Ch. 9-Medi-Cal MFBU

Question 1

What is MFBU?

Answer 1

MFBU stands for medical family budget unit. This is what is used to determine the household size of a home requesting Medi-Cal.

Question 2

What is the definition of a child for medical?

Answer 2

The definition of a child, for medical purposes is a person under the age of 21 still living with a parent and is a tax dependent to the parent also
If under 21 in married and still a tax dependent to parent

Question 3

Family members of medical purposes are considered:

Answer 3

A child or sibling children, including an unborn
The parents married or unmarried of the sibling children
The step parents of the sibling
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

Question 4

When does spouse to spouse end?

Answer 4

If a couple is married, and one of the couples goes into LTC, long-term care, the spouse to spouse counting in the household in the last day of admission to LTC

Question 5

Who are ineligible members for Medi-Cal?

Answer 5

Ineligible members are considered:
not requesting,
refusing to apply for Social Security number
refused to apply for Medicare
refused to apply for unconditionally available income
does not meet eligibility requirements
refused to comply with Medi-Cal support referral
not linked
minor parents who live with their parents, and are requesting only for their child
Parents living out of state that occluded in the case only because their child applying is claimed as a tax dependent

Question 6

How are income and resources counted for in-eligible members?

Answer 6

For ineligible members, all income and resources are counted in full also included in the size of the MFBU (Medi-Cal family budget unit)

Question 7

Who are considered excluded members to the MFBU?

Answer 7

Excluded members are:
Children under 21 who refused to provide verification of income or resources
Children who are excluded by the parent
Stepparents when their own children are not requesting, and the spouse is not requesting
Unmarried father of an unborn child living with a pregnant woman, and not requesting for self
Those receiving PA, which is public assistance (example CalWorks )
SSI recipients

Question 8

Are people receiving PA (public assistance) counted in the MFBU?

Answer 8

No, they are not

Question 9

How are income and resources counted for excluded members?

Answer 9

For excluded members all income and resources are exempt and not counted in the size of the MFBU

Question 10

Define caretaker relative.

Answer 10

A caretaker relative is a relative who provides care and supervision to a child, with no natural, step, or adoptive parent in the home with the child. In addition, the caretaker relative must be a relative as defined by mpg article one and reside in the home with the child a caretaker relative is not a “responsible relative”

Question 11

Can caretaker relatives have a linkage?

Answer 11

Yes, a caretaker can be link through AFDC linkage if they are requesting non-magi medical, and have no other linkage of their own meaning they are not aged or disabled.

Question 12

How will a caretaker/relative’s MFBU be counted?

Answer 12

They will have their own MFBU where their income and resources will be counted

Question 13

For a caretaker relative, how will their income and resources be counted in regards to the child MFBU?

Answer 13

All income and resources are exempt of the caretaker relative and is not included in the child’s MFBU

Question 14

When is a parent responsible for a child?

Answer 14

The parent is responsible for the child when the child is
1) living in the parents home
2)lives out of the parents house,
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 his/her financial affairs
Under 14 years old
3) is married even if the child is a parent of their own and the child is both a tax dependent of the parent and is between the ages of 18 to 21

Question 15

Is there an exception to when a parent is not responsible for the child?

Answer 15

Yes, an exception is when parents of a child have no responsibility when the child is applying for minor consent services

Question 16

When are spouses responsible for each other?

Answer 16

Both are responsible for each other when:
Both spouses are living together
Or one or both spouses are in an LTC/ B&C, and both are medically indigent or aid for dependent children medically needy

Question 17

Why do we care about the family size?

Answer 17

The MFBU size determines the share of cost that a family will be responsible for.

Question 18

What is considered other healthcare coverage OHC that are allowed for deductions?

Answer 18

OHC’s include vision and dental plans, as well as part B

Question 19

What healthcare deductions are not allowed for non-magi Medicare

Answer 19

You are not allowed to deduct prescriptions, service, dog, or transportation these deductions are not allowed

Question 20

When evaluating an LTC customer what must they first be evaluated for?

Answer 20

They must be a valuated for MAGI before being evaluated for non-MAGI, for example, a customer between the ages of 19 and 64 meet the new age group eligibility criteria for MAGI if they’re ineligible for MAGI then the worker would evaluate the customer for non-magi-medically needy

Question 21

What is a community spouse?

Answer 21

A community spouse is a person who is not in a long-term care facility, and as a spouse of an institutionalized individual meaning a purse their spouse is in an LTC, but not them

Question 22

What is SOC?

Answer 22

SOC. Stands for share of cost and this is the amount of money that an applicant is expected to pay when they use medical needs for that month. Example you’re in an LTC so you’re using it every month so you pay it every month however, another time you only use it saying May then you’re only using that you only pay it in May

Question 23

If an LTC resident has a spouse or children at home can their SOC be reduced by allowing an allocation?

Answer 23

Yes, it can be used to lower it

Question 24

How would the SOC be lowered for the LTC customer?

Answer 24

The community spouse’s income allocation for a spouse or family member can be found on the mpg or the maintenance needs chart in the desk aid and is adjusted each calendar year by the state. You would use that amount minus the community spouses income, and that would be compared to the LTC’s SOC, and if the community spouses allocation is larger than the LTC’s SOC, then the LTC’s SOC would be zero

Question 25

How are LTC’s resources treated when they have a spouse in the home?

Answer 25

The community spouse can retain a certain amount of property. This is called the community spouse resource allowance.(CSRA)

Question 26

Where can the CSRA be found?

Answer 26

The CSRA can be found in the maintenance need chart, desk aid binder

Question 27

Can the CSRA be increased?

Answer 27

It can be increased by a court order or fair hearing

Question 28

What is the resource limit amount for the LTC spouse when their MFBU is ONE that they can retain in their name?

Answer 28

$130,000 and the rest of the property both community and separate must be transferred into the community spouses name within 90 days

Question 29

Is Board and Care the same as LTC?

Answer 29

No, it is not. Board and Care is a deduction, and Medi-Cal does not pay for the monthly expense.

Question 30

What is the minimum Board and Care expense deduction?

Answer 30

It is $315. The allowable expense amount will be either the difference between the actual expense amount and the maintenance need for one (example $600) or the minimum BNC deduction of $315 we will allow the amount that is GREATER.