Medi-CalMedi-Cal

INDEX

Numerics100% program 36-35

approvals & denials 36-38determining eligibility 36-37discontinuance 36-38effective date 36-36MFBU requirements 36-38period of eligibility 36-36scope of benefits 36-37who is eligible 36-35

133% program (ages 1 - 5) 36-30application 36-30

continuing cases 36-31intake 36-30

definition 36-30MFBU considerations 36-34NOA requirements 36-35, 36-38period of eligibility 36-31scope of benefits 36-32

14 to 19 year old adult 36-3617 years of age & under 24-6

living at home 24-6living away from home 24-6

18-21 years of age 24-4living at home 24-4living away from home 24-5

60-day postpartum 36-1discontinuance 36-7eligibility requirements 36-1eligible persons

MI women (aid code 86, 87) 36-3minors, whose pregnancy terminates 36-4MN women (aid code 34, 37) 36-3PA or other PA (TMC) 36-4

ineligible persons 36-5issuance procedures 36-6

birth/termination of pregnancy 36-6overview 36-1period of eligibility 36-2retroactive Medi-Cal

pregnancy ends 36-1

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AABD-MN

aged persons 31-7blind 31-7general 31-6

Ability to Pay Program 41-58Accelerated Enrollment (AE)

approvals 41-29ineligible children 41-29scope of coverage 41-28Single Point of Entry (SPE)

accelerated enrollment 41-28termination of AE 41-30

Acellerated Enrollment (AE)informing notices 41-29

Adequate considerationdefinitions 3-5

Adopted children 31-15Adult

definition 3-5Adverse action

definition 3-5AFDC case, family member potentially eligible for Medi-Cal 31-11AFDC-MN Linkage 31-1

caretaker relative with spouse or childrenincome and property 31-6

nonparent careteker relative 31-2who is eligible 31-5

Aged and Disabled Federal Poverty Level (A&D FPL) Program 28-25Aged Blind and Disabled Programs 28-1Aid category

definition 3-6Aid code

definition 3-6AIDS waiver 42-23AIDS/HIV. See Presumptive disabilityAIM

application review 41-5AIM application assistance fee 41-7

checklist 41-7enrollment limits 41-8EW notification 41-8mail to 41-8

pregnancy verification 41-7care providers/covered services 41-5

coverage 41-5

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participants 41-5eligibility criteria 41-1income 41-2

documentation 41-3family size 41-2limits 41-2total family income 41-2

property 41-3subsciber conrtibution chart 41-3subscriber contribution 41-4

discount 41-4, 41-5mandatory payment 41-4payments 41-4penalty 41-4second payment 41-4

Annuities 26-81analysis samples 26-117

improperly structured 26-118properly annuitized 26-117

background 26-81characteristics 26-105

comparison chart 26-107Other Annuity 26-106

deferred 26-110period of ineligibility 26-110transfer of property 26-110

definitions 26-83annuitant 26-83annuitized 26-83annuity 26-84assets 26-84cash refund 26-84cost of living increase 26-85death benefit 26-85payment 26-85

distribution/treatment chart 26-113examples 26-114life expectancy tables 26-123

females 26-125males 26-123

OBRA ’93determining life expectancy 26-108distribution/treatment chart 26-113not properly annuitized 26-109

analysis sample 26-118treatment 26-109

properly annuitized 26-108

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analysis sample 26-117treatment 26-109

undue hardship 26-112Other Annuity 26-106, 26-112

characteristics 26-106distribution/treatment chart 26-113treatment 26-113undue hardship 26-113

overview 26-81Sneede considerations 26-126transferred asset 26-91treatment 26-109

chart 26-113OBRA ’93 26-109

not properly annuitized 26-109properly annuitized 26-109

Other Annuity 26-113verification 26-107

Annuities. See Pension fundsApplication for the A&D FPL Program 28-26Applications

accelerated enrollment 41-28CHDP Gateway 41-31denials/discontinuances 12-1LTC/incompetent persons 29-5

APPR 29-27definition 3-6

arrearage payments 25-34, 25-36Misc. income deductions

child support 25-34misc. income deductions

child support 25-36Authorized Representatives (AR)

DHS 7068 29-7LTC/incompetent prersons 29-5

Average Private Pay Rate. See APPR

BBackground 28-25Ball v. Swoap 50-17

decision 50-17issue 50-17treatment of payments 50-17

Bank accounts 26-27Beltran v. Rank 50-1

decision 50-1

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issue 50-1BIC

definition 3-6Billing methods

cost avoidance 46-22Blind or disabled child 31-15Bonds 26-29Border crossing card

California residence 7-11Budgeting 9-1Burial funds 26-43

irrevocable 26-43revocable 26-44

Burial insurance 26-41definition 3-7

Burial plots 26-41Business property 26-49

CCalifornia Partnership-Approved LTC Insurance Policy or Certificate

Spenddown 29-52California residence

case documentation 7-12case documentation w/border crossing card 7-11entry to seek medical care 7-12homeless persons 7-10how to establish residence 7-1migrant workers 7-9principal residence 7-13requirements chart 7-4short-term visa/border crossing card 7-11students and non-immigrant visas 7-10unmarried parents 7-8verification

AFDC to Medi-Cal only 7-3collateral contact 7-12exception 7-3when required 7-3who must verify 7-3

CalWORKs Denials 8-51Car. See VehicleCaretaker relative 24-18

adoptive relatives 24-20biological relatives 24-19relationship to child 24-19relinquishment 24-20

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spouses of relatives 24-19step relatives 24-19treatment of income and property 31-6

case with other family members 12-10Cash/Medi-Cal differences 31-9

budget unit - minor unmarried parent in the home 31-10caretaker in the budget unit 31-11linkage when parents are sponsored aliens 31-11linkage when the only child is on SSI/SSP 31-10U-parent distinctions 31-10

CEC 35-42redeterminations not completed timely 35-42

Certification effective datedefinition 3-8

Certification for medicaldefinition 3-8

Chartsinstitutional status 39-10

CHDP Gatewaybackground 41-31eligibility determination, M-C or HF 41-34eligible children 41-32enrollment criteria 41-31

Checking accounts. See Bank accountsCHI 41-25Child 3-8

definition 3-8Child abuse reporting requirements 38-2

mandatory reporting 38-2reporting numbers 5-2, 38-2

child only case 12-11Children’s Health Initiative 41-22

income 41-23release of information 41-27screening process 41-23toll-free number 41-23

COBRA 46-12continuation of benefits 46-12employers affected 46-13notification requirements to employer 46-13premium payment 46-13termination of coverage 46-13

Community propertydefinition 3-19

Community property - sharedefinition 3-20

Community spouse

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definition 3-9Competent

definition 3-9Consolidated omnibus budget reconciliation act. See COBRAContinued eligibility for pregnant women & infants

affected persons 35-2break in aid 35-12determining MFBUs/SOC 35-16ICTs 35-13increased income, infants 35-15increased income, PA/other PA recipients 35-16increased income, pregnant woman 35-14infants 35-18medical support referral 35-11newborn referral procedure 35-6overview 35-1pregnant women 35-3processing, eligibility, general 35-3RVs 35-13Sneede 35-11three month retroactive 35-11unmarried fathers 35-9

Continuous Eligibility for ChildrenCEC period 35-32eligibility rules 35-31exceptions 35-32

Continuous eligibility for childrenannual redetermination following cec 35-35cec procedures 35-41changes reported during the cec period 35-33children discontinued from CalWORKs 35-39children losing foster care 35-39children losing ssi cash-based medi-cal 35-40guaranteed CEC period 35-32linkage to section 1931(b) 35-38

continuous eligibility for childrencec for infants under one 35-38discontinuance whereabouts unknown 35-44intercounty transfers 35-43transitional medi-cal 35-40

Continuous period of institutionalizationdefinition 3-9

Conversion of property 26-9definition 3-10

Cost avoidance coverage 46-23County cash-based M/C

definition 3-7

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Court Orders 50-1Ball v. Swoap 50-17Beltran v. Rank 50-1Crawford v. Rank 50-12Edwards v. Kizer 50-12Gamma v. Belshe 50-22Gibbins v. Rank 50-15Hunt v. Kizer 50-19Ibarra v. Dawson 50-16Johnson v. Rank 50-16King v. McMahon 50-17Latino Coalition v. Belshe 50-23LTC prejudice cases 29-55Lynch v. Rank 28-1Radcliffe v. Coye,et al 50-20Ramirez v. Belshe 50-23Ramos v. Myers 50-19Reese v. Kizer 29-55Saldiva v. McMahon 50-19Sawyer v Shalala, Anderson, Belshe, Gould 50-21Tinoco v. Belshe 50-21

Crawford v. Rank 50-12decision 50-12issue 50-12

CSRAcalculation 29-17definition 3-9EW actions 29-21examples 29-21maximum 29-17

court order 29-18fair hearing 29-18

transfer to community spouse 29-19period 29-19

undue hardship 29-20

DDDS-HCBS Waiver 42-3

application referrals 42-6benefits 42-4Medi-Cal eligibility 42-6NOAS 42-10overview 42-3procedure 42-8

applicant 42-8, 42-19recipient 42-9, 42-20

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release of information 42-10requirements 42-4retro Medi-Cal 42-8RVs 42-10waiver discontinuance 42-11, 42-17

DEDaddress/phone 27-61applicants - deceased 27-20decision chart 27-17decisions 27-65disability evaluation forms 27-36

death certificate 27-38list 27-36MC 220 27-39

special situations 27-40MC 221 27-42MC 223 27-45, 27-51

part 1 completion 27-46, 27-51part II completion 27-47, 27-53part III completion 27-49, 27-56part IV completion 27-50, 27-56part V completion 27-50, 27-56, 27-57

medical records 27-37SSA documents 27-37

disabled persons - federally 27-1definition 27-1duration 27-2other linkage 27-2proc. 22C overview 27-1

EW observations 27-33guidelines 27-33use of MC 221 or DHS 7405 27-33

inquiries 27-73coordinator 27-74EWs 27-73

other linkage 27-19presumptive disability 27-94

3 month retro 27-96checklist 27-111conditions 27-97federal denial 27-96follow-up/expediting decisions 27-109HIV/AIDS 27-101

adults (presumptive criteria met) 27-102ages 1-17 (presumptive criteria met) 27-104procedure 27-101

urgent case request 27-106

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examples 27-108procedures 27-107

verification requirement 27-109presumptive eligibility 27-19procedures - EW 27-60

DED address/phone 27-61delayed DED referrals 27-62recording DED pending 27-60reporting changes to DED 27-64sending the DED packet 27-61

redeterminations 27-86reevaluations 27-87reexaminations 27-83reexaminations, reevaluations, and redeterminations 27-81

DED determined disability 27-82referrals to DED 27-82

reexams on appealed DED denials 27-93referral chart 27-89RSDI 27-81

follow-up 27-82procedures 27-81

referralblindness 27-8clients statement 27-8limited by SSA decision 27-11

completion of MC 223 27-13conditions 27-12informing notice/NOAs 27-13referring clients to Social Security 27-14screening form 27-13SSA approves disability after denying claim 27-14

MC 176S 27-8MC 210 27-7not required 27-2presumptive disability 27-9promptness 27-9required 27-4retro onset dates 27-10RSDI/SSI pending 27-10SSI pending 27-8

referrals - special 27-75DED referral for a retro month 27-77

after DED approval 27-77disabled former SSI/SSP 27-78limited DED referrals 27-75

allowable circumstances 27-75required forms 27-76

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SGA determination 27-20background/definition 27-20clarification 27-29impairment - related work expenses (IRWE) 27-24

budgeting IRWE 27-26MC 273 27-25

procedures 27-23retroactive Medi-Cal and SGA 27-22SGA does not apply 27-22types of IRWE 27-26

attendant care 27-26medical devices 27-27necessary items to control the disability 27-28residential modifications 27-28transportation costs 27-27work-related equipment and assistance 27-27

unsuccessful work attempt (UWA) 27-30when to apply 27-21work subsidies 27-28

status lists 27-69description 27-69

basis codes 27-70allowance codes (disability approved) 27-71denial codes (disability denied) 27-71no determination 27-72

closed list 27-70pending list 27-70

follow-upEW sups and EWs 27-73

MC 221 needed 27-73monitoring requirements 27-72

Deductionsearned income 25-42unearned income 25-68

Deemed EligibilityInfants born to Minor Consent mothers 35-20

Definitions 3-1, 20-1adequate consideration 3-5adult 3-5, 24-1adverse action 3-5aid category 3-6aid code 3-6average private pay rate 3-6benefits identification card (BIC) 3-6board and care 3-7burial insurance 3-7buy-in 30-14

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caretaker relative 24-11certification effective date 3-8certification for medical 3-8child 3-8, 24-1, 24-10, 38-4community property 3-19community property - share 3-20community spouse 3-9competent 3-9continuous period of institutionalization 3-9conversion of property 3-10county cash-based M/C 3-7CSRA 3-9current medical bill 33-17diligent search 3-11earned income 25-37encumbrances of record 3-11family member 24-10full-time student 25-41grantor/trustor 26-152heirloom 3-12HIPP program 46-15home 3-12income in-kind 25-29incompetent child 38-4in-home support services 3-12inmate 3-12, 39-5institution 3-12, 39-5

medical 3-13mental diseases 3-13nonmedical 3-13private 3-13public 3-13tuberculosis 3-13

institutionalized individual 3-13institutionalized spouse 3-14life estate 26-152life insurance 3-14

cash surrender value 3-14face value 3-14term insurance 3-14whole life insurance 3-14

life tenant/beneficiary 26-152limited service status 3-14linked 3-14LTC-facility 3-15marriage 3-15MBSAC 3-16

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Medi-Cal 3-15medical bills, medical expenses 33-18medical institution 39-5Medi-Cal only 3-15medically indigent 3-15medically needy 3-15medicare 3-16MFBU 24-10mini budget units 31-28, 34-15minor consent services 3-16month incurred 33-17multiple dwelling unit 3-16multiple owners 25-2nonmedical institution 39-5nonrecurring lump sum payment 3-17nursing facility 3-17nursing facility level of care 3-17obligate 3-17old medical bill 33-17other health coverage 46-1other PA 3-17other services 38-5overpayment 3-17ownership of income 25-1PA recipient 3-20parent 3-17parent - unmarried minor 3-18parents - unmarried 3-18part-time employment 25-41part-time student 25-40patient 3-18personal property 3-20prepaid health plan - comprehensive 3-19property - separate 3-20provider 3-20public funds 3-20QC 3-11real property 3-20reapplication 3-21redetermination 3-21relative 3-21relative - caretaker 3-21remainderman 26-152rep. payees 25-2repayment 3-22residence 3-22responsible relatives 3-22, 24-2, 24-11

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school attendance 25-41SDX 3-23self-employment income 25-50share of cost 33-1share of encumbrances 3-23skilled nursing/care facility 3-23Sneede case 31-19, 34-1SOC 3-23spenddown 26-10stepparents 3-23, 24-40therapeutic wages 3-24third party liability 3-25title II 3-25title II disregard person 3-25title XIX 3-25title XVI 3-25title XVIII 3-25transfer of property 3-25tuberculosis institution 39-6unpaid, old medical bill 33-17verification 3-26veteran 25-76veteran’s dependent 25-76

Denials/Discontinuances 12-1ability to pay program 41-58death 12-5good cause decision chart 12-7lack of information, noncooperation, loss of contact 12-1

documentation 12-3good cause 12-5reasons for action 12-1relative responsibility 12-4subsequent action 12-5

NOAs 12-6rescission 12-6

DIB 25-81Diligent search

definition 3-11Disability evaluation forms 27-36

death certificate 27-38list 27-36MC 220 27-39

completion requirements 27-39signature requirements 27-39

MC 221 27-42MC 221 - completion 27-42MC 223 27-45, 27-51

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part 1 completion 27-46, 27-51part II completion 27-47, 27-53part III completion 27-49, 27-56part IV completion 27-50, 27-56part V completion 27-50, 27-56, 27-57

medical records 27-37SSA documents 27-37

Disabled Rights Union v. Kizerissue 50-19

Discontinuances. See Denials/DiscontinuancesDivision of community property 29-36

automatic division rules 29-36community property 29-33interspousal agreements 29-34

limitations 29-35requirements 29-34

Dual eligibility60-day postpartum 36-2

EEarned income 25-37

allowable deductions 25-42AFDC-MN/MI ineligible members 25-46

dependent care 25-46spousal or child support 25-47WRE 25-46

aged/blind/disabled MN persons 25-42’any income’ deduction 25-43$65 plus 1/2 25-44court-ordered spousal or child support 25-44IHSS cost for ABD-MN SGA 25-45income necessary to achieve self-support 25-44student deductions 25-43work expenses of the blind 25-44

all MN or MI programs 25-47allocation to excluded children 25-48health insurance premiums 25-48income used to determine PA 25-47

deductions 25-33exempt earned income 25-40

child under 14 years 25-41earned income tax credit 25-41irregular or infrequent 25-40student exemption 25-40

definition 25-41student exemption definitions

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who is eligible 25-41net income from property 25-59nonexempt earned income 25-37

ABD persons 25-40AFDC-MN/MI persons 25-40

self-employment income 25-50definition 25-50determination of property and resources 25-52income determination 25-52

stepparent income 25-49deemed income 25-49treatment of income 25-49

verification 25-32Edwards v. Kizer 50-12

auto CDS/MEDS conversion 50-13discontinuing individuals from AFDC 50-14

decision 50-12general requirements 50-14issue 50-12manual 38 conversion 50-14MFBU considerations 50-15persons affected 50-13

EGHPQ & A on HIPP/EGHP 46-19

Eligibility Criteria 28-26Eligibility Determination 28-27Encumbrances of record

definition 3-11Ex Parte Process

Clients Alleging Disability 27-6Ex Parte Review 8-50Ex Parte Review

No Ex Parte Review Required 8-50Ex Parte Review Process

Eligibility Determination Procedures 8-51Ex Parte Review Timeframes 8-51Excess property applied to medical bills 26-12Excluded members 24-28

adding excluded persons to the MFBU 24-29rules 24-28

Exempt earned income 25-40Exempt Income

child support 25-34Exempt income 25-7

adoptive assistance payments 25-11Agent Orange 25-20Austrian social insurance payments 25-18

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description 25-18interest 25-18verification 25-18

child support 25-36child/spousal support disregard 25-7disaster assistance 25-21EITC 25-17executive volunteers 25-16exempted by public law 25-9federal housing assistance 25-10foster care payments 25-11GAIN/WIN 25-9general criteria 25-9IHSS cost deduction 25-34

eligible persons 25-34IHSS Plus Waiver Payments 25-26Indian claims 25-14Japanese-American and Aleutian restitution 25-18JTPA payments 25-15

adults 25-15children 25-15verification/ information 25-16

loans, grants, scholarships, and fellowships 25-11other 25-13title III loans 25-11title IV student assistance 25-12

needs-based assistance 25-9other exemptions 25-10property tax refunds 25-7public assistance grants 25-8Quilling v. Belshe payments 25-22relocation assistance 25-13senior citizen volunteers 25-16senior citizens rent assistance 25-17social services payments 25-9Susan Walker v. Bayer Corp. payments 25-21

description 25-21training expenses 25-10veterans benefits

$90 VA pension, veteran in LTC 29-47aid and attendance, veteran in LTC 29-45aid and attendance, veteran not in LTC 25-20

victims of crimes 25-13victims of National Socialist Persecution 25-17VISTA payments 25-15

Extended Medi-Cal Eligibility for Former Foster Care Children (FFCC) 18 to 20 Years of Age 35-47

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FFace-to-face interview

if required by EW - chart 10-81redeterminations 10-81

Family composition 24-23FBU considerations

pregnant minor consent 38-14Federal Poverty Level Programs 36-29, 36-33, 36-38FFCC 35-45

Application Process 35-55Background 35-45District Office Procedures 35-55FFCC and SSI 35-54Forms/Verifications 35-55General Eligibility Rules 35-47Income of FFCC Child Who Resides With Their Parents and Other Family Members 35-53Independent Living Program (ILP) 35-56MFBU Rules 35-53Phone Application Requests 35-56Redeterminations 35-57Retroactive Eligibility 35-53Who is Eligible 35-46

Four Month Continuingperiod of eligibility 37-23

GGamma v. Belshe 50-22

decision 50-22issue 50-22retroactivity 50-22

General public inquiries 4-2Gibbins v. Rank 50-15

decision 50-16issue 50-15

Good causedenials/discontinuances 12-5determinations

TMC 37-12

HHealth Care Options

HCO Flyer 14-5Health care options

enrollment contractor

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Maximus 14-5presentations 14-5

fee-for-service 14-1Managed care

disenrollments 14-9membership services 14-2Two-Plan Model

aid codes 14-1Other Health Care coding 14-10

Maximustelephone number 14-5

Two-Plan ModelKaiser

OHC coding 14-10overview 14-2

Health insurance premium payment program. See HIPPHealth insurance system action. See HIARHealthy Kids Insurance 41-21

description 41-21eligibility criteria 41-22purpose 41-21scope of coverage 41-21

Heirloomdefinition 3-12

HIAR 46-24HIPP 46-15

client volintarily disenrolls 46-18definition 46-15DHS responsibility 46-18disenrollment

NOA 46-18EW action 46-16NOA requirements 46-18Q & A on HIPP/EGHP 46-19qualifications 46-15

timely application 46-16HIV/AIDS. See Presumptive disabilityHome

definition 3-12Home equity conversion 26-32Hospice program

disqualifying transfer 29-25Hunt v. Kizer (applying old medical bills to SOC) 26-15, 50-19

background 33-16decision 50-20definitions 33-17

current medical bill 33-17

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medical bills, medical expenses 33-18month incurred 33-17old medical bill 33-17unpaid, old medical bill 33-17

denial of medical bill(s) 33-23discontinued cases 33-27EW instructions 50-20examples 33-28

continuing 33-29intake 33-28intake and/or continuing 33-29

incomplete information 33-23issue 50-19limitations on SOC adjustments 33-24

consecutive months 33-25future months 33-24must meet SOC 33-24past months 33-25

original bills versus photocopies 33-21policy 33-16procedure 26-16qualifying criteria 33-18

IHSS 33-19interest charges 33-19liability for debt 33-18MFBU 33-19no payment required 33-19one time only rule 33-19other health coverage 33-19

reviewing property balance at intake 26-16SOC adjustment methods 33-25

BIC "PME" 33-26MC 177 or adjustments through MEDS 33-27

verification requirements 33-20contact provider 33-21credit card statements 33-22original bills versus photocopies 33-21original medical bills 33-20other billing statements 33-21SC 101 33-22

IIbarra v. Dawson 50-16

effective date 50-16issue 50-16

ICT 15-1, 30-36

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client moves to our county 15-21discontinuance date 15-5ICT received from another county 15-21multiple transfers 15-23problems 15-9QMB 30-36recipient responsibility 15-13requirements 15-1

exceptions 15-8terminology 15-1transfer period 15-4

IHSS payments 26-62IHSS. See In-Home Support Services 3-12Impairment Related Work Expenses - QMB/SLMB. See IRWEIncarcerated Juveniles

suspension of benefits 12-8, 12-10, 12-11, 12-13Income 25-37

deductions 25-33definitions

community property laws 25-2multiple owners 25-2ownership of income 25-1rep. payees 25-2trusts 25-2

earned income 25-37exempt income 25-7IHSS deduction 25-34treatment of income

ABD-B&C - no community spouse 25-3allocations 25-3

ABD-MN LTC with community spousedependent family members 29-40proof of dependency 29-41

available income 25-4owner 25-5rule 25-4

budgeting 25-2, 29-48Medicare 25-2, 29-43other health insurance premiums 25-3, 29-43separate MFBUs 29-48

LTC statusmaintenance needs 29-43support of a disabled relative 29-45upkeep of home 29-44

maximum allocation to community spouse 29-41court order 29-41fair hearing 29-42

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total allocation 29-42unavailable income 25-5

advance earnings 25-7board & care 25-6exception 25-5overpayment adjustments 25-7rule 25-5types 25-5

unconditionally available income 25-3non-cooperation 25-4PA 25-4rule 25-3types 25-3

verification of community spouse allocation 29-42verification of dependent

family member allocation 29-42unearned income 25-62

verification 25-31Income disregard program

approvals & denials chart 36-14background 36-10determining eligibility 36-12exceptions 36-14hospitalized infants 36-28MFBU examples 36-16MFBU requirements 36-15

infants 36-15MFBU example 36-16pregnant women 36-15

minor consent 36-28NOA

approvals 36-26denials 36-27discontinuance of IDP & another 36-27discontinuance of IDP only 36-27

parental income disregard 36-13period of eligibility 36-10retroactive benefits 36-10RVs and status reports 36-29scope of benefits and aid codes 36-11who is eligible 36-9

Income in-kind 25-29definition 25-29eligible persons 25-34exceptions 25-30IHSS cost deduction 25-34stepparent computation 24-43

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treatment 25-30value determination 25-31verification 25-32

Ineligible Children 35-47Ineligible members 24-25

rules 24-27Ineligible vs excluded 24-29In-home Medical care waiver 42-22In-Home Support Services

definition 3-12In-home support services 25-34Inmate

definition 3-12Institution

definition 3-12Institutional status

chart 39-10definitions

inmate 39-5institution 39-5medical institution 39-5nonmedical institution 39-5tuberculosis institution 39-6

status considerations 39-9Institutionalized individual

definition 3-13disqualifying transfers 29-23non-disqualifying transfers 29-24

Institutionalized spousedefinition 3-14

Insurance policies 46-10Intercounty transfer. See ICTIRAs. See Pension fundsIRWE 30-52

JJewelry 26-52Johnson v. Rank 50-16

decision 50-16issue 50-16

Joint custody rules 24-20alternating arrangements 24-21alternating periods of one month or more 24-22equal amount of time with each parent 24-21equal responsibility 24-21

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KKaiser dues subsidy program

definition 46-31eligibility criteria 46-32how to apply 46-32TMC Program 46-31

Kaiser Permanente Steps PlanEligibility Criteria 46-33How to Apply 46-34Income Limit 46-34

Keoughs. See Pension fundsKing v. McMahon 50-17

issue 50-17treatment of payments 50-17

LLatino Coalition v. Belshe

Decision 50-23Issue 50-23Retroactivity 50-24

Life estate 26-151definitions 26-152

grantor/trustor 26-152irrevocable 26-153life estate 26-152life tenant/beneficiary 26-152remainderman 26-152revocable 26-153

interest 26-48interest in real property 26-153

determination of past value 26-156irrevocable/other life estates 26-155method of evaluation 26-154other real property (ORP) 26-153principal residence 26-153revocable life estate 26-154treatment 26-153verification 26-153when to evaluate 26-153

Life insurance 26-39definitions 3-14

Limited service statusdefinition 3-14

Limited services 42-1Due to Program Abuse 42-25

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background 42-25county responsibility 42-26DHS responsibility 42-26Medi-Cal benefits issuances 42-27

MIAs in SNF/ICFbackground 42-27county responsibility 42-27Medi-Cal benefits 42-28retroactive Medi-Cal 42-28undocumented immigrants in LTC 42-28

Linkeddefinition 3-14

Loans 26-36Long-term care

discharge with zero SOC 29-49facility 3-15

definition 3-15incompentent persons 29-5maintenance needs 29-43MIA in LTC

EW responsibilities 29-11APD program 29-11

prejudice cases 29-55issue 29-55

SOC 29-49noncovered medical expenses 29-53super-liability cases 29-50

statusdefinition 3-15

support of a disabled relative 29-45upkeep of home 29-44

LTC. See Long-term care 3-15Lump sum payments 26-37Lynch v. Rank 28-1

annual Pickle review requirementsticklers 28-23

COBRA - widow Pickle 28-18background 28-18widow Pickle screening test 28-18

definitions 3-26actual value 3-26burial funds 3-26

burial contract 26-43burial fund 26-43burial trust 26-43

couple 3-26both eligible 3-26

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eligible child 3-26eligible living with ineligible spouse 3-26unmarried couple 3-26

current market value 3-26dependent relative 3-27discounted amount 3-27equity value 3-27excludable equity value 3-27home 3-27household expenses 3-27immediate family 3-28independent living arrangement 3-28ineligible spouse 3-28in-kind support and maintenance 3-29institutionalization 3-29items of unusual value 3-29life estate and remainder interest 3-29liquid resources 3-30nonliquid resources 3-30non-medical out of home care (NMOHC) 3-30parent 3-30presumed maximum value 3-30principal place of residence 3-30property essential to self-support 3-31recreational vehicle (RV) 3-32rent-free shelter 3-32resources 3-32sharing 3-33value of the one-third reduction 3-33

DHS 7037 completion instructions 28-13disabled adult child (DAC) 28-24

aid codes 28-25background 28-24budgeting 28-25DAC screening test 28-24

disabled widow(er)s 28-19annual RV 28-21background 28-19budgeting 28-20criteria 28-19DHS 7089, screening worksheet 28-19verification requirements 28-20

financial eligibilitytreatment of income 28-3

earned income 28-4forms 28-2in-kind support and maintenance (ISM)

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DHS 7044 28-8examples of VTR and PMV 28-9excluding types of ISM 28-11ISM values 28-9rebutting the PMV 28-8

PMV - presumed maximum value 28-8VTR - value of one third reduction 28-7

overview 28-5Pickle charts and forms 28-25Pickle eligible child 28-16

needs test 28-16resource eligibility 28-18Title II disregard computation 28-16

Pickle tickler system 28-21MEDS tickler system 28-22overview 28-21

resource determinationdetermining value of a resource 28-12limits 28-12resource limits for couples 28-12SSI treatment of resources 28-13

screening processverification of SSI/SSP termination date 28-2when to screen 28-1

SSI/SSP discontinued due to COLAapprovals 28-23ineligibility 28-24

MManaged care

automatic default 14-8managed care goals 14-1Maximus 14-5

presentations 14-5mental health

overview 14-12Santa Clara County MHP 14-12

Two-Plan Modelaid codes 14-1cost 14-10enrollment packet 14-8EW’s role in enrollment process 14-6ID card 14-9mandatory enrollment

aid codes 14-3overview 14-2

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voluntary enrollment 14-4Marriage

definition 3-15Married minor

living at home 24-34MBSAC

definition 3-16MC 176 P 26-8MC 177S 33-2

client responsibility 33-2EW responsibility 33-3provider responsibility 33-2

Medicaid.See Medi-Cal 3-15Medi-Cal only

definition 3-15Medi-Cal Programs

Organ Transplant Anti-Rejection Medication Program 5-95Medi-Cal programs

100% program 36-35approvals & denials 36-38determining eligibility 36-37discontinuance 36-38effective date 36-36MFBU requirements 36-38period of eligibility 36-36scope of benefits 36-37who is eligible 36-35

who is eligible 36-36133% program (ages 1 - 5) 36-30

application 36-30continuing cases 36-31intake 36-30

definition 36-30MFBU considerations 36-34

example 36-34NOA requirements 36-35, 36-38period of eligibility 36-31scope of benefits 36-32

60-day postpartum 36-1discontinuance 36-7dual eligibility 36-2eligibility requirements 36-1eligible persons 36-3

MI women (aid code 86, 87) 36-3minors, whose pregnancy terminates 36-4MN women (aid code 34, 37) 36-3PA or other PA (TMC) 36-4

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ineligible persons 36-5issuance procedures 36-6

birth/termination of pregnancy 36-6newborns 36-5overview 36-1period of eligibility 36-2pregnancy definition 36-2pregnancy verification requirement 36-2retroactive Medi-Cal 36-5retroactive Medi-cal 36-1share of cost 36-1, 36-2

continued eligibility for pregnant women & infantsaffected persons 35-2break in aid 35-12determining MFBUs/SOC 35-16

change in MFBU size 35-18ICTs 35-13increased income 35-14

infants 35-15PA/other PA recipients 35-16pregnant woman 35-14

infants 35-18adding newborns 35-4deemed eligible 35-18important 35-19infant’s SOC 35-22

overview 35-1pregnant women 35-3processing, eligibility, general 35-3

exception 35-3RVs 35-13Sneede 35-11three month retroactive 35-11unmarried fathers 35-9

income/property 35-9information provided 35-10MFBU 35-9U-parent linkage 35-10

Continuous Eligibility for Children 35-31general list

cash grant programs 1-5Medi-Cal only programs 1-7

income disregard program 36-9approvals & denials chart 36-14background 36-10determining eligibility 36-12exceptions 36-14

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continued eligibility 36-14property waiver program 36-15

hospitalized infants 36-28MFBU requirements 36-15

infants 36-15MFBU example 36-16pregnant women 36-15

minor consent 36-28NOA

approvals 36-26denials 36-27discontinuance of IDP & another 36-27discontinuance of IDP only 36-27

period of eligibility 36-10infants 36-11pregnant women 36-10

retroactive benefits 36-10RVs and status reports 36-29scope of benefits and aid codes 36-11

infants 36-12pregnant women 36-11

who is eligible 36-9income generated from waived property 36-43property waiver program 36-40

background 36-40denials 36-46determining eligibility 36-44discontinuances 36-46examples 36-47

married couple with mutual children, continuing case 36-48pregnant woman with an absent parent 36-47unmarried couple with an unborn 36-48

income increases 36-47increased income 36-15program criteria 36-41property changes 36-47rental income from real property 36-43scope of coverage 36-42utilization of real property 36-44verification of property 36-43verifying income generated rom waived property 36-43zero share-of-cost 36-45

Medically Indigentadopted children 31-15blind or disabled child 31-15categories 31-13child 31-14

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definition 3-15foster children 31-15MIA and MN household MFBUs 31-16MIA exceptions 31-14MIA pregnant women & newborns 31-17

determine eligibility for the newborn 31-18eligibility for MIA pregnant women 31-17verify pregnancy and EDC 31-17

other foster/adopted children 31-16processing MIA applications 31-16property and income 31-13

Medically NeedyABD-MN linkage 31-6

aged persons 31-7blind 31-7general 31-6

AFDC case, family member potentially eligible for Medi-Cal 31-11AFDC-MN

who is eligible 31-5AFDC-MN Linkage 31-1cash/Medi-Cal differences 31-9

budget unit - minor unmarried parent in the home 31-10caretaker in the budget unit 31-11linkage when parents are sponsored aliens 31-11linkage when the only child is on SSI/SSP 31-10U-parent distinctions 31-10

chartsABD linkage 31-9connection with labor force 31-9

definition 3-15Medicare 30-1

buy-in 30-14alerts/messages 30-20

EW action 30-20budgeting

premium reimbursement 30-19SOC adjustment 30-19

definition 30-14DHS 6166 30-20

completion 30-22EW action 30-21, 30-22mailing address 30-22specific requests 30-21when to use 30-20

effective date 30-18eligible persons 30-14

MEDS INQB screen 30-19

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verification 30-19EW initiates 30-17

card 30-5claim number 30-5

examples of 30-6who issues 30-6

description 30-5coding 30-12crossover claims 30-4deductibles 30-5definition 3-16enrollment 30-11

general period 30-12initial period 30-11

M/C recipient suspends coverage 30-13EW action 30-13

overview 30-1part A 30-1

eligibility 30-2premiums 30-3

part B 30-1eligibility 30-2premiums 30-3

QDWI 30-56QMB 30-25QMB/SLMB income determination/budgeting

budgeting sequence chart 30-53required to apply 30-7

part A 30-7part B 30-8

exception to 30-8SLMB 30-41, 30-45uncovered services 30-5verify application 30-9

744 speedletter 30-9client refusal 30-10disenrollment 30-10proof of application 30-10SC 169 30-9timeframes 30-10

Medicare part A 30-1Medicare part B 30-1MEDS procedures 12-13Mental health applicants 38-16MFBU Determinations 24-14MFBU determinations 24-10

AFDC - MN linked limitations 24-38

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chart 24-39caretaker relative requirements 24-18

adoptive relatives 24-20biological relatives 24-19relationship to child 24-19relinquishment 24-20spouses of relatives 24-19step relatives 24-19

definitionscaretaker relative 24-11child 24-10family member 24-10MFBU 24-10

establishing an MFBU 24-22excluded child statement (Medi-Cal), SC 1599 24-29excluded members 24-28

adding excluded persons to the MFBU 24-29rules 24-28

foster care or relinquished for adoption 24-37chart 24-38

ineligible members 24-25rules 24-27

ineligible vs excluded 24-29joint custody rules 24-20

alternating arrangements 24-21alternating periods of one month or more 24-22equal amount of time with each parent 24-21equal responsibility 24-21

MFBU composition 24-23minor - living away from home but claimed as tax dependent 24-35minor consent services 24-37no family member in LTC/B&C 24-23

family composition 24-23responsible relative determinations 24-11stepparents 24-40unmarried minor parent lives with senior parent 24-31

chart 24-33income in-kind to minor 24-33minor’s income 24-33minor’s property 24-32unmarried minor’s child(ren) 24-32unmarried pregnant minor 24-31

unmarried minorslive at home 24-30

unmarried pregnant women 24-30MFBU Requirements 28-30MI. See Medically Indigent 3-15

Update #15-34Page -33

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MIA pregnant women & newbornsdetermine eligibility for the newborn 31-18eligibility for MIA pregnant women 31-17verify pregnancy and EDC 31-17

Miller v. Woods. See Retroactive IHSS paymentsMineral rights 26-30Minimum basic standard of adequate care. See MBSAC 3-16Minor consent 36-28, 38-1

application requirements 38-7confidentiality 38-3forms 38-7mental health statement 38-17period of eligibility 38-12

child abuse reporting requirements 38-2mandatory reporting 38-2reporting numbers 5-2, 38-2

confidentiality of SSA numbers 38-20definitions

child 38-4EDP/MEDS information

approvals on CDS 38-19BIC mail procedures 38-20

eligibility criteria 38-7citizenship/alien status 38-8health care options 38-10identity 38-8maintenance need 38-11MFBU 38-11OHC 38-9property 38-10responsible relatives 38-8Selecting an Aid Code 38-11

issuance procedures 38-19paper BIC 38-19reapplications / subsequent certifications 38-18

issuing benefits 38-6MEDS Online

SSA numbers 38-20mental health applicants 38-16notices of action 38-12pregnant minors 38-13

continued eligibility (CE) 38-15postpartum benefits 38-15verification 38-13

services other than pregnancyFBU considerations 38-14

who can apply 38-4

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incompetent child 38-4other services 38-5

MN. See Medically Needy 3-15Model waiver program 42-11

initial screening by DHS 42-13inquiries & referrals 42-12Medi-Cal eligibility 42-13

beginning date of aid 42-14NOAs 42-15

requirements 42-12Mortgages 26-31Multiple dwelling unit

definition 3-16Multipurpose senior service program waiver 42-15Mutual funds 26-29

Nn 26-161Newborn

Social Security Number 35-4Newborn referral form

continued eligibility for pregnant women and infants 35-5NOA requirements 12-13Nonrecurring lump sum payment

definition 3-17Notices of Action (NOA) Requirements 28-30Nursing facility

definition 3-17Nursing facility level of care

definition 3-17Nursing facility waiver 42-22

OObligate

definition 3-17OHC. See Other health coverageOil leases 26-30ORP. See Other real propertyOther health coverage 46-1

billing methods 46-21cost avoidance 46-22PHPs, HMOs, CHAMPUS 46-22

denial letter required 46-22outside of the service area 46-22service not covered 46-22

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client responsibility 46-1mandatory participation

fraud referrals 46-2reporting 46-1

cost avoidance coverage 46-23coding procedure 46-23effective date 46-24

definition 46-1discrepancies discovered by DHS 46-21EW responsibility 46-3

determine availability of OHC 46-4identify OHC 46-3informing applicant/beneficiary 46-3reporting OHC changes to DHS 46-6

HIAR 46-24how DHS identifies OHC 46-21identify/code OHC policies 46-10identify/code policies

cancer only 46-10CHAMPUS 46-10dental only 46-10employment - related 46-10ERISA trusts 46-10group health 46-10health 46-11hospital 46-11indemnity 46-11long-term care 46-11major medical 46-11medical supplemental 46-11medical support 46-11PHP/HMO 46-11prescription 46-12student health 46-12surgical 46-12unavailable coverage 46-13

other 46-14out of geographical service area 46-14

vision 46-12overview 46-1repayment for medical services 46-30

send to 46-31Overpayments

definition 3-17

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PPA recipient

definition 3-20Parent

definition 3-17Parent - unmarried minor

definition 3-18Parental responsibility chart 24-7

married, divorced or separated, under 21 living at home/away from home 24-9unmarried, under 21 living at home/away from home 24-7

Parents - unmarrieddefinition 3-18

Patientdefinition 3-18

Pension funds 26-58Personal Property

California Partnership-approved LTC Insurance Policy or Certificate 26-72Personal property 26-24

definition 3-20PHPs, HMOs, CHAMPUS 46-22Pickle. See Lynch v. RankPlan Selection 2-34Pregnant minors 38-13

continued eligibility (CE) 38-15postpartum benefits 38-15verification not required 38-13

Prepaid health plan - comprehensivedefinition 3-19

Presumptive disability3 month retro 27-96checklist 27-111conditions 27-97DED referrals 27-94federal denial 27-96follow-up/expediting decisions 27-109HIV/AIDS 27-101

adults (presumptive criteria met) 27-102ages 1-17 (presumptive criteria met) 27-104

urgent case request 27-106verification requirement 27-109

Presumptive Eligibility 41-9applicant not a co. resident 41-14card replacement 41-14eligibility criteria 41-9Minor Consent 41-10overview 41-9

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period of eligibility 41-14Principal property exemption

retro spenddown 26-18Principal residence 26-126Principe property exemption

definitions 26-19informing requirement 26-22MC 174 26-21overview 26-18verification 26-20

Probate/estate recoveryestate claims 45-5

what happens 45-9hardship waiver 45-7property liens 45-8

Property 26-1life estate 26-151limits 26-1

real property 26-1other real property 26-142

definitions 26-144encumbrances 26-145fair market value 26-144market value 26-145net market value 26-146

exemption/ unavailability 26-142ownership share/ utilization 26-146utilization 26-147

examples 26-149time limits 26-148

personal property 26-24Agent Orange payments 26-62Austrian social insurance payments 26-66bank or credit union accounts 26-27burial funds 26-43

commingled burial funds 26-46converting to new rules 26-45designating the CSV of life insurance 26-47exempt 26-44interest 26-45irrevocable 26-43revocable 26-44use for another purpose 26-47verification 26-45

burial insurance 26-41burial plots and related items 26-41business property 26-49

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conditions of exemption 26-50exempt 26-49nonexempt 26-50

cash 26-26exempt 26-26nonexempt 26-27

cash payments for medical and social services 26-56disaster assistance 26-63excess property due to SSI O/P 26-61HEC plans 26-32Japanese-American and Aleutian restitution payments 26-54jewelry 26-52

determination of value 26-52exempt 26-52nonexempt 26-52

life estate interest 26-48determination of value 26-49nonexempt/ exempt 26-48verification 26-48

life insurance 26-39availability of CSV 26-41determination of value 26-40exempt 26-39nonexempt 26-39verification 26-40

loans 26-36exempt 26-36nonexempt 26-36verification 26-36

lump sum payments 26-37exception 26-38exempt 26-37nonexempt 26-38verification 26-38

motor vehicles, boats, campers, trailers, and mobile homes 26-24exempt 26-24nonexempt 26-25verification of value 26-25

oil leases and mineral rights 26-30other items 26-74payment to victims of the National Socialist Persecution 26-53payments to crime victims 26-65pension funds 26-58Prop 103 refunds 26-65Quilling v. Belshe payments 26-69relocation assistance payments 26-67replacement of exempt property 26-64

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retroactive IHSS payments 26-62savings bonds 26-30senior citizens rent assistance 26-65stocks, bonds, mutual funds 26-29Susan Walker v. Bayer Corp. payments 26-69tax refunds 26-34

federal refunds 26-34state refunds 26-34verification 26-34

trust deeds, mortgages, notes, RAMs 26-31veterans’ educational assistance plan (VEAP) 26-53

principal residence 26-126charts and forms 26-141county level review 26-135

EW actions 26-135definitions 26-126

appertains 26-127contiguous 26-127

EW responsibilities 26-134list and lien requirements (LTC) 29-39

effective date of lien 26-139lien procedures 26-138non-cooperation 26-139

list requirements 26-136EW actions 26-137rule 26-136

MFBU member living in the homerule 26-127

net nonexempt income from principal residence 26-134no MFBU member living in the home

child, spouse, or dependent relative in home 26-131exempt principal 26-129intent to return 26-129, 29-38intent to return is questionable 26-131legal obstacles to sale 26-132LTC, sibling, or child over age 21 in home 29-38not in LTC, listed for sale 26-133

reporting responsibilities 26-140transfer of nonexempt principal residence by institutionalized persons 29-40

treatmentavailable 26-1considered in eligibility determination 26-4conversion of property 26-9excess property applied to medical bills 26-12

examples 26-14Hunt v. Kizer 26-15income v. property 26-13

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MC 174 26-14rule 26-12when it applies 26-13

MC 176 P 26-8property co-ownership chart 26-7spenddown 26-10

in month of application 26-10ongoing cases 26-11retro Medi-Cal 26-11

spouse in LTCdivision of community property 29-36

transfers of property 29-23consecutive transfers 29-31disqualifying transfers 29-23non-disqualifying transfers 29-24period of ineligibility 29-26transfers by others 26-23

unavailable 26-1Property - separate 3-20Property assessments 26-158Property waiver program 36-40

background 36-40children one to six years 36-41children six to nineteen years 36-42denials 36-46determining eligibility 36-44discontinuances 36-46examples 36-47income generated from waived property 36-43income increases 36-47no property verification required 36-43other family members

property verification 36-42pregnant women and infants 36-41program criteria 36-41property changes 36-47rental income from real property 36-43scope of coverage

pregnant woman 36-42utilization of real property 36-44verifying income generated from waived property 36-43zero share-of-cost 36-45

Property worksheet. See MC 176 PProvider

definition 3-20Public assistance

other PA

Update #15-34Page -41

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definition 3-17Public assistance recipient. See PA recipient 3-20Public funds

definition 3-20Public inquiries. See General public inquiries

QQC

definition 3-11QDWI 30-56

benefit 30-56citizen/alien status 30-58effective date 30-56eligibility criteria 30-57income limit 30-58medicare part A 30-56other requirements 30-57program overview 30-56property limit 30-58

QMB 30-25action/codes 30-32

conditionally eligible 30-32eligible 30-32not eligible 30-32

basic groups 30-26dual eligible QMBs 30-27QMB only 30-26

budgeting sequence chart 30-53effective date of eligibility 30-28eligibility criteria 30-26ICTs 30-36income determination and budgeting examples 30-50

income rules 30-50income determination and budgeting rules

MC 176 QMB/SLMB 2A 30-51MC 176 QMB/SLMB-1 30-50

IRWE 30-52MC 176 QMB-3 30-31NOAs 30-35

approvals 30-35denials/discontinuances 30-35

other requirements 30-34program overview 30-25property determination 30-32SC 176 QMB 30-31SSI QMBs

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application forms 30-37application requirements 30-38discontinuance 30-41discrepancies 30-40income determination 30-39mail-in referral procedure 30-37medicare part A

verification 30-39other referrals 30-38overview 30-37RVs 30-40

verification of medicare part A 30-30conditional enrollment 30-31eligible 30-30

when to evaluate 30-27Quality Control. See QC 3-11

RRadcliffe v. Coye,et al

decision 50-20issue 50-20

Ramirez v. Belshedecision 50-23issue 50-23

Ramos v. Myers 50-19issue 50-19state hearing requests

hearing requests based on county actions 50-19RDPs and Same-Sex Spouses 24-14Real property

definition 3-20limits 26-1

Reapplicationdefinition 3-21

Redeterminations 10-1additional forms 10-13definition 3-21face-to-face interview 10-81

if required by EW - chart 10-81frequency of redetermination

timeliness 10-1QMB 30-40statement of facts 10-9verifications - RV

pending verifications 10-57required at RV 10-56

Update #15-34Page -43

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Reese v. Kizer 29-55decision 29-55issue 29-55

Referral of Blind Applicants 28-26Referral to/from Social Security. See SC 169Refugees

entrants 40-1Relative

definition 3-21Relative - caretaker

definition 3-21Repayment

definition 3-22medical services 46-30

Replacement BIC when already eligible 38-6Replacement of exempt property 26-64Residence

case documentation 7-11, 7-12discrepancies and evidence to the contrary 7-15foreign students 7-10homeless persons 7-10how to establish residence 7-1migrant workers 7-9principal residence 7-13public assistance/ government benefits 7-14requirements chart 7-4unacceptable evidence 7-13unmarried parents 7-8

Residence in California 7-1acceptable verification 7-5

other evidence of residency 7-6border crossing cards 7-11free housing 7-8how to establish residence

additional ways 7-1ineligibility for Medi-Cal 7-4rent receipt from a relative 7-8specified documents

other evidence of residency 7-6temporary absence 7-16

definition 7-16EW actions 7-17more than 60 days 7-17

temporary visa 7-11Residency

preponderance of evidence 7-16Resources. See Property

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Responsible relativesdefinitions 3-22, 24-1

adult 24-1child 24-1responsible relatives 24-2

parental responsibility chart 24-7married, divorced or separated, under 21 living at home/away from home 24-9unmarried, under 21 living at home/away from home 24-7

tax dependency requirements 24-317 years of age & under 24-6

living at home 24-6living away from home 24-6

18-21 years of age 24-4living at home 24-4living away from home 24-5

Retroactive medi-cal60-day postpartum 36-5

RSDI 25-85

SSaldiva v. McMahon 50-19

decision 50-19issue 50-19

Savings accounts. See Bank accountsSavings bonds 26-30SAWS 2 Instead of MC 210 RV for CalWORKs 10-13Sawyer v Shalala, Anderson, Belshe, Gould 50-21

decision 50-21issue 50-21retroactivity 50-21

SC 169 30-9Scope of Benefits and Aid Codes 28-26SDX

definition 3-23Self-employment income 25-50

definition 25-50determination of property and resources 25-52income determination 25-52net income from property 25-59

Severely impaired working individual program 42-24aid type 8G 42-24background 42-24eligibility requirements 42-24model waiver referral 42-25procedure 42-25

SGA determination

Update #15-34Page -45

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background/definition 27-20clarification 27-29impairment - related work expenses (IRWE) 27-24procedures 27-23retroactive Medi-Cal and SGA 27-22SGA does not apply 27-22types of IRWE 27-26unsuccessful work attempt (UWA) 27-30when to apply 27-21work subsidies 27-28

Share of cost 33-1change in share of cost 33-3

decrease in SOC 33-3increase in SOC 33-4repayment of SOC for FPL programs 33-13

FPL program effective dates 33-14process (more than 12 months) 33-15process(12 months or less) 33-14rules 33-13SOC not met 33-14

retroactively reduced SOC 33-5Hunt v. Kizer (applying old medical bills to SOC) 33-16

original bills versus photocopies 33-21LTC with SOC 29-49

noncovered medical expenses 29-53super-liability cases 29-50

determination 29-50MC 177S 33-2

client responsibility 33-2EW responsibility 33-3provider responsibility 33-2

overview 33-1definition 33-1determining SOC 33-1

Share of encumbrancesdefinition 3-23

Share-of-Cost. See SOC 3-23Skilled nursing/care facility

definition 3-23SLMB 30-41, 30-45

benefit 30-42, 30-46, 30-47budgeting sequence chart 30-53citizen/alien status 30-43, 30-48dual eligibility 30-44, 30-49effective date 30-41, 30-46eligibility criteria 30-42, 30-47income 30-43, 30-48

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income determination and budgeting examples 30-50income rules 30-50MC 176 QMB/SLMB 2A 30-51MC 176 QMB/SLMB-1 30-50

IRWE 30-52NOAs 30-45, 30-49program overview 30-41, 30-45program requirements 30-43, 30-48property 30-42, 30-47when to evaluate 30-44, 30-49

Sneede v. Kizerbudget examples 31-54, 34-42

other caretaker relative in MFBU 31-55, 34-44stepparent household with pregnant woman 31-54, 34-42unmarried couple - mutual, separate, and excluded child 31-54, 34-43

definition 31-19, 34-1not optional 31-19, 34-2

Denial or discontinuancenoncooperation 31-21, 34-4

discontinuance 31-21, 34-4status reports 31-21, 34-4

federal poverty level programs (100/133/ income disregard) 31-49, 34-37family size 31-49, 34-37general 31-49, 34-37income 31-49, 34-37procedure 31-50, 34-38

general procedures 31-22, 34-4implementation date, continuing cases 34-6implementation date, new applicants 31-23, 34-5income and property allocations, general 31-25, 34-12

general allocation rule 31-25, 34-12income allocation rule 31-25, 34-12property allocation rule 31-25, 34-12property and income 31-26, 34-12

allocation example 31-26, 34-13allocations not allowed 31-26, 34-13

income determination 31-43, 34-31$50 child/spousal support deduction 31-45, 34-33ABD-MN deductions 31-46, 34-34

blind/disabled child 31-46, 34-34married couple 31-46, 34-34unmarried couple 31-46, 34-34

dependent care deduction 31-46, 34-34earned income in-kind 31-45, 34-33general 31-43, 34-31other health coverage premium 31-46, 34-34PA/other PA 31-48, 34-36

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procedure 31-47, 34-35support payments 31-43, 34-32unearned income in-kind 31-44, 34-32

maintenance need income levels and property limits 31-35, 34-22chart 31-37, 34-23formula 31-36, 34-23full amount 31-35, 34-22general 31-35, 34-22prorated amount 31-36, 34-22

mini budget unit determination 31-28, 34-15definition 31-28, 34-15MC 175-4 31-34, 34-21property/income MBUs are separate 31-28, 34-15rules for all cases 31-29, 34-15specific MBU determinations 31-29, 34-16

married couple and mutual children (no stepchildren) 31-29, 34-16married parents, only the separate children of one parent want Medi-Cal 31-30, 34-17married spouses (stepparent), mutual and separate children 31-30, 34-16minor mother with child(ren), living with her parent(s) 31-32, 34-18non-parent caretaker relative households and linkage 31-33, 34-19single parent, children 31-31, 34-17unmarried parents, mutual and separate children 31-31, 34-18

overview 34-1property determination 31-37, 34-25

changing exemptions 31-39, 34-27exemptions 31-38, 34-26

other caretaker relative 31-39, 34-27single/married parent(s) 31-39, 34-26unmarried couples 31-39, 34-26when only one applies 31-38, 34-26

general 31-37, 34-25jointly held assets 31-40, 34-27procedure 31-41, 34-28

example - stepparent household 31-42, 34-30example - unmarried parents 31-41, 34-29

property allocations 31-37, 34-25married couple with only mutual children 31-38, 34-25stepparent household 31-38, 34-25unmarried couple with mutual children 31-38, 34-26

property/income are separate 31-27, 34-14responsibility for processing 34-8responsible relative determination 31-24, 34-11

MC 175-2 31-24, 34-11retroactive Sneede 34-6

background 34-6claim period 34-7continuing requirement 34-7

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intake requirement 34-7MC 175 R-8 34-8treatment of payments 34-8

screening 31-23, 34-10income 31-24, 34-10property 31-23, 34-10

separate determinations 31-21, 34-3share of cost considerations/NOAs 31-51, 34-39

adjusting the SOC 31-53, 34-41children’s medical expenses 31-52, 34-40example of medical expenses 31-52, 34-40Hunt v. Kizer 31-52, 34-40multiple shares of cost 31-51, 34-39required notice 31-52, 34-40responsible relative’s medical expenses 31-51, 34-39Sneede NOAs 31-53, 34-42

treatment of children 31-27, 34-14SOC

definition 3-23Social Security Act 3-25

title II 3-25title XIX 3-25title XVI 3-25title XVIII 3-25

Social Security COLA 36-29, 36-33, 36-38Social Security Number

newborn 35-4Special treatment programs 43-1

aid types 43-7annual redetermination 43-13definitions 43-2

annual net worth 43-3dialysis 43-2MSTP - only 43-2MSTP - supplement 43-2parenteral nutrition 43-3percentage obligation 43-3tube feeding 43-3

determination of annual net worth 43-7percentage obligation 43-9

eligibility requirements 43-4MSTP - Only 43-4MSTP - Supplement 43-4

general 43-1MC 176-D 43-11

part I - identification 43-11part II-eligibility requirements 43-11

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part III 43-11annual net worth 43-11percentage obligation 43-12

MEDS record 43-12notice of action 43-13referrals to VMC 43-1SOC MSTP-supplement 43-10TB program 43-13

Specialized intakeproperty assessments 26-158

application forms 26-159completion of the MC 176PA 26-160requests 26-158

Spenddowndefinition 26-10excess property applied to medical bills 26-12

principal property exemption 26-18in month of application 26-10retro Medi-Cal 26-11

SSA documents 27-37SSA lump sum. See Lump sum paymentsSSI 25-88State Data Exchange. See SDX 3-23Status reports 31-21, 34-4Stepparent case 24-40

budget computation and MC 176 W.1 24-42definition of a stepparent case 24-40definitions 24-40establishing MFBU 24-41Income determination

Income in-kind 24-43income determination

income 24-42property & income determination

MFBU illustration 24-44parent is PA 24-43

property determinationproperty 24-42

Stocks 26-29Substantial Gainful Activity. See SGA determination

TTax dependency requirements

17 years of age & under 24-618-21 years of age 24-4responsible relatives 24-3

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Tax refunds 26-34TB program 43-13

application process 43-19application packet 43-19applications initiated by clinics 43-20homeless applicant 43-21introduction 43-19MC 274TB 43-20NOAs 43-21persons in LTC 43-21plastic BIC 43-21retroactive benefits 43-22

continuing activities 43-31active cases 43-31ineligible persons 43-31quarterly status report 43-31RVs 43-31

eligibility criteria 43-16certification of TB infection 43-17citizen/alien status 43-17general 43-16income limit 43-16ineligible spouse/child 43-18married person 43-19other requirements 43-17resource limit 43-16TB child 43-18undocumented persons 43-17

income determination & budgeting examples 43-25child’s income 43-27deemed income rules 43-26FBR rates/standard SSI allocation 43-25financial eligibility 43-25MC 280TB, instructions 43-29MC282TB, instructions 43-28TB income standards 43-25

overview 43-13aid code 43-14background 43-13covered services 43-14effective date 43-14program benefits 43-13role of TB providers 43-15who is eligible 43-14

property determination & examples 43-22child, under 18 43-23married couple 43-23

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MC 278TB/MC 279TB 43-22MC 279TB, instructions, child 43-24parental deeming 43-23property limits 43-22single person 43-23

Temporary absencedefinition 7-16

Therapeutic wagesdefinition 3-24

Third party liability 47-1client responsibility 47-1

assignment 47-1definition 3-25DHS action 47-3EW action 47-2

to inform 47-2notification of third party liability 47-1potential claims 47-1

Tinoco v. Belshe 50-21decision 50-21issue 50-21retroactivity 50-21

Title IIdefinition 3-25

Title II disregard persondefinition 3-25

Title XIXdefinition 3-25

Title XVIdefinition 3-25

Title XVIIIdefinition 3-25

TMC program 37-1adding a person to existing TMC 37-5aid code 39 - initial period 37-8aid code 59 - additional period

nonexempt earned income 37-13status report worksheet, SC 1638 37-14

continuing EWsend packet 37-18

eligibility determination procedures 37-7good cause determinations (Aid Code 39 or 59) 37-12ineligible persons 37-4nonexempt earned income 37-13persons leaving the home 37-5Second Year TMC (Aid Type 5X/5Y) 37-21status report

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aid code 39 37-11AFDC discontinued timely 37-11initial TMC period reduced 37-11

aid code 59 37-11incomplete status reports 37-12

status report worksheet, SC 1638 37-14verification requirements 37-13who qualifies 37-1

definitions 37-3adding a person 37-5family 37-3ineligible aid types 37-4

Transfer to Section 1931(b) Medi-Cal 8-49Transfers of property 29-23

definition 3-25non-disqualifying transfers 29-24

Transitional Medi-Cal. See TMC programTreatment of Property

LTC Insurance Exemption 29-52Trust deeds 26-31Trusts 26-81

background 26-81characteristics 26-88

comparison chart 26-89MQT 26-88OBRA ’93 26-88Other Trust 26-89

comparison chart 26-89definitions 26-83

assets 26-84beneficiary 26-84established 26-85irrevocable 26-85payment 26-85principal/corpus 26-86property right 26-86revocable 26-86similar legal device (SLD) 26-86trust 26-87trust income 26-87trustee 26-87trustor 26-87

for disabled individualsindividual trust 26-101

characteristic table 26-101notification to DHS 26-102

pooled trust 26-101

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characteristic table 26-101notification to DHS 26-102

living trust 26-104MQT 26-88

characteristics 26-88treatment 26-96undue hardship 26-99

OBRA ’93 26-88characteristics 26-88treatment 26-92undue hardship 26-95

Other Trust 26-89characteristics 26-88CUTMA/UTMA 26-102

treatment 26-103examples 26-99treatment 26-99

overview 26-81Sneede considerations 26-126Special Needs Trust 26-103transferred asset 26-91

income 26-92property 26-92

treatment 26-92CUTMA/UTMA 26-103exempt income or property 26-91MQT 26-96

irrevocable 26-97revocable 26-96

OBRA ’93 26-92irrevocable 26-93revocable 26-92

Other Trust 26-99irrevocable 26-100revocable 26-100

undue hardship 26-95MQT 26-99OBRA ’93 26-95

verification 26-90oral trusts 26-90written trusts 26-90

UUIB 25-81Undue hardship 29-20Unearned income 25-62

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allowable deductions 25-68AFDC-MN/MI ineligible members 25-72aged/blind/disabled MN persons 25-69

any income deduction 25-70court-ordered spousal or child support 25-70IHSS cost for ABD-MN SGA 25-71income necessary to achieve self-support 25-70support payment from an absent parent 25-69

all MN or MI programs 25-73allocation to excluded children 25-74health insurance premiums 25-73income used to determine PA 25-73

educational expenses 25-68COLAs for government pensions 25-90

civil service annuities 25-90PERS 25-90state teachers retirement system 25-90

deductions 25-33exempt unearned income 25-67

interest 25-67irregular/ infrequent 25-67

nonexempt unearned income 25-62disability benefits other than state 25-64dividends 25-65interest 25-66JTPA 25-66lump sum 25-66other 25-66personal property 25-65public assistance 25-66royalties 25-66SDI/DIB 25-64worker’s compensation 25-63

unavailable portion 25-64RSDI 25-85

EW responsibility 25-86general benefit information 25-87unconditionally available income 25-86

SSI 25-88other information on SSI 25-89verification 25-88who is eligible for SSI 25-88who must apply for SSI 25-88

UIB/DIB 25-81budgeting information 25-83EW responsibility 25-82unconditionally available income 25-81

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verification 25-31veteran’s benefits 25-74

Unmarried minor parent lives with senior parent 24-31chart 24-33income in-kind to minor 24-33minor’s income 24-33minor’s property 24-32unmarried minor’s child(ren) 24-32unmarried pregnant minor 24-31

Unmarried minorslive at home 24-30

Unmarried pregnant women and MFBU 24-30Urgent case request 27-106

procedures 27-107

VVehicles 26-24

verification of value 26-25Verification

definition 3-26Verifications 25-91, 27-110

Blindness and Disability 27-110Income 25-91

verifications 25-95income

income deductions 25-95Veteran’s benefits 25-74

aid and attendance 25-75background 25-74budgeting information 25-79CA 5 procedures 25-77definitions 25-76

veteran 25-76veteran’s dependent 25-76

educational benefits 25-79responsibility, client 25-76responsibility, EW 25-77

WWaiver Programs 42-1

AIDS waiver 42-23background 42-1DDS-HCBS waiver 42-3IHMC waiver 42-22model waiver 42-11

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MSSP waiver 42-15NF services waiver 42-22overview 42-1

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