ARTICLE 19 SECTION 1 GENERAL ELIGIBILITY REQUIREMENTS 1 GENERAL Effective 112014 1931b is replaced by MAGI MediCal programs for children and caretaker relatives See MPG SN 1309 and Article 21 for more details For more information about the elimination of Deprivation see SN 1309 Addendum J Section 1931b referred to throughout the MediCal Program Guide as 1931b of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 PRWORA established a new mandatory coverage group in Section 1931b of the Social Security Act Section 1931b requires that MediCal be provided to lowincome families who met the provision of the July 16 1996 AFDC state plan requirements for income resources and deprivation or more liberal provisions at State option Section 161 of Assembly Bill 1542 established the California Work Opportunity and Responsibility to Kids CalWORKs Program and provided that it was to be implemented in January 1998 The Department of Health Services extended eligibility for health services under MediCal to all CalWORKs recipients as well as those in 1931bonly For the purposes of establishing requirements for the 1931b group AFDC provisions have been modified as of January 1 1998 to the extent possible as permitted by PRWORA in order to align the 1931b Program with CalWORKs Senate Bill 708 chaptered on July 22 1999 raised the income limits for 1931b to 100 percent of the federal poverty level There are no time limits under the 1931b program Persons applying for MediCal who are not on Public Assistance PA or other PA must first be evaluated for 1931b prior to any other fullscope MediCal programs if they are otherwise eligible eg meet residency age deprivation income and property requirements A flow chart illustrating the order of evaluation is included as MPG Appendix 191A Exceptions A pregnant woman is not required to include the unmarried father of an unborn in the MFBU If she chooses not to include the father the pregnant woman must be evaluated as Medically Indigent MI or for the 200 FPL Program not 1931b The ET must explain the advantages of the 1931b Program to a pregnant woman who is in her last trimester of her pregnancy at the time of application so she is able to make an informed choice about her level of benefits The benefits are that the mother may remain linked to MediCal after the pregnancy ends and be potentially eligible to TMC if income increases in a later month However the entire family including the father must be evaluated for 1931b eligibility if either parent requests MediCal after the baby is born or after the childs first birthday whichever is earlier MEM PROC 5S Individuals who are eligible for 1931b may choose to be aided under other mandatory programs such as Pickle or limited benefits programs such as QMB Persons requesting property waiver benefits are not required to submit property verifications and therefore are not evaluated for 1931b 2 MEDICAL FAMILY BUDGET UNIT MFBU COMPOSITION The MFBU for 1931b is the basic unit of persons considered in determining an individuals or familys eligibility to 1931b Sneede rules apply to the 1931b determination Persons eligible to 1931b have a zero share of cost SOC MFBU composition and Sneede rules are explained in detail in MPG Article 19 Section 4 3 DEFINITION OF A CHILD A person is considered a child until the childs eighteenth birthday or the child is 18 years old but is currently enrolled in school as a fulltime as defined by the school high school student or if the child has not completed high school is in a vocational or technical training program which cannot result in a college degree provided the child reasonably anticipates graduating before age 19 Note This differs from the Medically Needy MN or Medically Indigent Programs in which a person is considered an adult at age 21 18yearolds must be discontinued from 1931b at the end of the month in which they graduate and evaluated for the MNMI Programs Exception Once a child turns 18 whether living in the senior parents home or not heshe may apply for 1931b as an adult parent or caretaker relative see Deprivation below The income and resources of the senior parents are not considered in making a 1931b determination 4 DEFINITION OF AN ADULT A person who is 18 years old or older and no longer meets the1931b definition of a child as described above in item 3 is considered an adult for the purpose of evaluating 1931b eligibility An adult may complete a statement of facts and be considered for 1931b eligibility as a parent of a deprived child 5 DEPRIVATION The deprivation regulations in MPG Article 5 Section 2 apply to 1931b except as described in this Article A Deprived Child with Zero SOC For a parent to be eligible for 1931b there must be at least one AFDC deprived child living in the home eligible for zero SOC MediCal under the 1931b SSI MN MI Public Assistance Continuous Eligibility for Children Continuing Eligibility or Percent Programs A pregnant woman who has no other zero SOC eligible children but whose unborn will be deprived may not be aided under 1931b until the last trimester last four calendar months of her pregnancy If the father of the unborn is living in the home he may not be aided under 1931b until the baby is born and AFDC deprived The father may be eligible for the MN Program because he may be linked by the deprived unborn under MEM PROC 8G2 that program The fathers income and property is considered for a 1931b determination even though he is an ineligible member of the 1931b MFBU The unborn may be included in the 1931b MFBU prior to the last trimester if there are other 1931b eligible or potentially eligible children B Unemployment For general rules on unemployment deprivation see MPG 527 The UParent deprivation test does not apply to 1931b recipients A recipient for purposes of the UParent deprivation test is a person who has been terminated from CalWORKs with no break in eligibility between CalWORKs and 1931b disregarding any intervening Edwards months The statement of facts with the PWE and UParent determination from the CalWORKs case must be copied and filed in the 1931b case file or is receiving 1931b in the month after the person became eligible for 1931b as an applicant A recipient may begin or continue working 100 hours or more in the second month of receiving 1931b and remain eligible if the family income is below the 1931b recipient limit using either alternative A or B and is otherwise eligible This is true even if the family was never receiving CalWORKs If there is a break in aid such as when the family does not return information requested by the county eg statement of facts and good cause has not been established for the termination to be rescinded the PWE must be redetermined as an applicant for the purpose of determining unemployment deprivation This is true even if the break is less than one month Different rules apply for determining applicantrecipient status for budget purposes See MPG Article 19 Section 2 See MPG Appendix 191A for a desk aid on determining when to apply the unemployed parent test Example A family is discontinued from 1931b for failure to provide effective 113000 and reapplies 121500 The family must be reevaluated as an applicant for Uparent deprivation 6 ESSENTIAL STEPPARENT A stepparent may be aided as an essential person in 1931b regardless of whether the stepparent has deprived children or nondeprived mutual children of his or her own Hisher linkage may be based only on the fact that heshe is a spouse of a parent who has a separate child deprived by an absent parent The MN Program only allows a stepparent to be linked if heshe is a spouse of a parent who has a separate child deprived by that parents incapacity Regardless of whether the stepparent wishes to be aided heshe is included in the 1931b MFBU as an eligible or ineligible person depending on hisher choice The exception is when only the separate children of the spouse wish to be aided the stepparent would not be in the budget unit However the spouseparent would allocate some of hisher income to the stepparent and any mutual children 7 8 9 ADULT PARENT MINOR CHILD AND CARETAKER RELATIVE LIVING IN THE HOME An otherwise eligible adult parent hisher minor child and a caretaker relative may all be aided under 1931b if they live in the same home and the caretaker relative has care and control of the deprived child The parent is still financially responsible for the child even if the caretaker relative has care and control of the child This differs from the MN Program which does not aid a caretaker relative if the parent is in the home The caretaker relative must sign the statement of facts Both the caretaker relative and parent must cooperate in providing requested items The scenario described in this section would most often occur when the adult parent is incompetent See MPG Article 4 Section 19 for instructions on how to treat incompetent applicants See MPG Article 19 Section 4 for more information regarding caretaker relatives INELIGIBLE CALWORKS ASSISTANCE UNIT MEMBERS CATEGORICALLY ELIGIBLE Persons who are not eligible for CalWORKs such as those who are WelfaretoWork sanctioned fleeing felons aliens without satisfactory immigration status or who have reached their CalWORKs time limits are eligible for 1931bonly without a separate determination if other family members remain eligible for CalWORKs and they are a deprived child or the parent of a deprived child These persons are financially eligible for CalWORKs and their income and property was counted in the CalWORKs determination They are considered to be categorically eligible A nonneedy caretaker relative whose income is not considered by CalWORKs is not considered categorically eligible Open a 1931b FBU for the categorically eligible family members Include a print out of the MEDS records of the active CalWORKs family members and a copy of the CalWORKs statement of facts in the 1931b case record at application and redetermination Synchronize the redetermination date of the 1931b case and the CalWORKs case to prevent eligibility errors RETROACTIVE APPLICATIONS MEM PROC 8G2 In determining eligibility for retroactive benefits for 1931b determine whether the person is a recipient or an applicant see MPG Article 19 Section 2 for the definition of applicantrecipient and apply the appropriate income limit test If the MFBU does not meet the 1931b eligibility requirements then eligibility under other MediCal programs must be evaluated The recipient deductions cannot be used to establish retroactive eligibility unless the family is considered a recipient for budget purposes in the retroactive month See MPG Article 19 Section 2 Apply the applicant income limit test to the earliest month for which the family has requested retroactive eligibility If the family does not pass that month apply the applicant income limit test to each successive retroactive month until the applicant passes the test Once applicant status is determined for a retroactive month the subsequent months are subject to recipient deductions for each successive retroactive month and the application month Example A family has not previously received either CalWORKs or 1931bonly They apply for both ongoing MediCal for January and at the same time retroactive MediCal for October November and December The family is able to pass the applicant income limit test in the retro month of November but cannot pass in October because of excess income Therefore the applicant income test applies in October and November and the recipient deductions apply in December and forward In the illustrations below AILT is the applicant limit test and RILT is the recipient limit test If the family is found to be eligible for retroactive benefits beginning the month after the month in which the family requested retroactive MediCal benefits evaluate the family for eligibility in the 1931b Program as recipients If the family fails to qualify for 1931b in that month do not reevaluate them for eligibility for 1931b as recipients in later months Exception A later month may be evaluated as a recipient if the family meets the recipient definition for that month The familys MediCal status through the period for which they were previously determined eligible for another MediCal program will not change as a result of retroactive eligibility determination Example A family applies for MediCal in January 2000 and is approved for the MN Program In November 2000 they request retroactive benefits for October November and December 1999 They pass the applicant test and qualify for 1931b for December As illustrated below the family is not eligible for consideration for retroactive eligibility for October or November 1999 because these two months are more than 12 months previous to the month in which retroactive eligibility was requested See illustration below Because the family was determined retroactively eligible for 1931b in a retroactive month evaluate the family for 1931b for December 2000 as recipients applying the 240 and onehalf deduction to their qualifying income if using budget alternative A If the family does not qualify for 1931b in December 2000 and if the family is evaluated for 1931b in a subsequent month they will have to pass the applicant test in that subsequent month The family is not eligible to a retroactive evaluation or reevaluation of eligibility for any months outside of the 3month retroactive period 10 TRANSITIONAL TMC AND 4MONTH CONTINUING MEDICAL Persons discontinued from 1931b must be evaluated for TMC or Fourmonth Continuing MediCal Persons discontinued from CalWORKs must be evaluated for 1931b before TMC The reason for 4Month Continuing MediCal eligibility is increased child support income The reason for TMC eligibility is increased earnings from employment This does not include other forms of earned income such as State Disability Benefits or Workers Compensation Benefits See MPG Article 5 Section 7 Persons on TMC are not considered MEM PROC 5S7 1931b beneficiaries When a familyperson is discontinued from TMC they must be evaluated for applicantrecipient status per MPG Article 19 Section 2 11 AUTOMATION CODES See MPG Appendix 191C for automation codes associated with 1931b MEDICAL PROGRAM GUIDE 191A1 MPG Letter 435 Evaluate Evaluate for for the 6 mos TMC TMC Program APPENDIX 191A2 ORDER OF EVALUATION FLOWCHART MEDICAL PROGRAM GUIDE 191A2 MPG Letter 435 Grant up to 6 mos TMC Eligible Yes for 6 mos TMC No Evaluate for MI programs or 1931bAFDCMN if deprivation exists Evaluate for MI programs or 1931bAFDCMN if deprivation exists Evaluate for MI programs or 1931bAFDCMN if deprivation exists Evaluate for AFDCMN or 1931b applicant APPENDIX 191A3 ORDER OF EVALUATION FLOWCHART MEDICAL PROGRAM GUIDE 191A3 MPG Letter 435 Grant appropriate program Evaluate for programs No change Grant appropriate program No change APPENDIX 191B 1931B DEPRIVATION DESK AID Apply the Uparent test if the PWE was previously absent from the home returns and is employed 100 hours or more or previously incapacitated and becomes employed 100 hours or more Please note a new evaluation to determine PWE must take place Use applicant deductions for Uparent test and if the family has recipient status use recipient deductions for the income limit test Do not apply the Uparent test if the PWE works less than 100 hours or the PWE is a Uparent and becomes employed 100 hours or more a 1931b recipient may work more than 100 hours or the PWE is a Uparent becomes incapacitated and is then reemployed becoming a Uparent again In this situation do not reestablish the PWE or complete a Uparent test even if the PWE works 100 hours or more or deprivation is absence death or incapacity or the household consists of an unmarried father and pregnant woman only and father is excluded from the MFBU The woman can choose to be evaluated as a MI pregnant woman instead of Section 1931b The ET must explain to the family consequences of exclusion which are mom is not linked after pregnancy ends and later if income goes up and they decide they want MediCal family will not be eligible to TMC 0 SOC MediCal for up to two years MEDICAL PROGRAM GUIDE 191B MPG Letter 463 APPENDIX 191C 1931b AUTOMATION GRANTED MEDICAL PROGRAM GUIDE 191C MPG Letter 463 APPENDIX 191D 1931b AUTOMATION SNEEDE APPENDIX 191E 1931b AUTOMATION RETRO 1001 APPENDIX 191F 1931b AUTOMATION TMC 1931b case closed for excess earnings must be evaluated for TMC If your 1931b case is closing for excess earnings Use negative action code on AA 2A 2B etc 032 Use BDLM CopyFeature to copy 1931b AAFBUto TMC FBU 70 or 3A Referto MPG Article 5 Section 7 MPG Article 10 Section 7 and MPG Letter 423 for TMC processing MEDICAL PROGRAM GUIDE 191F MPG Letter 435