Article 11 Section 1 Maintenance Needs
Table of
Contents
Title MPG Cite
Child Maintaining Separate Residence 11101
Persons With Long Term Care Status LTC 11102
Special No Share Of Cost Programs 11103
Qualified Medicare Beneficiary Program QMB 11104
Maintenance Needs Assistance Standards See Appendix A
11101 Child Maintaining Separate Residence
A The maintenance need is the amount of income a person or family is General
allowed to keep for living expenses Maintenance need amounts are set by State legislation Identified in this article are specific situations that affect the determination of maintenance needs A maintenance need chart is provided in Appendix 111A Historical information on maintenance needs can be found in MEM procedures Article 11
B Determining Maintenance Need for the Children
This is a situation in which a child lives apart from the parents and eligibility is determined as one MFBU including the parents and children
If the child is living alone or one child is living with people who are not financially responsible for the child use the maintenance need for one
If two or more children are living together out of the parents home and they are claimed by their parents as tax dependents use the maintenance need for the number of children in the separate residence
If the child is married and living with hisher spouse use the CalWORKs payment level for two as the maintenance need which can be located on the CalWORKs Assistance Standards Chart
C After determining the appropriate maintenance need for the children Determining
determine the maintenance need for the parents household Combine
Maintenance
the two maintenance needs to determine the maintenance need for
Need for
the entire MFBU
MFBU
MPG Letter 419
11102 Persons With Long Term Care Status LTC
A LTC Status with TherapeuticWages
The maintenance need for a beneficiary who will remain in LTC status MEM for the entire calendar month is provided in Appendix 111A
MPG Article 1 contains the definition of therapeutic wages Persons whose wages meet this definition of therapeutic wages receive the LTC maintenance need plus one of the following
70 of gross therapeutic wages or
70 if the maintenance need level of the noninstitutionalized person
Add the lesser amount to the LTC maintenance need to determine the maintenance need
B LTC Status with Upkeep of Home
Criteria The beneficiary with LTC status can retain an amount for upkeep of hisher home when ALL of the following conditions are met
The spouse or family of the LTC person is not living in the home and
The home whether rented or owned by the LTC status person is being maintained for the return of the LTC status person and
Medical verification on file that the LTC person will return to the home within six months from the date LTC patient status was established
Allowance When the above conditions are met the beneficiary is allowed a deduction for upkeep of the home The amounts allowed are listed in Appendix 111A
C LTC Status with CommunitySpouse Minoror DependentChildren Dependent Parents or Siblings ofEither Spouse
The person with LTC status can be allowed a deduction for support and maintenance of hisher community spouse minor or dependent children dependent parents or dependent siblings of either spouse provided the individuals reside with the community spouse
Maintenance need of the community spouse and other dependent relatives shall be a base amount adjusted yearly Appendix 111A The Maintenance need of the community spouse can be increased if
There is a court order for support that exceeds the base amount
A state fair hearing establishes that the community spouse needs income above the base amount due to exceptional circumstances resulting in financial duress
Examples of these circumstances are special diet foods prescribed
electrical medical equipment and home repairs
D LTC Status with Supportof Disabled Relative
Criteria The person with LTC status is allowed a deduction for care of a disabled relative when ALL of the following conditions are met
The disabled relative is NOT the LTC persons spouse or child and
The LTC patient has and will continue to support the relative on a regular basis
Computation
The amount allowed as a deduction is the LESSER of
Actual contribution or
MediCal Maintenance need for 1 minus the disabled relatives net income
MPG Letter 83
11103 Special No Share Of Cost Programs
A Income Disregard and Asset Waiver Programs
ACWDLs
The 133 Income Disregard and Asset Waiver Programs provide no
8950
SOC MediCal benefits to certain beneficiaries when their family 89103
incomes exceed the maintenance need level but are equal to or less 89104 9407
than certain percent of the federal poverty level Appendix 111A of this section provides the current maintenance need levels and 133 185 and 200 of Federal Poverty Levels needed to determine eligibility for these programs Article 5 Section 12 describes these programs and specific benefits to which beneficiaries are entitled under the program
11104 Qualified Medicare Beneficiary Program QMB
A Qualified Medicare BeneficiaryProgram
ACWDL
The QMB program provides MediCal benefits to recipients of Part A Medicare when their income is 100 or less of Federal Poverty Level Appendix 111A of this section provides a chart with the current percentage of the Federal Poverty Level updated yearly effective April 1st Article 5 Section 13 of this manual describes the QMB program and benefits
MPG Letter 237