Article 8 Section 1 MediCal Family Budget Unit MFBU
Table of
Contents
TITLE MPG CITE
General 080101
Responsible Relatives 080102
MediCal Family Budget Unit MFBU 080103
Status of Family Members 080104
MFBU Composition Appendix A
Treatment of MFBU Members Appendix B
Questions and Answers Regarding Responsible Relatives Appendix C
080101 General
Information
Credits please see Special Notice 1309 Addendum A
A General
This section
contains regulations for determining the MediCal Family Budget Unit MFBU
describes responsible relative criteria
identifies eligible and ineligible members of the MFBU and
specifies who may be excluded from the MFBU
MPG LTR 16 488
080102 Responsible Relatives
A Introduction The responsibility of a relative to contribute to the cost of health care services of a MediCal applicant or beneficiary shall be limited to spouse for spouse and parent for child A caretaker relative as defined in Article 8 Section 5 is not considered to be a responsible relative MEM 50351
MPG LTR 16 488
B Spouse forSpouse
Spouses are responsible for each other when
Both spouses live together in the home or
One or both spouses are in LTCBC and both are MI or AFDCMN
Spouse for spouse responsibility is for the month of admission to LTCBC only when one or both spouses are in LTCBC and one or both are ABD In this situation spouse for spouse responsibility ends on the last day of the month of admission
MPG LTR 16 488
C Parent for Child
A parent is responsible for a child when the child
Lives in the parents home
Lives out of the parents home and the child is A tax dependent of the parent 18 to 21 years old 14 to 18 years old and the parent is handling some or all of hisher MEPM
8C
financial affairs
under 14 years old
Is married even if the child is a parent and the child is both A tax dependent of the parent 18 to 21 years old
EXCEPTION Parents of a child have no responsibility when the child is applying for Minor Consent services
MPG LTR 16 488
080103 MediCal Family Budget Unit MFBU
A The MFBU is the basic unit of persons considered in determining a Introduction persons or familys MediCal eligibility and share of cost SOC
MPG LTR 241 394
B Family Members Family members for MediCal purposes are
A child or sibling children including an unborn Verification of pregnancy must be on file for fullscope coverage See MPG 040708
The parents married or unmarried of the sibling children
The stepparents of the sibling children
The separate children of either unmarried parent or the parent or stepparent
If there are no children family members mean a single person or a married couple MEM 50041
MPG LTR 241 394
C Persons TemporarilyAbsent from the Home People temporarily absent from the home because of hospitalization visiting vacation trips in connection with work or for similar reasons are considered living in the home MPG LTR 241 394 MEM 50371
D Public Assistance PA Recipients
MEM
Family members who are PA or Other PA recipients are eligible to
50373
receive MediCal benefits under the PA or Other PA program ACWDL
9265
Therefore they will not be part of the Medically Needy Only MNO MFBU Family members who are eligible for FourMonth Continuing TMC or Edwards shall be included in the MFBU
MPG LTR 241 394
080104 Status of Family Members
A Family members may be eligible or ineligible members of the MFBU or Introduction
may be excluded from the MFBU per F below
MPG LTR 411 301
B Eligible MFBU members are entitled to receive MediCal benefits
Eligible MFBUTheir income and property are included for eligibility and SOC Members
determinations
MPG LTR 411 301
C Reasons for Ineligibility People are considered ineligible members of the MFBU when they Refuse to apply for a Social Security number Refuse to apply for Medicare Refuse to apply for and accept unconditionally available income Are unable to meet the basic eligibility criteria for any of the MediCal programs Refuse to cooperate with the Medical Support Enforcement Program without good cause MEM 50379 MEM 507715
MPG LTR 411 301
D Circumstance s of Ineligibility
ACWDL
People in the following circumstances are ineligible members of the
9265
MFBU
People receiving MediCal as FourMonth Continuing Edwards or TMC eligible
People 21 or over and under 65 who are not blind disabled pregnant and are not linked to AFDC
Minor parents living with their parents are ineligible members of the MFBU that includes the minor parents children except when the minor parent wishes to receive only Minor Consent services Minor parents who wish to receive MediCal other than Minor Consent services shall be included in the MFBU with their parents
Parents who reside outside the state and who claim their children residing in the state as dependents in order to receive a tax credit or deduction for state or federal income tax purposes are ineligible members of their childrens MFBU
MEM
The following people shall be ineligible members of the MFBU when
50379
a person 18 to 21 years old is claimed by hisher parent as a
dependent in order to receive a tax credit or deduction for state or
E Special Consideration s
federal income tax
The spouse children and parents of the married child claimed
as a tax dependent are ineligible members of the MFBU which
includes the tax dependent
The person 18 to 21 years old claimed as a tax dependent is an
ineligible member of the MFBUs which include either hisher
parents or hisher spouse and children
ACWDL
An infant under age of one year receiving benefits through the
8950
Income Disregard or Asset Waiver programs see MPG Article 5
89103
Section 12 These infants are treated as ineligible members of the
MIMN MFBU Although treated as ineligible members of the MFBU
they are able to link parents to MediCal as AFDCMN
Children age one up to age six receiving benefits through the 133 ACWDL
9061
federal poverty level FPL Program These children are treated as
ineligible members of the MIMN MFBU They are able to link
parents to MediCal as AFDCMN
Children age six up to age 19 receiving benefits through the 100 FPL Program These children are treated as ineligible members of the MIMN MFBU They are able to link parents to MediCal as AFDCMN
Children receiving Stateonly AAPAAC are ineligible members of the MFBU They are considered to be medically indigent not medically needy
MPG LTR 411 301
A child who is otherwise eligible or ineligible for any of the reasons listed in C or D above may be treated as an ineligible member of the MFBU or may be excluded from the MFBU This choice is the option of the person who has legal responsibility for the child In either case the child may not link parents to MediCal as AFDCMN To treat an otherwise eligible person as ineligible obtain all forms and verifications as required for an eligible person but select Y in the Ignore Eligibility Determination on the Collect Case Individual Detail window
Ineligible members will
Have their income included in eligibility and SOC determinations
Have their property counted in eligibility computations
Have their medical expenses used to meet the SOC for the MFBU
Not be considered in determining the program for which persons MEM included in the MFBU are eligible
MPG LTR 471 1101
F Excluded MFBU Members The only family members that may be excluded from the MFBU are A child of any age for example from one day old to 21 years old who either Refuses to provide information about hisher own income or MEM 50381
property
Chooses not to receive MediCal Whenever a child is excluded from the MFBU the parent or caretaker relative must be provided MEPM 8F14
the excluded child statement form MC 239 SN3 The worker is
required to provide the form to the parent or caretaker relative
however if the form is not returned notate in the Case Comments
that the form was provided and not returned Continue to exclude the child from the MFBU as requested but do not deny or
discontinue other family members based on nonreceipt of the MC
239 SN3 Send informing notice MC 239 SN2 to the applicant
Members of a stepparent unit other than the parent of the child requesting MediCal shall be excluded from the MFBU MEM 50381
The unmarried father of an unborn when the unmarried father lives
with the pregnant woman and she wants MediCal only for herself
andor her separate children
Children receiving federal AAP with or without a cash grant are excluded from the MFBU because they are receiving PA or Other
PA
MPG LTR 471 1101
G Excluded Members Restrictions
Excluded members are not eligible to MediCal benefits Excluded members may not
Apply separately except for Minor Consent services for which they may receive benefits
Be included in the MFBU for eligibility or SOC determinations
Have their medical expenses used to meet the MFBUs SOC
Be considered in determining the program for which persons MEM
50205
included in the MFBU are eligible
MPG LTR 471 1101
H The property of excluded family members will not be counted in Property of
determining the eligibility of the MFBU
Excluded
Members MPG LTR 471 1101
I The income of excluded MFBU members will be treated as follows Income of
Excluded Members
The income of an excluded children will not be counted in determining the SOC for the MFBU An allocation of income may be made to an excluded children but not when the child is excluded because the parents refuse to provide information See MPG Article 10 Section 5 for instructions on calculating the allocation to an excluded child
The income of the members of a stepparent unit will be treated in accordance with the Sneede v Kizer lawsuit described in MPG Article 5 Section 14 ACWDL 0425
MPG LTR 471 1101
J Changes in the MFBU
MEM
Changes in the MFBU may be made at the request of the
50371
applicantbeneficiary Changes may be reflected in the month the changes are reported if it is to the beneficiarys advantage Any advantage shall be explained to the beneficiary The beneficiary shall determine whether the change shall be reflected in the month it is reported MPG Article 12 Section 1 describes how to make changes and adjustments
MPG LTR 562 904
MFBU Once the potential members of the MFBU have been identified the Composition
MFBU may be determined in accordance with the following
Appendix A MFBU Composition
Family members living in the home who are not PA or Other PA recipients MFBU
Individual adult Individual adult
Individual Spouse Individual Spouse
Parent Children Parent Children
Both unmarried parents Mutual children Both unmarried parents Mutual children
Both unmarried parents Mutual children Separate children of either or both parents Both unmarried parents Mutual children Separate children except that when all the mutual children are excluded each unmarried parent and parents separate children shall be in a separate MFBU
Parent Spouse Mutual children Parent Spouse Mutual children
Parent Parent
Spouse Spouse
Mutual children andor Mutual children
Separate child of either or both parents Separate children or Parent and the separate children of that parent
Minor parent Minor parents children Minor parents parent and That persons spouse andor children Two MFBUs One Minor parent as an ineligible member Minor parents children Two Minor parent Minor parents parent and That persons spouse andor children
Unmarried minor parent Second unmarried parent Mutual children Two MFBUs One Unmarried minor parent as an
Separate children of either or both ineligible member
Unmarried minor parents parent and Second unmarried parent
That persons spouse andor children Separate children of either unmarried parent Mutual children Two Unmarried minor parent Unmarried minor parents parents and Hisher spouse andor children
Married minor parent Minor parents spouse Mutual children Separate children of either or both Minor parents parent and That persons spouse andor children Three MFBUs One Married minor parent Married minor parents spouse and children as ineligible members and Married minor parents parent and that persons spouse as ineligible members Two Married minor parent as an ineligible member Married minor parents spouse Children Three Married minor parent as an ineligible member Married minor parents parent and That persons spouse andor children
Child living with the childs parents requesting MediCal for Minor Consent services Childs children Child Childs children
Sibling children if all other family members are PA or Other PA Sibling children
Parent Spouse if all children are PA or Other PA Parent Spouse
Sibling children Caretaker relative Sibling children Caretaker relative when the caretaker relative chooses to be included
Caretaker relative if all children are PA or Other PA Caretaker relative
Sibling children Caretaker relative Two MFBUs One
Caretaker relatives spouse andor Sibling children
Caretaker relatives children Two Caretaker relative Hisher spouse andor children
Caretaker relative Sibling children Caretakers spouse spouse does not want MediCal or is not eligible Caretaker relative Sibling children
Caretaker relative caretaker has linkage Two MFBUs
only as a caretaker relative One
Sibling children Caretaker relative
Caretakers spouse spouse has no Sibling children
linkage Two
Caretakers children Caretaker relative and hisher spouse as ineligible members Caretakers children
Caretaker relative Sibling children Other related sibling children Two MFBUs Option 1 One Sibling children Two Other sibling children Caretaker relative Two MFBUs Option 2 One Sibling children Caretaker relative Two Other sibling children
Caretaker relative caretaker has linkage only as a caretaker relative Sibling children Caretakers spouse spouse is PA Caretaker relative Sibling children
Caretaker relative caretaker has linkage Two MFBUs
only as a caretaker relative or chooses to One
be linked to related children other than Caretaker relative
hisher own Two
Sibling children are PA Caretaker relative as ineligible
Caretakers spouse Spouse
Caretakers own children Hisher own children
Caretaker relative caretaker has linkage only as a caretaker relative or chooses to be linked to related children other than hisher own Sibling children Two MFBUs One Caretaker relative Sibling children Two
Caretakers spouse is PA Caretakers own children Caretaker relative as ineligible Hisher own children
Family members not living in the home MFBU
Person 18 to 21 when the person is claimed by hisher parents as a dependent in order to receive a tax credit or deduction for state or federal income tax Person Parents
Person 18 to 21 Persons spouse Children Persons parents when the person is claimed by hisher parents as a dependent in order to receive a tax credit or deduction for state or federal income tax Three MFBUs One Person claimed as a tax dependent Persons spouse and children as ineligible members Persons parents as ineligible members Two Person claimed as a tax dependent as an ineligible member Persons spouse Persons children Three Person claimed as a tax dependent as an ineligible member Persons parents
Child in foster care Child
Sibling children in foster care Each sibling in hisher own MFBU even if placed in the same foster home
Child detained or placed by a court or court designated agency under Welfare and Institutions Code Sections 300 or 601 Child
Child not living with a parent or relative for whom a public agency is assuming financial responsibility in whole or in part Child
Child not living with a parent or caretaker relative when the parents or public agencies have been contacted to determine whether they will accept legal responsibility for the child Child
MPG LTR 411 898
Appendix B Treatment of MFBU Members
Treatment of MFBU Members
Eligible Ineligible Excluded
MFBU Member Yes Yes No
Income counted Yes Yes No
MFBU Person count for Maintenance Need Yes Yes No
Property counted Yes Yes No
MFBU Person count for Property Limit Yes Yes No
Medical Bill count for SOC Yes Yes No
If a child used for linkage to AFDC Yes No No
Apply separately No No No
Receive MediCal benefits Yes No No
Except Minor Consent
MPG LTR 16 488
Appendix C Questions and Answers Regarding Responsible Relatives
Question 1 Is a legally separated couple living in the same home in the same MFBU
Answer
Yes Couples who are legally separated continue to remain married under California law If a legally separated couple is living together in the same home which contains common facilities for example eating bathing etc the couple would be in the same MFBU This answer does not apply to cases where one spouse is institutionalized If a couple is divorced living together and have children in the home they are treated as unmarried parents MEPM 8E
MPG LTR 509 902
Question 2 If an emancipated 19yearold child living with hisher parents is selfsupporting and not claimed by hisher parents as a tax dependent is heshe in the same MFBU with the parents
Answer
Yes The use of the term emancipated has no bearing on any MediCal determination A 19 to 21 year old child living with hisher senior parents is in the MFBU with the senior parents and any siblings whether or not heshe is a tax dependent Heshe is an ineligible member of the Section 1931b program since heshe is over the age limit for that program Heshe may be eligible for the Medically Needy MN or Medically Indigent MI programs until age 21 If heshe has a deprived child of hisher own heshe may be eligible for Section 1931b as an adult with his spouse or second parent if applicable and the senior parents are not in the MFBU
MPG LTR 509 902
Question 3 Can a grandmother who is the legal guardian of a child living in her home be linked to MediCal if the parent of the child is also living in the home
Answer
Yes The Section 1931b program allows a caretaker relative or senior parent who has care and control of an adult parents child to be aided regardless of whether or not the parent lives in the home The MN MI and Percent programs do not allow the caretaker to be aided if the parent is in the home unless the parent is a minor In this case the caretaker may be linked to the minor parent but is not responsible for the minor parents child Note A parent who is only temporarily visiting the home is not considered living in the home
MPG LTR 509 902
Question 4 Must an unmarried father of an unborn who lives in the home with the mother of his unborn be included in the MFBU if he does not wish to be aided Answer No If the father has not other mutual children living in the home who are requesting MediCal he does not have to be included in the MFBU with the mother and his unborn until the child is age one Since the implementation of Sneede v Kizer would require that the unmarried parents be in separate MFBUs if there were a SOC or excess property and the fathers income and property would not affect the child under age one Deemed Eligibility workers are not required to include the father in the MFBU However if the father is unemployed or incapacitated and the mother wishes to be aided past the 60day postpartum period and has no other basis for deprivation the father may be included in the MFBU MPG LTR 509 902 MEPM 8E
Question 5 A pregnant mother receiving Supplemental Security Income SSI is living in the home with the unborns father and their mutual twoyearold The father and the twoyearold apply for MediCal What is the MFBU composition Answer The father the unborn and the twoyearold are in the same MFBU The mother is not included because she is receiving PA Note When the pregnant mother is receiving cash benefits the unborn is in the same MFBU with the father MPG LTR 509 902
Question 6 If a Foster Care FC or County Foster Care child is living with a caretaker relative may that relative be linked for MediCal benefits Answer
Yes The CalWORKs program allows caretaker relatives of children receiving FC grants to receive CalWORKs thus automatic MediCal therefore a caretaker relative of these children may also apply for MediCal only benefits if otherwise eligible This would be similar to parents or caretaker relatives that are linked to children who receive PA for example CalWORKs or SSI NOTE Children who are receiving PA are not in the same MFBU with the caretaker relative
MPG LTR 509 902
Question 7 If the stepparent refuses to cooperate can the separate child of the spouse receive MediCal
Answer
Yes Under Sneede v Kizer procedures the mother would be an ineligible member in the MFBU with her child regardless of whether the stepparent has sufficient income to meet the needs of the stepparent unit If the mother mutual children or his children wish to be aided the father is required to be in the MFBU
MPG LTR 509 902
Question 8 If a child is receiving SSISSP or CalWORKs may the parents be linked If so what is the MFBU composition
Answer
Yes The parents are alone in the same MFBU The child who is receiving SSISSP or CalWORKs will not be included in the MFBU
MPG LTR 509 902
Question 9 Can a senior mother living in the home with her daughter and the daughters baby be linked to her 19yearold daughter if the daughter and her baby receive CalWORKs or Section 1931b
Answer
Yes The senior mother is eligible for the MN Program if her 19yearold daughter is receiving CalWORKs or Section 1931b and is deprived because the MN Program defines a child as a person under
21 The senior mother would be in her own MFBU Care and control is not an issue for the MN Program if the children are under 21 and living with the senior parent
MPG LTR 509 902
Question 10 A mother living in the home with only one disabled MN child age 18 and not enrolled in school requests MediCal May she use this child for linkage Answer No The child is defined in MPG Article 1 as an adult MPG LTR 509 902
Question 11 A couple has started adoption proceedings for an unrelated child with whom they are living May this couple apply for MediCal using the child for linkage Answer No The couple cannot apply until the adoption is final MPG LTR 509 902
Question 12 Would two persons of the same sex who live together are registered as domestic partners be financially responsible for each other if one or both apply for MediCal Answer No Domestic partners are not financially responsible for each other except for any income that they may contribute to the household in excess of their share of the expenses MPG LTR 509 902
Question 13 A child between 18 and 21 is away at college and is claimed as a tax dependent HeShe is considered a child for the MNMI programs and is included in the MFBU with hisher parents May the parents use himher for linkage if the child is deprived Answer Yes MPG LTR 509 902
Question 14 If a deprived child age 19 who is claimed as a tax dependent by hisher parents is living out of state and does not plan to return may the parents use himher for linkage
Answer
No This child is not considered to be temporarily absent from the home
MPG LTR 509 902
Question 15 What are the consequences of excluding a child from the MFBU
Answer
Although a parent may allocate some of hisher income to the excluded child the family size is reduced which affects the incomeproperty limits for the family Since Sneede rules would apply if the child has incomeproperty it may be more beneficial to not exclude the child unless there are other issues such as not wanting to pursue medical support Note Workers must inform parents about the consequences of excluding a child from the MFBU
MPG LTR 509 902
Question 16 If a relative of a child had hisher marriage annulled may the former spouse of the relative be considered a caretaker relative
Answer
No An annulment means that the marriage was invalid and did not exist
MPG LTR 509 902