MC Budgeting Part 1
San Joaquin County Human Services Agency
Created on November 9, 2023
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AFDC-MN and MI
MEDI-CALBUDGETING
Exercises, Exercises, Exercises!
MC 176 W MC 176 M
Budgeting Forms
Non-MAGI & MAGI
Review of Medi-Cal Programs
OBJECTIVES
4. Budgeting Forms
3. Share of Cost
2. Budgeting Methods
1. Medi-Cal - Free VS Share of Cost
Sections
- In general, to be eligible for Medi-Cal, income limits and resource limits cannot be exceeded.
- Limits vary among the different Medi-Cal programs.
- Individuals who exceed income limits may still be eligible for Medi-Cal, but it is not “free.” They are required to pay a Share of Cost.
FREE VS SHARE OF COST
- If you receive your Medi-Cal associated with a Public Assistance program, it is “free.” It is full-scope Medi-Cal and there is no Share of Cost.
- Public Assistance Programs are:
- CalWORKs
- SSI/SSP
- Refugee Cash Assistance
FREE MEDI-CAL
- Other Medi-Cal Programs that will qualify an individual for “free” Medi-Cal are:
- TMC (Transitional Medi-Cal)
- Pickle
FREE MEDI-CAL
- Persons eligible to Medi-Cal only programs such as Medically Needy or Medically Indigent may or may not be eligible to “free” Medi-Cal.
TO BE FREE OR NOT TO BE
IN THIS COMPONENT WE WILL FOCUS ON AFDC-MN & MI SOC
- Budgeting Methods vary according to how an individual is linked to a Medi-Cal program.
- The 3 methods of budgeting that we will cover are:
- AFDC-MN & MI Share of Cost Determination
- A&D FPL Program
- ABD-MN Share of Cost Determination
- AFDC-MN/MI Sneede
BUDGETING METHODS
- To be linked to AFDC-MN Medi-Cal, the family must have an age eligible child.
- Age Eligible: A non-disabled child under the age of 21 or a disabled child under the age of 18
REMEMBER YOUR LINKAGE
An eligible child is:
- A member of the MFBU, and
- A non-disabled child under the age of 21 or a disabled child under the age of 18, and
- Living in the home of a caretaker relative, and
- Meets other eligibility criteria
AFDC-MN
- All family members living in the home are included in the MFBU except those who are PA, Other PA, or Excluded.
- PA (Public Assistance)
- SSI/SSP recipients
- CalWORKs recipients
- RCA recipients
- Other PA
- Pickle eligible persons
- 250% Working Disabled individuals
REMEMBER YOUR MFBU RULES
CalSAWS will look for Medi-Cal linkage in the following order:
- MAGI Medi-Cal
- A&D FPL
- ABD-MN
- AFDC-MN
- MI
MEDI-CAL HIERARCHY
- Share of Cost (SOC) is the amount of net income that exceeds the Maintenance Need (MN) level for the size of the MFBU.
- Persons or families whose monthly income exceeds the maintenance need level for the household size are entitled to Medi-Cal coverage only after their Share of Cost has been met.
- The SOC must be paid or obligated toward the cost of health care services received before Medi-Cal will cover additional services.
SHARE OF COST
A Share of Cost can be for the whole family or certain individuals in the family.
The Share of Cost covers a one-month period.
Those who receive Medically Needy or Medically Indigent Medi-Cal may be eligible with or without a “Share of Cost”.
SHARE OF COST
- Determine the net nonexempt income currently available to the MFBU (traditional rounding to the nearest dollar).
- Subtract allowable deductions
- Subtract the appropriate maintenance need level for the size of the MFBU.
- The remainder, if any, is the SOC.
COMPUTING THE SOC
APPLICANT EXAMPLE
$1410 – 1100 = $310 SOC The family will have a SOC
Earnings: $1500 $90 work expense - 90 Net nonexempt income $1410 Using the MED 34, Medi-Cal Budgeting Guide, compare the net non-exempt income to the maintenance needs for the number of MFBU members (4)
Applicant Example
When is SOC Determined?
Info
NON-MAGI
MAGI
- SDI income is treated as earned income and entered on the MC 176 W earned income section
- Child support received is counted as unearned income
- The following deductions ARE allowed:
- Health insurance premiums
- Child support paid
- Child/Dependent care expense
- SDI income is not counted
- Child support received is not counted
- The following deductions ARE NOT allowed:
- Health insurance premiums
- Child support paid
- Child/Dependent care expense
BUDGETING DIFFERENCES BETWEEN MAGI & NON-MAGI
BUDGETING FORMS
Lets take a minute and look at the Medi-Cal budgeting forms for AFDC-MN and MI
BEFORE WE BEGIN BUDGETING
Info
Let's take a break and look at some budgets together.
WAIT
MC 176 WSECTION I & II
- The most frequently used section of the MC 176 W is the AFDC MN / MI earned income section
- Enter the earned income of each MFBU member who has earnings on line 2 in their respective column
- Enter $90 Work Expense for each on line 3
- Enter net earnings on line 4
- FYI: The $30 and 1/3 deduction are no longer applicable. So, we skip lines 5 and 7 in this section.
- If there is paid dependent care, this will be entered on line 9.
- Total countable earnings by person on line 10
- Total all 3 columns on line 11
- Enter this amount on form MC 176 M column II, line 6.
MC 176 W Section IV
- Before we go into our first exercise, don’t forget MAGI MC.
- It’s at the top of the hierarchy and each household member should be evaluated for MAGI MC before Non-MAGI MC.
- You may have some household members that are on MAGI MC and others that are on Non-MAGI MC. This is called a Mixed Household.
DON’T FORGET ABOUT MAGI
- Remember to follow the Medi-Cal program hierarchy when determining eligibility.
- We always review for MAGI before making a Non-MAGI determination.
- Some household members may not have linkage to Non-MAGI and should always be screened for MAGI.
- The MAGI budget previously used is a work tool that we will no longer use going forward.
MAGI MC REVIEW
- Determine the MAGI household size
- Determine how much income to use in the MAGI determination
- Divide the total income by 100% of the FPL for the HH size
- On your 10-key calculator:
- Enter the total income then the division key
- Enter 100% of the FPL from the MED 34 then hit the % key
MAGI MC REVIEW
- All of the following references can also be found on HSANet under e-handbooks. Then select References.
- Medi-Cal Program Hierarchy Chart
- Medi-Cal Budgeting Guide (MED 34)
- MAGI Household Size Flow Chart
- MAGI & APTC/CSR Income And Deduction Types
- MAGI Whose Income Counts Household Flowchart
MAGI MC REVIEW
- HH consists of married couple Mike (42) and Carol (39).
- They have 6 children: Greg (17), Marcia (16), Peter (14), Jan (13), Bobby (9), and Cindy (8).
- They file taxes jointly and claim all 6 children as tax dependents.
- Mike works for San Joaquin County with 40 hours per week and earns $37 per hour. He is paid bi-weekly.
- He opted out of health insurance through his employer and the entire family is applying for Medi-Cal.
MAGI REVIEW EXERCISE #1
- HH consists of Troy (Single adult male age 20.)
- He files taxes as single.
- He works for Amazon and earns $16.95 per hour at 25 hours per week and is paid bi-weekly.
- Health insurance is not available through his employer.
MAGI REVIEW EXERCISE #2
- HH consists of Tanya, pregnant person (1 unborn baby reported) age 35.
- She files taxes as single.
- She works for PMZ Real Estate and earns $2400 monthly and is paid once per month.
- Health insurance is not available through her employer.
MAGI REVIEW EXERCISE #3
Reminders
SSI/SSP Persons are not included in the Non-MAGI MFBU
But
SSI/SSP Persons are included in the MAGI HH size
Also
If there are any HH members who are not eligible to MAGI but have linkage to a Non-MAGI program, determine their eligibility
Then
Determine if anyone is eligible to MAGI
First
NON-MAGI
MAGI
- This same HH is at 152% of the FPL for a HH of 3 and are determined ineligible for MAGI.
- They are then evaluated for Non-MAGI.
- The child is now PA in the Non-MAGI MFBU.
- The Maintenance Need for Non-MAGI will be for a HH size of 2.
- The SSI/SSP income is excluded.
- Married couple applying for Medi-Cal with their 1 child.
- The child is receiving SSI/SSP.
- The parents file married filing jointly and claim the child.
- The parents MAGI HH size is 3 (includes the SSI/SSP child).
- The SSI/SSP income is excluded.
SSI/SSP EXAMPLE #1
NON-MAGI
MAGI
- SSI/SSP Person will not count in the Non-MAGI MFBU
- If an SSI/SSP Person is pregnant, the number of unborn’s will count in the Non-MAGI MFBU.
- This applies to AFDC-MN, A&D FPL, and ABD-MN.
- SSI/SSP Person will count in the MAGI HH.
- If an SSI/SSP Person is pregnant, the number of unborns will count in the MAGI HH of a pregnant SSI/SSP person.
- The SSI/SSP Person is not given a MAGI aid code as they receive their Medi-Cal through their PA program (SSI/SSP)
SSI/SSP HH MEMBERS
NON-MAGI
MAGI
- Dad’s income is at 170% of the FPL for a HH of 1 and he is determined ineligible for MAGI.
- The unborn child gives him linkage to Non-MAGI AFDC-MN, so he is evaluated for Non-MAGI. Mom is PA in the MFBU.
- The unborn child will be included in the maintenance need.
- So, the maintenance need for Non-MAGI will be for a HH size of 2.
- Pregnant SSI/SSP person is applying for Medi-Cal with the father of her unborn.
- They are not married, and both file their taxes as single.
- Because mom and dad are not in the same MAGI HH, Dad’s HH size is 1 and mom is Ineligible to MAGI.
SSI/SSP EXAMPLE #2
61
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Time for Knowledge Check!
MC 176 M
This is the most common form used when determining a SOC using a manual budget. We will take a look at this form and how to complete it as a class. This formula is used in CalSAWS to determine the SOC so being familiar with how this works will help you in reviewing your EDBC results.