Part 3 - Non-MAGI MC MFBU

stepparent cases

What is a stepparent case and who is included in the MFBU?

A stepparent case is one where only the separate children of one spouse want Medi-Cal. The parent, children of the parent, and the stepparent must all be in the home, If all family members or either adult want Medi-Cal, the case is not a stepparent case.

Info

Stepparent

• If the parent of the applicant child wants Non-MAGI Medi-Cal then his/her spouse MUST be included in the MFBU because of responsible relative rules. It would no longer be considered a Stepparent case. Income and resources of the spouse must be counted.
• In the last example, if the Mom decided she wanted Non-MAGI Medi-Cal, the stepparent would be pulled into the MFBU. He is responsible for her as her spouse, so we would need to use his income and resources in determining her eligibility and share of cost.

Stepparent Exclusion Example

This family wants Non-MAGI Medi-Cal for the child only. The child’s parent must be included in the MFBU. The stepparent may be excluded. The child’s parent is ineligible. This parent’s income and resources count but the parent will not be covered by Medi-Cal.

EX

IE

Responsible relative rules: Parent is responsible for child. The parent must be in the MFBU with the child. The stepparent is only responsible for the spouse. He is not the parent of the child and can therefore be excluded.

Needs Medi-Cal

Exercise #7

• Morgan – 38 yr old employed stepparent
• Nicky – 35 yr old spouse
• Their 2 common children
• Peyton - Nicky’s child
• They only want MC for Peyton

Who is in the MFBU?

Nicky IE

Morgan EX

Nicky & Peyton

Mom must be in the MFBU because she is the parent of the child requesting aid. As long as she does not want aid for herself, the stepparent unit can be excluded. She is an ineligible member of the MFBU…the others are excluded members.

EX

EX

Exercise #8

Spouse for spouse. Since she wants aid for herself, she pulls the stepparent in. The common children can still be excluded but it is no longer considered a “stepparent case”.

• River – 40 yr old
• Taylor – 35 yr old spouse
• Their 1 common child
• Taylor’s 2 children

Only Taylor and Taylor’s children want Medi-Cal. They want to exclude all other family members.Who is in the MFBU?

River IE

Taylor

River, Taylor & Taylors 2 children

EX

ineligible mfbu members

Some members of the MFBU may be ineligible because of something they have done, or they may just not want the coverage

Reasons for Ineligible Members:

• Don't want/need Medi-Cal coverage.
• Not meeting basic eligibility requirements (linkage).
• Refusing to apply for SSN, Medicare Part B, or Potentially available income.
• Three generation rule: a minor parent, living with their parent, is an ineligible member in their own child's MFBU.

ineligible mfbu members

More reasons a person might be an ineligible member of the MFBU:

Info

Ineligible mfbu members

Some final thoughts on Ineligible MFBU Members

An ineligible member MUST be included in the MFBU for determining eligibility based on income and Share of Cost (SOC).

IE members are issued a BIC card and their medical expenses CAN be used to meet the SOC of the MFBU. An IE member does not provide linkage to AFDC-MN.

Exercise #9

Ineligible due to unable to verify SSN. Again, ineligible members are in the MFBU for determining eligibility.

• Finley - 52 year old permanently disabled, receives SSA Disability
• Tommie – 66 yr old spouse, unable to verify SSN

Who is in MFBU?

Finley

Tommie-IE

Both

Exercise #10

• Jordan – 35 yr old that refuses to apply for UIB
• Remy – 33 yr old spouse
• Their 1 common child

Who is in MFBU?

Jordan IE

Remy

Everyone

Jordan is ineligible to Medi-Cal because of his refusal to apply for UIB; however, he’s included in the MFBU because everyone wants Medi-Cal and spouse is responsible for spouse and parent for child. Although client is requesting Medi-Cal, you as the worker determine that Jordan is ineligible.

Exercises

Exercise #11

Jackie

Danny

Everyone

Exercise #12

Andy

Exercise #13

Mandy PA

PA

PA

Henry

Exercise #14

PA

EX

Ann & Angie

Exercise #15

Donna & the unborn

Exercise #16

Harper

Heidi

Heidi, Harper & child

Everyone is in the MFBU. Since Heidi wants Medi-Cal for herself, this draws Harper into the MFBU. Harper can choose to be aided or not.

Exercise #17

Lula & Ren

EX

Exercise #18

Reese IE

Alexis

Alexis & Reese

Both are in the MFBU…spouse for spouse….but Reese can choose not to receive the benefit (she would be an ineligible member of the MFBU).

Exercise #19

Charlie PA

Arlo

Arlo, Marlie, Mason & Bodhi

Winston EX

Exercise #20

19 yr. old

Exercise #21

Aspen Other PA

Delta

Delta & both kids

Exercise #22

Ray IE

Dawson

Ray, Dawson, & both kids

Exercise #23

Jim IE

Kayla

Everyone

Can’t exclude stepparent if his spouse wants Medi-Cal, stepparent is ineligible and rule for income is spouse for spouse.

THANKS!

We hope you found this enjoyable and informative

Stepparent

The parent of a child requesting Non-MAGI Medi-Cal can't be excluded from the MFBU because of responsible relative rules - spouse for spouse. The child's parent's income and resources must be counted in determining Medi-Cal for his/her child. The child's parent would be an ineligible member of the MFBU and would not receive Medi-Cal benefits.

Ineligible Members

• The parent of the child, in a stepparent case, when only the applicant children want Medi-Cal.
• Child of a minor consent recipient in minor parent's minor consent case.
• Parent who resides out of state and claim their children living in the state as tax dependents.

• Parent or caretake relative who refuses to:
• Assign medical support rights.
• Cooperate in establishing paternity for a child under 18 born out of wedlock and/or in obtaining medical support and payments.

Parents/caretaker of a child under 18 must agree to assign to the State their right to any medical assistance received from the absent parent & help in determining paternity for children born out of wedlock. Failure to comply with this can result in the parent becoming ineligible.