20-year-old>

 

Mother can be considered for 1931(b) because there are no work requirements for this program. The 20-year-old is included as an ineligible member of the Section 1931(b) MFBU, but also evaluated under regular Medi-Cal in his/her own MFBU. Since the 20-year-old is included in the 1931b MFBU, his income is used when determining income eligibility to 1931b for the rest of the family. Also, since he is not 1931b eligible, his income is used again to determine his MN/MI eligibility. If the rest of the family is eligible for Section 1931(b), they may continue to receive zero SOC Medi-Cal under this program. Should they later be terminated for an increase in earnings, they would be eligible for Transitional Medi-Cal; however, the 20-year-old would not.

 


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 3: Applicant Family – Sneede & Poverty Level Programs Apply (No budget example provided)

 


The same family as described in Example 2 now has different circumstances. They are applying as applicants after not receiving CalWORKs or Medi-Cal for six months and are not eligible for 1931(b) using applicant (Alternative B) income limits (100 percent with $90 deductions). Sneede rules apply because Child #1 has income. In this case, everyone except the 20-year-old and Child #1 are found to be eligible for 1931(b) after the Sneede determination.

 

(FBU AA)                                (FBU 2A)

1931(b)                                    Sneede

                                                MBU #1                                   MBU #2

 

Father                                      Father                                      Child #1 ($)

Child #2                                   Mom

Mom                                        Child #2

Child #1 ($)                            <20-year-old>

<20-year-old>

 

Child #1 would be evaluated with the 20-year-old under the MN Program. Sneede would apply if they have an SOC.

 

(FBU 02)                                             (FBU 9B)                                 (FBU 9A)

MN/MI                                                 Sneede MN/MI

                                                            MBU #1                                   MBU #2

 

20-year-old

Child #1 ($)                                         20-year-old                              Child #1 ($)

 

These children have a SOC               20-year-old has no SOC         Child #1 has a SOC

                                                            RID “G”                                   RID “G”

                                                            $600 MN                                 $600 MN

 

Poverty Level Program

 

All family members are included in the poverty level determination for child #1. Compare the net nonexempt income of the responsible relatives to the poverty limit for five. If child #2 or the 20-year-old had income, their income would not be used, but the family size would remain the same.

 

<Father>

<Child #2>

<Mom>

Child #1 ($)

<20-year-old>

 


Assume Child #1 is eligible. The 1931b family members are considered recipients in the following month. The family should be redetermined as recipients to determine if Child #1 is now eligible for Section 1931(b) using Alternative A limits and deductions. The 20‑year-old is still ineligible to 1931b.

In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 4: Stepparent with Separate and Non-Deprived Mutual Children (No budget example provided)

 

Husband and wife with separate children and two mutual children apply for Medi-Cal. This family was not terminated from CalWORKs or Section 1931(b) in the last four months; therefore, they are treated as applicants. The children have no income. The wife is the principal wage earner, is employed over 100 hours and the family’s earned income is above the Unemployed Parent income limit (100 percent of the FPL); therefore, the mutual children are ineligible for Section 1931(b) because they are not deprived. Since the separate children are deprived due to an absent parent, only the mutual children have no linkage.

 

         (FBU 2A)                             (FBU 2B)                     (FBU 2C)

1931(b)                                         Sneede                        Sneede                    Sneede

Husband                                      MBU #1                        MBU #2                    MBU #2

Wife Husband

<Mutual Children>                     Wife                              Mom’s Child            Dad’s Child

Wife’s Separate Child              <Mutual Children>

Husband’s Separate Child

 


The family is evaluated for 1931b and is over the applicant limit. Sneede rules apply. Assume MBU #1 passes. Evaluate the separate children for the MN or Percent Programs if they have a SOC and the mutual children for the MI Program. If the children have a SOC in the MN/MI Program, after applying Sneede rules, then they would be evaluated for the Percent Program using the responsible relative’s family’s income in the MFBU. Compare the income limit to the poverty limit for a family size of six. If the parents have no mutual or separate children eligible for a program with zero SOC, they will not be eligible for 1931b and must be evaluated for the MN Program.

 

Note: If the stepparent had no separate child in the household, he/she could be linked as an essential person for Section 1931(b), but not for the MN Program. His income must be included if his spouse is requesting benefits even if he does not wish to be aided. See Example 7.

 

MN Program                 MI Program

 

Separate Children       Mutual Children

 


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 5: Only the Separate Children of a Parent in a Stepparent Household Apply (No budget example provided)

 

If only the separate children of a parent wish to be aided (applicants), Section 1931(b) uses the same rules as the MN/MI Program. Only the separate children and their ineligible parent are in the MFBU. In making this determination, use the applicant (Alternative B) income deductions, parental needs allowance, and income limits. The ineligible wife is allowed to allocate to her spouse, separate child, and any non-deprived mutual children, which reduces her total income. The allocation to her spouse and any mutual children are deducted from the net non-exempt income (net balance available to the MFBU from Mom). This balance plus any income from the separate children are compared to the 100 percent limit for a family size of those in the budget unit only. If the separate children are ineligible for Section 1931(b) and are eligible as MN’s with a SOC, determine eligibility for the Percent Program and compare the parent and her children’s income to the limit for only the ineligible parent and her separate children.

 

(FBU AA)

1931(b)

 

<Mom>  (Net income minus deductions and allocations to spouse and mutual children)

Mom’s Separate Children

 


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 6: Sneede Case – Child with Income is only Eligible for Percent Program (Applicant)

 

A single mother and her nine-month-old child with OASDI “Survivors Benefits” income apply for Medi-Cal. The mother has net earned nonexempt income of $889 and the child has net nonexempt income of $620. The county determines Section 1931(b) and then applies Sneede because the family is over the Section 1931(b) limit.

 

         1931b                                1931b

         (FBU 2B)                           (FBU 2A)

Section 1931(b) MFBU              Sneede                         Sneede

         MBU No. 1                        MBU No. 2

Earnings       ($979-90)

Mother               $   889              Mother    $696             Child      $620  + $193 from Mother

Child $   620         Total              $696        Total             $813

Total $1,509         Limit              $696        Limit             $469

Limit (2)             $   938

 

The mother passes Section 1931(b) because she keeps her parental needs amount of $696 and allocates the remainder to her child; however, the child is above the prorated Sneede 100 percent limit. The county then evaluates the child for the MN Program. Since the child has a SOC, he or she is evaluated for the 200 Percent Program. There are no health premiums to add back.

 

(FBU 02)                                        (FBU 55)

MN   200 Percent Program

 

Child    $620                                 Mother’s Income    $   889

Total     $620                                 Child’s Income       $   620

Limit     $600                                 Total                         $1,876

         Limit (2)                                 $1,876

 

Child is eligible for the 200 Percent Program. Mom is eligible for Section 1931(b) because she has a child who is eligible for Medi-Cal with no SOC. The child may be eligible as a recipient the following month if Mom has earned income using Alternative B.


County of San Diego                                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) APPLICANT AND RECIPIENT BUDGET FORM: FOR DETERMINING NET NON-EXEMPT INCOME AND SECTION 1931 (b) INCOME ELIGIBILITY FOR APPLICANTS, AND FOR RECIPIENTS UNDER ALTERNATIVE METHOD B

CASE NAME

                    Example 6

COUNTY DISTRICT

 

COUNTY USE

 

 NEW APP.     REDETERMINATION      CHANGE      RETRO ELIG.     CORRECTION

EFFECTIVE ELIG. DATE FOR THIS BUDGET

MONTH:                                     YEAR:

 

Name of MFBU PN# _____

Mother

Name of MFBU PN# _____

Other Coverage

Name of MFBU PN# _____

Child

Name of MFBU PN# _____

Name of MFBU PN# _____

 

Name of MFBU PN# _____

Name of MFBU PN# _____

 

Name of MFBU PN# _____

Name of MFBU PN# _____

 

Name of MFBU PN# _____

 

1

Enter unearned income of each MFBU member, then total for MFBU (include nonexempt disability-based income…SSD or private DIB; not TWC or SDI)

TOTAL MFBU UNEARNED INCOME

 

$     620         

Unearned Income MFBU PN#    Child   

$                            620      +  

Unearned Income MFBU PN#                

$                                              +

Unearned Income MFBU PN# _____

$ ___________________  +

Unearned Income MFBU PN# _____

$ ___________________  +

2

  Educational Exp. Deduction

- $         0            

 

 

EXEMPT  OR  UNUSUAL INCOME (LIST EXEMPT  OR UNUSUAL INCOME HERE)

 

Child       $620  ‘OASDI’

 

3

  $50 Child or Spousal Support     Received

- $         0            

4

Remaining Nonexempt unearned income

BOX 4

=$      620         

5

 

Enter earnings of each MFBU member, subtract $90 WRE from each, then total remainders for MFBU.  (Remember to include TWC-as appropriate, & SDI)

 

Total MFBU Earnings:

 

 

 

$      889    

Earnings, etc.  of PN# Mother   

$        979       

-        $ 90 WRE

=                889  

Earnings, etc.  of PN#                 

$                      

-        $ 90 WRE

=                       

Earnings, etc.  of PN#                          

$                      

-        $ 90 WRE

=                      

Earnings, etc.  of PN#                          

$                      

-        $ 90 WRE

=                     

6

 Dependent Care Deduction

- $         0          

 

County Use

 

SHOW INCOME AVERAGING AND APPORTIONMENT HERE

 

 

 

7

Remaining Nonexempt Earned Income

BOX 7

= $      889       

8

Total Remaining income:  Nonexempt Unearned Income and Non exempt earned income (BOXES 4 + 7)

 

 

$       1,509      

9

  Child/Spousal Support Payments

- $         0          

10

  Allocation to Excluded Children

- $         0          

11

  Allocation to PA Family Member

± $       0          

12

Total MFBU net nonexempt income (Rounded down to the nearest dollar)

 

 

= $           1,509     

13

1931 (b) FPL  INCOME LIMIT FOR FAMILY

 

$         938                                (Enter 100% Income Limit for Appropriate Family Size Here)

 

 

IF INCOME FROM LINE 12 IS LESS THAN OR EQUAL TO LIMIT FROM LINE 13, FAMILY IS INCOME ELIGIBLE

 

   ELIGIBLE

  NOT ELIGIBLE: IF NO SNEEDE-ELIGIBLE CLASS MEMBER, EVALUATE FOR OTHER MEDI-CAL PROGRAMS, IF SNEEDE-ELIGIBLE CLASS MEMBER, EVALUATE FOR 1931(B) UNDER SNEEDE.

Eligibility Worker Signature:

 

Worker Number

Computation Date

County Use

 

14-60 HHSA (4/00)                                                                                                                                                                                                       (4/02)

(APPLICANT OR RECIPIENT METHOD “B” BUDGET)


County of San Diego                                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) SNEEDE V. KIZER NET NONEXEMPT INCOME DETERMINATION AND MINI BUDGET UNIT (MBU) DETERMINATION – APPLICANT or RECIPIENT METHOD “B”

CASE NAME

                       Example 6

COUNTY DISTRICT

 

COUNTY USE

 

CASE NUMBER

EFFECTIVE ELIG. DATE FOR THIS BUDGET

MONTH:                                                                YEAR:

 

CASE TYPE:                 APPLICANT OR RECIPIENT  “B” USING FPL INCOME STANDARD

 

PART 1:

INSTRUCTIONS:

*              CHILD/SPOUSAL SUPPORT PAYMENTS RECEIVED:            Child support is income to the child, not to the parent or caretaker                 relative.    Divide the $50 per month child/spousal support deduction by the number of persons for whom the income is intended.  Any                 unused remainder will be prorated among the remaining persons who still have support payments to apply against the deduction.

 

**            UNEARNED IN-KIND (IKI) INCOME:                Prorate the unearned in-kind income among the persons who receive the income.                  Example: MFBU of 4 receives free housing.  Use in-kind for 4 and each person receives ¼  of the in-kind income.  Add an unborn’s share of in-kind to the pregnant woman’s share.  If the pregnant woman is PA/Other PA,  and not in the MFBU, give the unborn’s    share to the father of the unborn if he is in the MFBU.                                                  

 

NOTE:    The only deduction applicable to the Section 1931 (b) program is the deduction for Educational Expenses, as provided in Section 50547,

                 Title 22, California Code of Regulations.

ENTER NAME OF EACH MFBU MEMBER

(Do not list unborns)

Name

Mother

Name

Name

Child

Name

Name

Person Type

  Parent A or

  Caretaker Rel.

  Parent B or

  Caretaker Rel.

A

   Child of

/  B

   Child of

A /  B

   Child of

A /  B

A.  NONEXEMPT UNEARNED INCOME (EXCLUDING DISABILITY-BASED INCOME)

1.     Nonexempt Unearned Income:  List Sources:

        Child OASDI ‘Survivors Benefits’

0

 

620

 

 

2.     Net Child/Spousal Support Received. *

0

 

0

 

 

3.     In-Kind Income (IKI) **

0

 

0

 

 

4.     Income available from PA/other PA

        (see MC 175-6, line A.4)

0

 

0

 

 

5.     Total nonexempt unearned income

        (add lines 1, 2, 3 and 4)

0

 

620

 

 

 

CHILD/SPOUSAL SUPPORT AND/OR IN-KIND INCOME COMPUTATIONS:

 

B.     DISABILITY-BASED INCOME

6.     Disability-based income:  List Source:

 

 

 

 

 

 

C.    NONEXEMPT EARNED INCOME:  Include “Sawyer” TWC, SDI, and earned IKI

 

7.     Nonexempt Earned Income  (Employment)

979

 

0

 

 

 

 

8.     $90 Work expense deduction.

$90

$90

$90

$90

$90

 

9.     Remaining nonexempt earned income (subtract

        Line 8 from line 7)

889

 

0

 

 

 

 

10.    Child Care Deduction.

0

 

0

 

 

 

11.    Other Deductions.

0

 

0

 

 

 

 

14-66 HHSA (4/00)                                                                                                                                                                                                        (4/02)

1931(B) SNEEDE APPLICANT OR RECIPIENT “B” BUDGET                                                                                                                     PAGE 1 OF 3

 

 

12.    Total Deductions. (ADD LINES 10 & 11)

0

 

0

 

 

13.    Total Net nonexempt earned income (SUBTRACT LINE 12 FROM 9).

889

 

0

 

 

 

D.     TOTAL COUNTABLE INCOME

14.    Total Countable nonexempt unearned income

         (LINE 5).

0

 

620

 

 

 

15.    Total Countable disability-based income

         (LINE 6).

0

 

0

 

 

 

16.    Total Countable nonexempt earned income

         (LINE 13).

889

 

620

 

 

17.    Income allocated from LTC/B&C person to

         Family members at home (from MC176W, Part B, or from MC175-7, line C.2).

0

 

0

 

 

 

18.    Total countable income (Lines 14, 15, 16, 17)

889

 

620

 

 

E.    TOTAL NET COUNTABLE INCOME  AFTER OTHER DEDUCTIONS

19.    Court-ordered child support or alimony.

0

 

0

 

 

 

20.    Income used to determine PA eligibility

         (MC175-6, line B.3 or B.4).

0

 

0

 

 

 

21.    Other Deductions:

0

 

0

 

 

22.    Total Deductions (LINES 19, 20, 21).

0

 

0

 

 

23.    Total Net countable income (subtract line 22  from line 18).  Enter this amount on MC 175-4 if no parent in MFBU.  If parent in MFBU, continue.

889

 

620

 

 

 

F.    PARENTAL/SPOUSAL (P/S)  ALLOCATION COMPUTATION (Skip if no parent in MFBU)

24.    P/S own needs (FPL for 1)

696

 

 

 

 

25.    Total unearned in-kind income, income from PA or income allocated from LTC/B&C spouse (Add lines 3, 4 and 17).

0

 

 

 

 

 

26.    Parent’s total net nonexempt income (Subtract

         Line 25 from line 23).

889

 

 

 

 

 

27.    Parent’s net nonexempt income less P/S allocation (Subtract line 24 from line 26); if

         negative, enter 0.

193

 

 

 

 

 

28.    Number of persons for whom Parent A is responsible (MC 175-2, Section B).  DO NOT COUNT PARENT A.

1

 

 

 

 

 

29.    Number of persons for whom Parent B is responsible (MC 175-2, Section B).  DO NOT COUNT PARENT B.

 

 

 

 

 

 

30.    Child’s natural/adoptive parent – check if Parent A and/or Parent B (see MC 175-2).

 

 

 

 A     B

 A     B

 A     B

31.    Parent A’s allocation to spouse (if any) and natural/adopted children (divide parent A’s line 27 by line 28 and enter in applicable box). Do not enter under Parent B if unmarried.

 

 

 

193

 

 

32.    Parent B’s allocation to spouse (if any) and

         Natural/adopted children (divide parent B’s line 27 by line 29 and enter in applicable box.). Do not enter under Parent A if unmarried.

0

 

 

0

 

 

33.    Enter the lesser of either line 24 or 26

696

 

 

 

 

34.    Parent’s total net nonexempt income (add lines

         25, 31 or 32, and line 33)

696

 

 

 

 

 

35.    Child’s total net nonexempt income (add lines

         23, 31 and 32) enter on MC175-4.

 

 

 

813

 

 

14-66 HHSA (4/00)                                                                                                                                                                                                         (4/02)

1931(B) SNEEDE APPLICANT OR RECIPIENT “B” BUDGET                                                                                                                                          PAGE 2 OF 3

County of San Diego                                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) SNEEDE V. KIZER MINI BUDGET UNIT (MBU) DETERMINATION – APPLICANT OR RECIPIENT METHOD “B”

 

PART 2:

SECTION 1931 (b) MBU DETERMINATION – PROPERTY AND

FEDERAL POVERTY LEVEL INCOME (FPL)

  SECTION 1931 (b) FPL TEST

  SECTION 1931 (b) PROPERTY DETERMINATION

INSTRUCTIONS:

 

1.        Include unborn in the mother’s MBU and property limit/FPL income level unless mother is married, and only her separate children want Medi-Cal.  If

Pregnant woman is PA/Other PA, include the unborn in the spouse’s or father’s MBU.

2.        Do Not include an excluded child.

3.        Do not list MBU members in more than one MBU.

4.        If any MBU has excess property, check to see if Medi-Cal linkage still exists for other family members.

5.        Property determinations:  enter the allocation for each spouse from MC324, line 29

6.        Enter each person’s net nonexempt income from lines 38 or 39.

 


                          MBU NUMBER     1     

Person name/number

Net Nonexempt

 Property              Income

1.   Mother

696

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

696

MBU’s        Property limit

                    FPL

696

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or  below FPL – Property Eligible – PASS

 

MBU NUMBER ______________

Person name/number

Net Nonexempt

 Property              Income

1.

 

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

 

MBU’s         Property limit

                     FPL

 

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or below FPL – Property Eligible – PASS

 

14-66 HHSA (4/00)                                                

                          MBU NUMBER            2

Person name/number

Net Nonexempt

 Property              Income

1.   Child

813

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

813

MBU’s         Property limit

                     FPL

469

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or  below FPL – Property Eligible – PASS

 

MBU NUMBER ______________

Person name/number

Net Nonexempt

 Property              Income

1.

 

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

 

MBU’s         Property limit

                     FPL

 

(Check One)

   Excess Property – FAIL

   Inc. Ineligibility exceeds FPL – Property Elig – FAIL

   Inc. Eligible – at or below FPL – Property Eligible – PASS

 

                                                                                                      (4/02)

                                                                                          PAGE 3 OF 3


SAN DIEGO COUNTY                                                                                                                            DEPARTMENT OF SOCIAL SERVICES

MEDI-CAL

INCOME WORKSHEET

Case Name       Example 6                                                                                               Budget Eff. Mo/Yr                                                            

Case Number                                                                                                                        Computation Date                                                            

Worker Name/No.                                                                                 

 

Income Recipient        Child                                                               

NOTE:    Use a separate form for each

             person with Income.

A.    DOCUMENTATION OF INCOME

BUDGET METHOD(S):

 Actual          Apportioned          Fluctuating    

        Date Received

              Amount

                                

$              620             

COMPUTATION & NOTES

       

       

        Child          $620   (OASDI)

                          - 600   (MN)

                            $20   SOC

 

        *  Child < 1 yr see 14-11 for 200% program

            determination.

               

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

TOTAL (if applicable)

$                                   

1.   EARNED INCOME PATTERN:

       Weekly      Monthly      Other (list)

       Bi-Weekly (Every other week)

       Semi-Monthly (Twice a month)

      Day of the Week Paid:                                                    

      Day(s) of the Month Paid:                                             

2.   UNEARNED INCOME PATTERN:

       Weekly      Monthly      Other (list)

       Bi-Weekly (Every other week)

       Semi-Monthly (Twice a month)

      Day of the Week Paid:                                                    

       Day(s) of the Month Paid:                                             

B.  APPORTIONED INCOME

1.    Earned

$                                  x    2            =    $                                

$                                  x    2.167    =    $                                

$                                  x    4.33      =    $                                

$                                  x                  =    $                                

2.   Unearned (UIB, DIB, WBA, (WEEKLY

BENEFIT AMOUNT) x 2 = Bi-Weekly

Amount usually issued).                                                                                                                                                          

    UIB   $                                  x    2.167          = $                                 

    DIB   $                                  x    2.167          = $                                 

$                                  x                  =    $                                

$                                  x                  =    $                                

 

 

 

 

 

 

 

 

 

MFBU TOTAL EARNED INCOME            $                                    

MFBU TOTAL UNEARNED INCOME      $                                    

 

(File:  Financial folder)      (7/88)

14-29 DSS  (5 / 91)                                                                                                                                                                                                (5 / 93)


SAN DIEGO COUNTY

DEPARTMENT OF SOCIAL SERVICES

                                                                                                                                         Worker Name:                                                               

                                                                                                                                         Date:                                                                               

SPECIAL (100, 133 OR 200) % PROGRAM ELIGIBILITY WORKSHEET *

 

 

CASE NAME:                                      Example 6               

 

CASE NUMBER:                                        

Evaluation for:                    Month/Year

   Child                                 Person(s)/Age

 

 

 

 

 

 

 

 

Number in MFBU

2

 

 

 

A.  BUDGET COMPUTATION

Net nonexempt income from MC 176/278F:

 

1,509

 

 

 

ABD deductions if previously allowed

                                                             +

0

 

 

 

Health insurance premiums if

Previously allowed                               +

0

 

 

 

 

Adjusted net nonexempt income          =

1,509

 

 

 

B.              200                    (ENTER 100, 133, OR 200) % PROGRAM EVALUATION

Maintenance Need Level (MNL)        $

750

 

 

 

          200            Poverty Level        $

1,876

 

 

 

DOES ADJUSTED NET NONEXEMPT INCOME EXCEED MAINTENANCE NEED LEVEL

BUT NOT EXCEED THE EVALUATED % POVERTY LEVEL?

YES:   Eligible, grant the % case, mark (ü)

ü

 

 

 

NO:    Not eligible*, mark an (X).           n                                                       

 

 

 

 

 

C.      Aid Types For 200% (Income Disregard) Program

 

Recipient Type (J-Line)                       Income Disregard Program               Asset Waiver Provision

 

“Citizen” Pregnant Woman                                440                                                44W

“OBRA” Pregnant Woman                                480                                                48W

“Citizen” Infant Up To 1 Year                           470                                                47W

“OBRA” Infant Up To 1 Year                           690                                                69W

 

B-Line Aid Type                                                MB2                                               MBN (No QSR)**

 

*     There is no need to set up a % case if the MFBU’s net nonexempt income is less than the MNL.

       A person eligible for Medi-Cal with a SOC (or property ineligible pregnant woman) and potentially eligible under a % Program shall be evaluated for eligibility under that % Program. If not eligible, the ET will keep a copy of this evaluation in the Medi-Cal case. No need to set up a separate % case or send a % denial NOA unless the client specifically applies for the % Program.

 

**   Use only when there is no other Medi-Cal case active.

 

14-11 DSS (11/97)                                                                                                                                                                                           (10/99)


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 7: Married Couple, Mutual and Separate Children, and a 20-Year-Old (Applicant)

 

Married parents apply for Medi-Cal for themselves, their two mutual children and the mother’s two separate children, one of whom is a 20-year-old child. The mother’s net nonexempt earned income is $1,000 and the father’s net nonexempt unearned income is $589. The mother’s 20-year-old has net nonexempt earned income of $500. The principal wage earner works 100 hours or more and the family passes the earned income U-parent test so there is deprivation for their mutual children.

 

Section 1931(b) MFBU

 

Mother                                    $1,000    Mother (1090 – 90)

Father                                     $   589    Father

Mutual Child no. 1                         0

Mutual Child no. 2                         0

Mother’s 10-Year-Old                    0

<Mother’s 20-Year-Old>      $   500   20 Year Old (590 – 90)

Total                                        $2,089

Limit for 6                               $1,905

 

Since the family is over the Section 1931(b) 100 percent limit and there are Sneede class members, Sneede rules apply. The Section 1931(b) Sneede parental needs amount at this time is $696. The mother keeps $696 and allocates $304 ÷ 5 = $60.80. The father keeps $589 because he has less than the parental needs limit.

 

(FBU2A)

MBU No. 1 Sneede

 

Mother                           $696.00                                           $     696.00

Father                            $589.00 + $60.80 from Mother    $     649.80

Mutual Child no. 1       $  60.80 from Mother                    $       60.80

Mutual Child no. 2       $  60.80 from Mother                    $       60.80

Total                                                                                        $ 1,467.40

Limit                                                                                        $ 1,421.00

 

The mother, father, and mutual children are not eligible for Section 1931(b). The mother, father, and the mutual children should be evaluated for the MN Program.

 

(FBU 2B)

MBU No. 2                                                                    MBU No. 3            (Not necessary to complete

Sneede                                                                         Sneede                 the MBU computation.)

 

Mother’s 10-year-old = $0 +  $  60.80 (from Mother)         <20-Year-Old> = $500.00 + $60.80 from Mother

Total  $  60.80                                  Total                      $560.80

Limit  $469.00                                   Limit                       $469.00

 

Mother’s 10-year-old is eligible for 1931(b)                     This child is not eligible for 1931(b) because

                                                                                    he/she is over the age limit.

 

The income of the 20-year-old is used again because children are not responsible relatives. Anytime a child returns to a MN/MI FBU, his/her income is used again in that Program’s budget. In order to deduct Mom’s allocation from her income to her mutual children 1 and 2, enter her gross income in the MN/MI budget and deduct the $60.80 using BIC 885.

 

MN/MI

 

Father                                $   589.00

Mother                               $1,000.00 - $60.80 allocated to 10-year-old

Mutual Child No. 1          $         .00

Mutual Child No. 2          $         .00

Mother’s 20-Year-Old     $   500.00

Total                                  $2,028.20

Limit                                  $1,259.00

 

These family members are over the limit. Sneede rules would apply. Those children who did not pass would be evaluated for the Percent Program. NOTE: If Sneede applies to a MN/MI budget unit and there are no parents in the MFBU because they were eligible for Section 1931(b), the child(ren) in the MBU receive a full standard of need rather than a prorated income/property limit similar to when a parent is PA or other PA. In month two, redetermine the family as recipients using Alternative A and the $240 + ½ disregards.


County of San Diego                                                                                                                                                                               Health and Human Services Agency

 

SECTION 1931 (b) APPLICANT AND RECIPIENT BUDGET FORM: FOR DETERMINING NET NON-EXEMPT INCOME AND SECTION 1931 (b) INCOME ELIGIBILITY FOR APPLICANTS, AND FOR RECIPIENTS UNDER ALTERNATIVE METHOD B

CASE NAME

                    Example 7

COUNTY DISTRICT

 

COUNTY USE

 

 NEW APP.     REDETERMINATION      CHANGE      RETRO ELIG.     CORRECTION

EFFECTIVE ELIG. DATE FOR THIS BUDGET

MONTH:                                     YEAR:

 

Name of MFBU PN# _____

Mother

Name of MFBU PN# _____    Mother’s 20 Yr Old

Other Coverage

Name of MFBU PN# _____

Father

Name of MFBU PN# _____

Name of MFBU PN# _____

Mutual Child #1

Name of MFBU PN# _____

Name of MFBU PN# _____

Mutual Child #2

Name of MFBU PN# _____

Name of MFBU PN# _____

Mother’s 10 Yr Old

Name of MFBU PN# _____

 

1

Enter unearned income of each MFBU member, then total for MFBU (include nonexempt disability-based income…SSD or private DIB; not TWC or SDI)

TOTAL MFBU UNEARNED INCOME

 

$       0            

Unearned Income MFBU PN#                

$                                         +  

Unearned Income MFBU PN#                

$                                              +

Unearned Income MFBU PN# _____

$ ___________________  +

Unearned Income MFBU PN# _____

$ ___________________  +

2

  Educational Exp. Deduction

- $         0            

 

 

EXEMPT  OR  UNUSUAL INCOME (LIST EXEMPT  OR UNUSUAL INCOME HERE)

 

 

3

  $50 Child or Spousal Support     Received

- $         0            

4

Remaining Nonexempt unearned income

BOX 4

=$        0            

5

 

Enter earnings of each MFBU member, subtract $90 WRE from each, then total remainders for MFBU.  (Remember to include TWC-as appropriate, & SDI)

 

Total MFBU Earnings:

 

 

 

$     2,089   

Earnings, etc.  of PN# Mother   

$      1,090      

-        $ 90 WRE

=             1,000  

Earnings, etc.  of PN#   Father   

$        679       

-        $ 90 WRE

=        589       

Earnings, etc.  of PN# 20 Yr Old              

$        590       

-        $ 90 WRE

=         500       

Earnings, etc.  of PN#                          

$                      

-        $ 90 WRE

=                     

6

 Dependent Care Deduction

- $         0          

 

County Use

 

SHOW INCOME AVERAGING AND APPORTIONMENT HERE

 

 

 

7

Remaining Nonexempt Earned Income

BOX 7

= $    2,089      

8

Total Remaining income:  Nonexempt Unearned Income and Non exempt earned income (BOXES 4 + 7)

 

 

$       2,089      

9

  Child/Spousal Support Payments

- $         0          

10

  Allocation to Excluded Children

- $         0          

11

  Allocation to PA Family Member

± $       0          

12

Total MFBU net nonexempt income (Rounded down to the nearest dollar)

 

 

= $           2,089     

13

1931 (b) FPL  INCOME LIMIT FOR FAMILY

 

$       1,905                               (Enter 100% Income Limit for Appropriate Family Size Here)

 

 

IF INCOME FROM LINE 12 IS LESS THAN OR EQUAL TO LIMIT FROM LINE 13, FAMILY IS INCOME ELIGIBLE

 

   ELIGIBLE

  NOT ELIGIBLE: IF NO SNEEDE-ELIGIBLE CLASS MEMBER, EVALUATE FOR OTHER MEDI-CAL PROGRAMS, IF SNEEDE-ELIGIBLE CLASS MEMBER, EVALUATE FOR 1931(B) UNDER SNEEDE.

Eligibility Worker Signature:

 

Worker Number

Computation Date

County Use

14-60 HHSA (4/00)                                                                                                                                                                                                       (4/02)

(APPLICANT OR RECIPIENT METHOD “B” BUDGET)


County of San Diego                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) SNEEDE V. KIZER NET NONEXEMPT INCOME DETERMINATION AND MINI BUDGET UNIT (MBU) DETERMINATION – APPLICANT or RECIPIENT METHOD “B”

 

CASE NAME

                          Example 7

COUNTY DISTRICT

 

COUNTY USE

 

CASE NUMBER

EFFECTIVE ELIG. DATE FOR THIS BUDGET

MONTH:                                                                YEAR:

 

CASE TYPE:                 APPLICANT OR RECIPIENT  “B” USING FPL INCOME STANDARD

 

PART 1:

INSTRUCTIONS:

*              CHILD/SPOUSAL SUPPORT PAYMENTS RECEIVED:            Child support is income to the child, not to the parent or caretaker                 relative.    Divide the $50 per month child/spousal support deduction by the number of persons for whom the income is intended.  Any                 unused remainder will be prorated among the remaining persons who still have support payments to apply against the deduction.

 

**            UNEARNED IN-KIND (IKI) INCOME:                Prorate the unearned in-kind income among the persons who receive the income.                  Example: MFBU of 4 receives free housing.  Use in-kind for 4 and each person receives ¼  of the in-kind income.  Add an unborn’s share of in-kind to the pregnant woman’s share.  If the pregnant woman is PA/Other PA,  and not in the MFBU, give the unborn’s    share to the father of the unborn if he is in the MFBU.                                                  

 

NOTE:    The only deduction applicable to the Section 1931 (b) program is the deduction for Educational Expenses, as provided in Section 50547,

                 Title 22, California Code of Regulations.

ENTER NAME OF EACH MFBU MEMBER

(Do not list unborns)

Name

Mother

Name

Father

Name

Mutual Child #1

Name

Mutual Child #2

Name

Mother’s

10 Yr Old

Name

Mother’s

20 Yr Old

Person Type

Parent A or

Caretaker Rel.

Parent B or

Caretaker Rel.

A /  B

 Child of

 

A /  B

 Child of

     

A

 Child of

               / B

A

 Child of

              / B

A.  NONEXEMPT UNEARNED INCOME (EXCLUDING DISABILITY-BASED INCOME)

1.   Nonexempt Unearned Income:  List Sources:

0

0

0

0

0

0

2.   Net Child/Spousal Support Received. *

0

0

0

0

0

0

3.   In-Kind Income (IKI) **

0

0

0

0

0

0

4.   Income available from PA/other PA

      (see MC 175-6, line A.4)

0

0

0

0

0

0

5.   Total nonexempt unearned income

      (add lines 1, 2, 3 and 4)

0

0

0

0

0

0

 

CHILD/SPOUSAL SUPPORT AND/OR IN-KIND INCOME COMPUTATIONS:

 

B.     DISABILITY-BASED INCOME

6.   Disability-based income:  List Source:

       

0

0

0

0

0

0

 

C.    NONEXEMPT EARNED INCOME:  Include “Sawyer” TWC, SDI, and earned IKI

 

7.   Nonexempt Earned Income 

1,090

679

0

0

0

590

 

8.   $90 Work expense deduction.

$90

$90

$90

$90

$90

$90

 

9.   Remaining nonexempt earned income (subtract

      Line 8 from line 7)

1,000

589

0

0

0

500

 

10.   Child Care Deduction.

0

0

0

0

0

0

 

11.   Other Deductions.

0

0

0

0

0

0

 

14-66 HHSA (4/00)                                                                                                                                                                                                 (4/02)

1931(B) SNEEDE APPLICANT OR RECIPIENT “B” BUDGET                                                                                                                  PAGE 1 OF 3

 

12.    Total Deductions. (ADD LINES 10 & 11)

0

0

0

0

0

0

13.    Total Net nonexempt earned income  (SUBTRACT LINE 12 FROM 9).

1,000

589

0

0

0

500

D.     TOTAL COUNTABLE INCOME

14.    Total Countable nonexempt unearned income

         (LINE 5).

0

0

0

0

0

0

15.    Total Countable disability-based income

         (LINE 6).

0

0

0

0

0

0

16.    Total Countable nonexempt earned income

         (LINE 13).

1,000

589

0

0

0

500

17.    Income allocated from LTC/B&C person to

         Family members at home (from MC176W, Part B, or from MC175-7, line C.2).

0

0

0

0

0

0

18.    Total countable income (Lines 14, 15, 16, 17)

1,000

589

0

0

0

500

E.    TOTAL NET COUNTABLE INCOME  AFTER OTHER DEDUCTIONS

19.    Court-ordered child support or alimony.

0

0

0

0

0

0

20.    Income used to determine PA eligibility

         (MC175-6, line B.3 or B.4).

0

0

0

0

0

0

21.    Other Deductions:

0

0

0

0

0

0

22.    Total Deductions (LINES 19, 20, 21).

0

0

0

0

0

0

23.    Total Net countable income (subtract line 22  from line 18).  Enter this amount on MC 175-4 if no parent in MFBU.  If parent in MFBU, continue.

1,000

589

0

0

0

500

F.    PARENTAL/SPOUSAL (P/S)  ALLOCATION COMPUTATION (Skip if no parent in MFBU)

24.    P/S own needs (FPL for 1)

696

696

 

 

 

 

25.    Total unearned in-kind income, income from PA or income allocated from LTC/B&C spouse

(Add lines 3, 4 and 17).

0

0

 

 

 

 

 

 

26.    Parent’s total net nonexempt income (Subtract Line 25 from line 23).

1,000

589

 

 

 

 

 

 

27.    Parent’s net nonexempt income less P/S allocation (Subtract line 24 from line 26); if negative, enter 0.

304

0

 

 

 

 

 

 

28.    Number of persons for whom Parent A is responsible (MC 175-2, Section B).  DO NOT COUNT PARENT A.

5

 

 

 

 

 

 

 

29.    Number of persons for whom Parent B is responsible (MC 175-2, Section B).  DO NOT COUNT PARENT B.

 

3

 

 

 

 

 

 

30.    Child’s natural/adoptive parent – check if Parent A and/or Parent B (see MC 175-2).

 

 

 

 A     B

 A     B

 A     B

 A    B

31.    Parent A’s allocation to spouse (if any) and natural/adopted children (divide parent A’s line 27 by line 28 and enter in applicable box). Do not enter under  Parent B if unmarried.

 

 

60.80

60.80

60.80

60.80

60.80

32.    Parent B’s allocation to spouse (if any) and Natural/adopted children (divide parent B’s line 27 by line 29 and enter in applicable box.). Do not enter under Parent A if unmarried.

0

 

 

0

0

0

0

33.    Enter the lesser of either line 24 or 26

696

589

 

 

 

 

34.    Parent’s total net nonexempt income (add lines 25, 31 or 32, and line 33)

696

649.80

 

 

 

 

 

35.    Child’s total net nonexempt income (add lines 23, 31 and 32) enter on MC175-4.

 

 

 

60.80

60.80

60.80

560.80

14-66 HHSA (4/00)                                                                                                                                                                                                         (4/02)

1931(B) SNEEDE APPLICANT OR RECIPIENT “B” BUDGET                                                                                                                                             PAGE 2 OF 3

County of San Diego                                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) SNEEDE V. KIZER MINI BUDGET UNIT (MBU) DETERMINATION – APPLICANT OR RECIPIENT METHOD “B”

 

PART 2:

SECTION 1931 (b) MBU DETERMINATION – PROPERTY AND

FEDERAL POVERTY LEVEL INCOME (FPL)

  SECTION 1931 (b) FPL TEST

  SECTION 1931 (b) PROPERTY DETERMINATION

INSTRUCTIONS:

 

1.        Include unborn in the mother’s MBU and property limit/FPL income level unless mother is married, and only her separate children want Medi-Cal.  If

Pregnant woman is PA/Other PA, include the unborn in the spouse’s or father’s MBU.

2.        Do not include an excluded child.

3.        Do not list MBU members in more than one MBU.

4.        If any MBU has excess property, check to see if Medi-Cal linkage still exists for other family members.

5.        Property determinations:  enter the allocation for each spouse from MC324, line 29

6.        Enter each person’s net nonexempt income from lines 38 or 39.

 


                          MBU NUMBER               1          

Person name/number

Net Nonexempt

 Property              Income

1.   Mother

696

2.  Father

649.80

3.  Mutual Child #1

60.80

4.  Mutual Child #2

60.80

5.

 

6.

 

                             TOTAL =

1,467.40

MBU’s         Property limit

                     FPL

1,421

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or  below FPL – Property Eligible – PASS

 

                          MBU NUMBER               3          

Person name/number

Net Nonexempt

 Property              Income

1.   Mother’s 20 Yr Old

560.80

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

560.80

MBU’s          Property limit

                      FPL

469

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or below FPL – Property Eligible – PASS

14-66 HHSA (4/00)

1931(B) SNEEDE APPLICANT / RECIPIENT “B” BUDGET

                          MBU NUMBER             2       

Person name/number

Net Nonexempt

 Property              Income

1.   Mother’s 10 Yr Old

60.80

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

60.80

MBU’s          Property limit

                      FPL

469

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or  below FPL – Property Eligible – PASS

 

                          MBU NUMBER                           

Person name/number

Net Nonexempt

 Property              Income

1.

 

2.

 

3.

 

4.

 

5.

 

6.

 

                             TOTAL =

 

MBU’s          Property limit

                      FPL

 

(Check One)

    Excess Property – FAIL

    Inc. Ineligibility exceeds FPL – Property Elig – FAIL

    Inc. Eligible – at or below FPL – Property Eligible – PASS

                                                                                                      (4/02)

                                                                                          PAGE 3 OF 3


SAN DIEGO COUNTY                                                                                                                            DEPARTMENT OF SOCIAL SERVICES

MEDI-CAL

INCOME WORKSHEET

Case Name       Example 7                                                                                               Budget Eff. Mo/Yr                                                            

Case Number                                                                                                                        Computation Date                                                            

Worker Name/No.                                                                                 

 

Income Recipient                                                                                  

NOTE:    Use a separate form for each

             person with Income.

A.    DOCUMENTATION OF INCOME

BUDGET METHOD(S):

 Actual          Apportioned          Fluctuating    

        Date Received

              Amount

                                

$                                   

COMPUTATION & NOTES

       

                                                                           Allocation to 10 Yr Old

       

  Mother                       $939.20   (1,090 – 90 WRE – 60.80)

  Father                        $589.00   (679 – 90 WRE)

  Mutual Child #1                      0

  Mutual Child #2                     0

   Mother’s 20 Yr Old      $500.00   (590 – 90 WRE)

                                  $2,028.20   (Total)

                                  - 1,259.00   (MN)

                                    $769.20   (SOC)

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

                                

$                                   

TOTAL (if applicable)

$                                   

1.   EARNED INCOME PATTERN:

       Weekly      Monthly      Other (list)

       Bi-Weekly (Every other week)

       Semi-Monthly (Twice a month)

      Day of the Week Paid:                                                    

      Day(s) of the Month Paid:                                             

2.   UNEARNED INCOME PATTERN:

       Weekly      Monthly      Other (list)

       Bi-Weekly (Every other week)

       Semi-Monthly (Twice a month)

      Day of the Week Paid:                                                    

       Day(s) of the Month Paid:                                             

B.  APPORTIONED INCOME

      1.    Earned

$                                  x    2            =    $                                

$                                  x    2.167    =    $                                

$                                  x    4.33      =    $                                

$                                  x                  =    $                                

      2.  Unearned (UIB, DIB, WBA, (WEEKLY

BENEFIT AMOUNT) x 2 = Bi-Weekly

Amount usually issued).                                                                                                                                                          

    UIB   $                                  x    2.167          = $                                 

    DIB   $                                  x    2.167          = $                                 

$                                  x                  =    $                                

$                                  x                  =    $                                

 

 

 

 

 

 

 

 

 

MFBU TOTAL EARNED INCOME            $                                    

MFBU TOTAL UNEARNED INCOME      $                                    

 

(File:  Financial folder)      (7/88)

14-29 DSS  (5 / 91)                                                                                                                                                                                                     (5 / 93)


In the example below, <   > indicates a person is an ineligible member of the MFBU.

 

Example 8: Employed Unmarried Parents with Mutual and Separate Children (Applicant)

 

Unmarried parents apply for Medi-Cal for themselves and their two mutual children and the mother’s two separate children, one of which is a 20-year-old child. The mother’s net nonexempt income is $600 and the father’s net nonexempt income is $896. Both are employed but the family’s earned income is below the 100 percent limit for the U-Parent test; therefore, there is deprivation for their mutual children. The mother’s 20-year-old has unearned net nonexempt income of $500.

 

Section 1931(b) MFBU

 

Mother                                          $   600    (690 – 90)

Father                                           $   896    (986 – 90)

Mutual Child #1                                    0

Mutual Child #2                                    0

Mother’s 10-Year-Old                          0

<Mother’s 20-Year-Old>            $   500    (590 – 90)

Total                                              $ 1,996

Limit                                              $ 1,905

 

Since the family is over the Section 1931(b) limit and there are Sneede class members, Sneede rules apply. The Section 1931(b) Sneede parental needs amount for applicants at this time is $696. The mother keeps $600 and allocates nothing because she has less than $696. The father keeps $696 and allocates $200 ÷ 2 = $100 (mutual children #1 and #2).

 

MBU No. 1                                 MBU No. 2                                  MBU 3               MBU 4

Sneede                                      Sneede                                       Sneede

 

Mother                          $600       Father   $696      Mutual Child #1  $100 (father)      <20-Year-Old>  $500

Mother’s 10-Year-Old          0       Limit     $696      Mutual Child #2  $100 (father)        Limit               $469

Total  $600                                                     Total                       $200

Limit  $938                                                     Limit                        $711

 

All are eligible except the 20-year-old. Evaluate him for the MN Program.

 

MN MFBU

 

Mother’s 20-Year-Old  $ 500

Total                                $ 500

Limit                                $ 600

 

The 20-year-old is eligible for the MN Program.


County of San Diego                                                                                                                                                                                Health and Human Services Agency

 

SECTION 1931 (b) APPLICANT AND RECIPIENT BUDGET FORM: FOR DETERMINING NET NON-EXEMPT INCOME AND SECTION 1931 (b) INCOME ELIGIBILITY FOR APPLICANTS, AND FOR RECIPIENTS UNDER ALTERNATIVE METHOD B

CASE NAME

                    Example 8

COUNTY DISTRICT

 

COUNTY USE

 

 NEW APP.     REDETERMINATION      CHANGE      RETRO ELIG.     CORRECTION

EFFECTIVE ELIG. DATE FOR THIS BUDGET

MONTH:                                     YEAR:

 

Name of MFBU PN# _____

Mother

Name of MFBU PN# _____   

Mother’s 20 Yr Old

Other Coverage

Name of MFBU PN# _____

Father

Name of MFBU PN# _____

 

Name of MFBU PN# _____

Mutual Child #1

Name of MFBU PN# _____

 

Name of MFBU PN# _____

Mutual Child #2

Name of MFBU PN# _____

 

Name of MFBU PN# _____

Mother’s 10 Yr Old

Name of MFBU PN# _____

 

 

1

Enter unearned income of each MFBU member, then total for MFBU (include nonexempt disability-based income…SSD or private DIB; not TWC or SDI)

TOTAL MFBU UNEARNED INCOME

 

$       0            

Unearned Income MFBU PN#                

$                                         +  

Unearned Income MFBU PN#                

$                                              +

Unearned Income MFBU PN# _____