medi-cal handbook court orders 50. court orders · court orders the ew must inform the client that...

Medi-Cal Handbook page 50-1Court Orders

50. Court Orders

50.1 Beltran v Rank

50.1.1 Issue

Whether transfers of property without adequate consideration should be allowed. (Transfer took place within a two-year period preceding the date of initial application.)

50.1.2 Decision

An applicant or beneficiary's eligibility will not be affected by a transfer of exempt property whenever such transfer occurred. This court order is effective July 2, 1981.

50.2 Craig v Bontá

50.2.1 Issue

The Superior Court in the Craig v. Bontá lawsuit prohibited the Department of Health Care Services (DHCS) from terminating the Medi-Cal benefits of beneficiaries discontinued from Supplemental Security Income/State Supplementary Payment (SSI/SSP) on or after June 30, 2002, except for those beneficiaries discontinued due to death or incarceration.

50.2.2 Decision

The Superior Court ruled that Senate Bill (SB) 87 Redetermination Process must be implemented for beneficiaries losing SSI/SSP effective July 1, 2003.

Update # 13-07 Revised: 10/06/16

2 Medi-Cal HandbookCourt Orders

50.2.3 SB 87 Redetermination Process

The SB 87 Redetermination Process consists of three parts:

• Ex parte Review (without client contact)• Direct contact (phone call)• Request for information

[Refer to “Senate Bill (SB) 87 Process,” page 8-1 for additional information.]

Ex parte Review

The Ex parte review involves evaluation of all sources of information available to the EW to make a Medi-Cal redetermination. Information sources include the following:

• Information from the Social Security Administration through the State Data Exchange (SDX) on MEDS. However, Social Security does not compute income the same way that the Medi-Cal program determines income. Therefore, verification of this information is necessary.

• Case files of Craig beneficiaries and/or any of their immediate family members, which are open or were closed within the last 45 days (Medi-Cal, CalWORKs, CalFresh, General Assistance and Foster Care).

• Other sources of relevant information, including IEVS, SAVE, MEDS and the Federal Hub.

If the EW cannot establish continued Medi-Cal eligibility after the ex parte review, then the EW must contact the client either by direct contact or written request for information.

Direct Contact

The EW must attempt to contact the Craig beneficiary if Medi-Cal eligibility cannot be established by the ex parte review. The client’s telephone number is displayed on the Address Inquiry [INQA] Screen on MEDS. If the telephone number is not available on the [INQA] screen, or the number is incorrect, then a written request for information is required.

Revised: 10/06/16 Update # 13-07


The EW must inform the client that his/her Medi-Cal eligibility is being redetermined and more information is needed to confirm continued eligibility. The EW must further inform the client that his/her continued eligibility can be established under other avenues of eligibility, including an allegation of disability.

•

Reminder:All telephone contacts must be clearly documented in the Maintain Case Comments window.

If the EW’s efforts to obtain the information necessary to redetermine eligibility after ex parte review and telephone contact have failed, then the EW should send a written request for information.

Request for Information

When the ex parte review and telephone contact have been unsuccessful, the EW must send the "Medi-Cal Request for Information" (MC 355) or "Request for Tax Household Information" (SCD 2350) depending on potential eligibility to MAGI or Non-MAGI.

EWs may not request information that:

• Has previously been provided, • Is not subject to change, or • Is not necessary to complete a Medi-Cal eligibility redetermination.

When Written Requests are not Required

Written requests for information are not required in the following situations:

• If the telephone contact establishes continued Medi-Cal eligibility, or• If the telephone contact with the client establishes ineligibility for the Medi-Cal

program, and all avenues of continued Medi-Cal eligibility have been explored, including the allegation of disability.



50.2.4 MC 355/SCD 2350 Timelines

Craig beneficiaries MUST be given a minimum of 30 days to respond to the written request for information.

If the beneficiary... Then the EW must...

Does not return the completed form to the EW within 30 days of the date the EW mailed the form,

Send the client an SCD 50 requesting the missing information and explain that their MC will discontinue if they do not provide the information. If after 10 days the client still has not provided the information, send a discontinuance Notice of Action (NOA) stating that his/her eligibility will be terminated 10 days from the date of the NOA and the reasons for termination.

Submits an incomplete form within 30 days,

Attempt to contact the beneficiary either by telephone or in writing to request the necessary information. If the beneficiary does not provide the necessary information to the EW within 10 days from the date the EW contacts the beneficiary in regard to the incomplete form, a 10-day discontinuance NOA of Medi-Cal eligibility must be sent.

Reminder: All telephone contacts must be clearly documented in the case record.

Submits the needed information or returns the form within 90 days of the discontinuance,

Determine eligibility as though the form had been submitted in a timely manner. If the client is found eligible, the discontinuance must be rescinded.

Note:The steps outlined above are generic guidance for the Craig v Bonta redetermination process. Actual business processes may vary depending on individual office needs. EWs should ask their supervisors for more information on business process.



50.2.5 When an SB 87 Redetermination is Not Necessary

An SB 87 Redetermination is not necessary in the following situations:

IF... THEN...

The facts clearly demonstrate that a Craig client cannot be eligible for Medi-Cal due to an event such as:

• Death,

• Loss of California residency, or

• Incarceration,

Benefits must be discontinued WITHOUT an SB 87 Redetermination.

NOTE: The [INQP], [INQM] & [INQX] MEDS screens indicate if a person has died, moved out of state or is incarcerated. DHS will discontinue these Craig clients at the State level and send the appropriate Notice of Action (NOA).

The EW receives a written request from a Craig beneficiary to discontinue Medi-Cal benefits,

The EW does not have to complete an SB 87 Redetermination. However, the client’s request must be clearly documented in the case file. and send the appropriate Notice of Action (NOA

50.2.6 Craig Redetermination Process

Follow the guidelines below to re-evaluate Medi-Cal eligibility for Craig beneficiaries:

STEP WHO ACTION

1. DHCS • Forwards listing of Craig beneficiaries to counties.



2. Designated Clerical Staff

• Receives listing of Craig beneficiaries

• Identifies if a Craig case is assigned in another office. If so, the appropriate information must be forwarded to the office where the case is assigned

• Completes the “Identification & Intake Record” (SCD 41) for each Craig beneficiary included in the Craig Listing (client’s information is obtained from MEDS)

• Performs file clearance procedures for each Craig beneficiary (prints appropriate CalWIN and MEDS screens)

• Completes case processing per District Office procedures

• Sends Informational Packet to all Craig beneficiaries (Coverletter, MC 007, MC 219, SCD 391, DHS 7077 & DHS 7077A) REMINDER: Craig beneficiaries are NOT required to submit a Medi-Cal application or redetermination form.

• Assigns case to an EW for Medi-Cal eligibility redetermination (the EW may be in Continuing or Intake, depending on the individual case situation).

3. EW • Receives assigned case from clerical staff

• Applies SB 87 Redetermination Process:

• Redetermines Medi-Cal eligibility by evaluating the Craig beneficiary’s information (there are no changes to the Medi-Cal eligibility determination process).

• Sends appropriate NOA(s). For adverse actions (i.e., discontinuance or share of cost), send the appropriate 10-day NOA(s).

• Completes a “Request for Online Action“ (SCD 1296) to send a MEDS AP18 transaction to report the start date of the SB 87 Redetermination Process or AP 34 or EW 34 to report discontinuance, if the CalWIN interface was unsuccessful.

STEP WHO ACTION



50.2.7 Case Assignment

Follow the chart below for case assignment

Open CalWIN Case Caseload Assignment

No N/A Medi-Cal Benefits Assistance (MBA)

Yes A7QB MBA

MC-Only Caseloads (excluding A7QB)

Benefits Service Center (BSC)

Other Caseloads Assigned District Office (i.e. North County, South County, etc.)

:

50.2.8 DDSD Disability Referral Packets

A “LIMITED” DDSD referral packet must be sent on all Craig disability redetermination referrals including SSI/SSP discontinuance reasons other than “Cessation of Disability.” If the client was discontinued for “Cessation of Disability” and claims a different disabling condition, then a “FULL” DDSD referral packet must be submitted.

[Refer to Sections 31.1 and 32.4 for more information regarding LIMITED and FULL DDSD referral packets.]

50.2.9 Aid Codes Under State Control

Due to the Craig v. Bontá lawsuit, DHS created three MEDS Aid Codes for the aged, blind, and disabled population losing their SSI-based Medi-Cal. They are as follows:

State-Controlled Aid Codes Description

1E Craig Continued Medi-Cal eligibility for the Aged

2E Craig Continued Medi-Cal eligibility for the Blind

6E Craig Continued Medi-Cal eligibility for the Disabled



Exception:The State will maintain control or discontinue the Medi-Cal benefits for those beneficiaries who are appealing Social Security findings of “no longer disabled,” beneficiaries who have moved out of state, or persons discontinued due to death or incarceration.

50.2.10 Exception Eligibles Report

“Exception Eligibles” reports were originally designed to track cases that were the result of exceptional circumstances such as the Edwards and Burman lawsuit cases, Accelerated Enrollment (AE), Breast and Cervical Cancer Treatment Program (BCCTP), CHDP Gateway, and the Single Point of Entry (SPE) child cases. This report now includes the Craig cases.

DHS sends the “Exception Eligibles” tracking reports on a monthly basis as the primary tool for processing the Craig cases. All the beneficiaries in Aid Codes 1E, 2E, and 6E are identified on this report.

50.2.11 Identification of Craig Clients Groups by Codes

The discontinued SSI/SSP groups are being tracked and identified by assigning special codes in the [Pickle] fields on MEDS. The impacted groups of which the Aid Codes were transferred to the Craig Aid Codes are the following:

• No Longer Disabled• Disabled Adult Child• Disabled Widow(er)s• Pickle• All Others Discontinued from SSI/SSP Benefits (i.e., excess income, excess

property, etc.)• Beneficiaries in Long Term Care.Exception:

Since MEDS does not currently have the information necessary to identify beneficiaries who were receiving In-Home Supportive Services (IHSS) at the time they were discontinued from SSI/SSP, those IHSS beneficiaries will not have a unique [Pickle Status], but will have one of the [Pickle Types] Codes identified below.

The codes placed in the [Pickle Type] and [Pickle Status] fields on MEDS allows DHS to track eligibility and to group beneficiaries on the county reports. The groups identified below must not be discontinued from Medi-Cal without first receiving an SB 87 Redetermination as required by Welfare and Institutions Code, Section 14005.37.



The No Longer Disabled Group

Beneficiaries losing SSI/SSP eligibility on the basis that they are no longer disabled will continue to be placed in the Medi-Cal Aid Code 6N for three months to allow time for an appeal to Social Security Administration (SSA).

• If the appeal is filed within the three month period, the MEDS programming edits from the SDX file will register that an SSA appeal is in progress and will keep the beneficiary in the full-scope Aid Code 6N until the appeal process ends.

• If the beneficiary loses his/her appeal or the appeal is not filed within the three months, MEDS programming logic will change the 6N Aid Code to a 6E Aid Code to ensure the client is reported on the “Exception Eligibles” tracking report. Once these clients appear on this report, the SB 87 Redetermination Process must be completed. Code “D” will be placed in the [Pickle Type] field on MEDS to identify this unique population. There are no special eligibility determination procedures for this group other than the SB 87 Redetermination Process.

Disabled Adult Child (DAC) Group

The Disabled Adult Child (DAC) clients will automatically be moved into Aid Code 2E or 6E. Code “T” will be placed in the [Pickle Type] field on MEDS to identify this unique population. Upon seeing the “T” on the MEDS record, EWs must complete an eligibility determination for the DAC program when evaluating the case under the SB 87 Redetermination Process following the Pickle regulations. [Refer to Section 68.13 for more information.]

Disabled Adult Widow(er)s Group

The Disabled Widow(er)s and surviving divorced spouses will automatically be moved into Aid Code 6E. Code “W” will be placed in the [Pickle Type] field on MEDS to identify this unique population. Upon seeing the “W” on the MEDS record, EWs must complete an eligibility determination for the Disabled Widow(er)s program when evaluating the case under the SB 87 Redetermination Process following the Pickle regulations. [Refer to Section 68.12 for more information.]

Pickle Group

The aged, blind and disabled Pickle beneficiaries will automatically be moved into Aid Code 1E, 2E or 6E. Code “C” will be placed in the [Pickle Type] field on MEDS to identify this unique population. Upon seeing the “C” on the MEDS record, EWs



must complete an eligibility determination for the Pickle program when evaluating the case under the SB 87 Redetermination Process following the normal Pickle regulations. [Refer to Section 68.1 for more information.]

All Other Discontinued from SSI/SSP Benefits

Beneficiaries losing SSI/SSP eligibility, who do not fall into one of the specific groups above, will automatically be transferred into Aid Code 1E, 2E or 6E and code “X” will be placed in the [Pickle Type] field on MEDS. There are no special eligibility determination procedures for this group other than the SB 87 Redetermination Process.

50.2.12 Alleged Disability

The client can be granted Medi-Cal on the basis of alleged disability if there is a new condition (different from what Social Security based the cessation of disability).

50.2.13 ICTs and Craig Beneficiaries

When the original (Sending) County receives the “Exception Eligibles” report and finds out the Craig client moved to another county, the Sending County must do an Intercounty Transfer (ICT) to the new (Receiving) County. The Receiving County is responsible for the SB 87 Redetermination Process.

The Sending County must report the residence address change to MEDS so that the individual will appear in the Receiving County’s “Exception Eligibles” report. The Sending County must include in the ICT packet the "Medi-Cal Intercounty Transfer" (MC 360) form, clearly documented as an ICT for a Craig beneficiary; all appropriate MEDS screens; and any other pertinent information.



50.2.14 CEC and Craig Children

Continuous Eligibility for Children (CEC) for Craig children applies as follows:

If the SSI/SSP Redetermination has been... Then...

LESS than 12 months, • An ex parte review (no client contact) is required. Use the information from existing case records, MEDS, SAVE and IEVS.

The EW must place the Craig child in the appropriate CEC Aid Code and set the redetermination date for 12 months from the last SSI/SSP determination date. Unless there is contradicting information, the EW must not contact the child or the child’ parents/caretaker relatives for additional information. The child is eligible for CEC for the remaining 12 months from the last SSI/SSP determination date until the next RD. - The EW must ensure that the 12-month CEC Time Clock in the Collect Individual Time Clock Detail window is correct. The begin date must be the date of the last SSI/SSP determination and end date to be the next RD. - If the child did not live with the parent (when on SSI), use the income as shown on MEDS INQX screen as the child’s income. Evaluate the child for the appropriate Federal Poverty Level (FPL) program since eligibility is based on income test, not property test. Set up the child for the FPL program for which he/she qualifies. If the child is ineligible for the FPL program, set up the child on CEC and do not contact the child. Note: To determine whether the discontinued SSI child lived with a parent (when on SSI), check the SSI-LVG-ARR-CD in the INQX screen. A code of "C" means the child lived with the parent. Refer to [Refer to User’s Guide to State Systems Handbook, “SSI-LVG-ARR-CD,” page 12-101] for additional codes.

• If the REDET-DT field on the MEDS [INQM] screen does not show a redetermination date, check Title XVI section of the IEVS report for the "Date of Last Redetermination."

• If neither the INQM nor IEVS has the last redetermination date, the EW must contact the Social Security Administration to obtain this date via “Referral To/From Social Security” (SC 169) and clearly indicate that the request is regarding a Craig client.



50.2.15 Annual Redetermination

The Medi-Cal Annual Redetermination (RD) dates are as follows:

Type of Craig Cases The Annual RD will be 12 months from the date the...

• For persons discontinued from SSI/SSP PRIOR to 07/01/03,

• EW actually determines the beneficiary’s Medi-Cal eligibility.

• For persons discontinued from SSI/SSP 07/01/03 and AFTER,

• Beneficiary was discontinued from SSI/SSP.

NOTE: If a Craig individual is being added to an active case, the same annual RRR due date for other family members in the case applies. If CEC applies, evaluate if the child’s eligibility goes beyond the family’s annual RRR due date.

Do NOT change the existing RRR due date. When the existing RRR becomes due, the following applies to the former SSI child only:

If no SOC Medi-Cal is determined during the annual RRR, a new 12-month CEC period begins.

If the former SSI child is found ineligible or eligible with share of cost (SOC), the child must remain in a CEC aid code until the end of the original CEC period. Example: Last SSI redetermination date was 12/07. Child discontinued from SSI 2/08. Child’s 12-month CEC is from 01/08-12/08. RRR for existing family member’s case is due 06/08. At RRR, child is found eligible with SOC, the former SSI child continues on CEC for 07/08-12/08.

Note:If MEDS or IEVS does not have the last SSI redetermination date, the EW must contact SSA to find out when the last redetermination was completed.

50.2.16 IHSS and Craig Clients

The “Exception Eligibles” report includes individuals who were discontinued from SSI/SSP. Some of these individuals received IHSS services when they were discontinued from SSI/SSP. However, the “Exception Eligibles” report does not

OVER 12 months prior to the Craig Child’s discontinuance,

There is no time left in the CEC “guaranteed” period, and the EW will need to follow the SB 87 process to establish eligibility which may include contacting the chid/parents. Upon redetermination, a new 12 month CEC period, if appropriate, begins at that time.

If the SSI/SSP Redetermination has been... Then...



identify which clients received IHSS. These Craig clients are intermixed throughout the report with other SSI/SSP discontinued clients. Nevertheless, the SB 87 Redetermination Process is the same for all Craig clients listed on the report.

Individuals who ONLY received In-Home Supportive Services (IHSS) and were not discontinued from SSI/SSP, do not fall under the Craig v. Bontá lawsuit and will not be included on the “Exception Eligibles” report.

50.2.17 Forms

All Craig beneficiaries must receive information regarding Medi-Cal property limits and spend down.

Medi-Cal Informational Craig Packet

A Medi-Cal Informational Packet consisting of the following forms must be provided to all Craig beneficiaries:

• “Redetermination of Medi-Cal Benefits Coverletter” (SC 104)• “Medi-Cal General Property Limitations” (MC 007)• “Rights and Responsibilities” (MC 219)• “Keep Your Medi-Cal on Target” (SC 391)• “Notice Regarding Standards for Medi-Cal Eligibility” (DHS 7007)• “Notice Regarding Transfer of Home for Both a Married and An Married

Applicant/Beneficiary” (DHS 7007A).Reminder:

The “Medi-Cal Mail-In Application and Instructions” (MC 210), “Medi-Cal Annual Redetermination” (MC 210RV) and “Application for Cash Aid, Food Stamps, and/or Medical Assistance” (SAWS1) are NOT required for the Craig beneficiaries Medi-Cal redetermination. The “Statement of Citizenship, Alienage and Immigration Status” (MC 13) must be completed by the beneficiary ONLY when there has been a change in citizenship/immigration status.

50.2.18 Questions and Answers

Questions and answers are added in the handbook to provide further clarity.

Q1: If there is no time left in the 12-month CEC period, can we mail an application form and discontinue the child if it is not received?



A1: No. All Craig individuals are NOT required to complete an application or redetermination form. The ongoing Medi-Cal eligibility must be determined using the SB 87 process (ex parte, phone contact, MC 355). If it is determined that the child qualifies for no share of cost (SOC) Medi-Cal, then a new 12-month CEC applies.

Q2: If the client fails to provide information/verification during the SB 87 process and the client is eligible for Medicare Part A, do we set up QMB only?

A2: If the SB 87 process is completed and the client failed to provide necessary information/verification, the EW must check MEDS if the client is back on SSI. If so, an SSI QMB case must be set up and discontinue the Medi-Cal benefits.

Q3: If the client was discontinued from SSI due to cessation of disability, do we keep the case in pending status in CalWIN and leave the Aid Code 6E active on MEDS until a disability decision is received from SP-DDSD?

A3: When the reason for SSI discontinuance is due to cessation of disability, a DDSD referral is required when the individual alleges a new disabling condition not already considered by Social Security Administration (SSA). The EW may need to contact SSA. Since a Craig individual is a Medi-Cal recipient, the client can be granted Alleged Disability Aid Code (6J/5J) until a disability decision is received from SP-DDSD.

Q4: What is the purpose of sending a limited DDSD referral for former SSI individuals discontinued for reasons other than cessation of disability?

A4: If the client was receiving SSI based on disability and was discontinued for other reasons other than cessation of disability (e.g., income, property, etc.), a limited DDSD referral must be sent to request for the disability reexamination date.

50.3 Crawford v Rank

50.3.1 Issue

Whether multiple dwelling units will be exempted as homes (Principal Residences).



50.3.2 Decision

State law was changed to allow an entire multiple dwelling unit to be exempt as a home. This court order was effective January 1, 1983.

[Refer to “Principal Residence,” page 48-1 for Principal Residence procedures.]

50.4 Edwards v Kizer (AKA Edwards v Myers)

50.4.1 Issue

Effective April 30, 1982 a preliminary injunction required the continuation of no share-of-cost Medi-Cal benefits to persons discontinued from AFDC until eligibility or ineligibility for Medi-Cal Only is completed and an adequate and timely notice is issued.

50.4.2 Decision

After several years of negotiations, DHS has formally reached an agreement with the Plaintiff's attorneys. The Stipulation for Entry of Judgement and Judgement Pursuant to Stipulation were filed with the Superior Court of Los Angeles County on October 6, 1989.

The new provisions of the Judgement which were not previously part of the preliminary injunction are:

1. The establishment of MEDS modifications to automatically establish Aid Code 38 Medi-Cal for persons discontinued from cash, and

2. A new, shorter Statement of Facts form (the MC 210E) was used to determine Medi-Cal eligibility after discontinuance of AFDC when there is insufficient information in the case file.



50.5 Gibbins v Rank

50.5.1 Issue

Whether spousal and child support payments should be allowed as deductions from the income of ABD-MN cases.

50.5.2 Decision

The court ordered that Medically Needy aged, blind and disabled persons be allowed court ordered spousal and child support payments as deductions from their income, retroactive to August 1, 1984. All cases were to be converted by January 18, 1985.

50.6 Ibarra v Dawson

50.6.1 Issue

Effective July 1, 1985, mandatory payroll deductions are no longer allowed when computing the SOC.

50.6.2 Effective Date

For Medi-Cal applicants and beneficiaries, this change was effective May 1, 1985.



50.7 Johnson v Rank

50.7.1 Issue

A federal court lawsuit, Johnson v Rank, specified that LTC beneficiaries shall be able to use medical items or services which are not covered by Medi-Cal to help meet their SOC.

1. LTC beneficiaries will receive their Medi-Cal cards on the first of the month.

2. The LTC facility will bill the beneficiary on the first of each month for the total SOC indicated on the card.

3. The LTC facility must pay for necessary noncovered medical services from the total SOC collected.

50.7.2 Decision

Effective October 1, 1989, all Medi-Cal recipients in LTC facilities must obtain a physician's prescription or order for any noncovered medical or remedial drug or service, when the cost is to be applied toward their share-of-cost amounts. [Refer to “Follow these steps when a SOC has already been certified on MEDS and the date of service is more than 12 months ago:,” page 62-15, for instructions.]

50.8 King v McMahon

50.8.1 Issue

“King Payments” are issued to beneficiaries by the State. The State is required to pay $100 for each month or portion of a month that the receipt of a fair hearing decision exceeds the 90-day limit.



50.8.2 Treatment of Payments

King payments are exempt as income, and exempt as property in the month of receipt. Beginning the month following the month of receipt, any portion of the payment retained is counted in the property reserve.

50.9 Lomeli v. Shewry

50.9.1 Issue

To consider a request for retroactive coverage valid, an applicant must apply within one year of the month the eligible expenses were incurred. Without the SSI applicant being informed of this time limit, the individual would miss the deadline to apply for retroactive Medi-Cal.

50.9.2 Settlement

The Department of Health Care Services (DHCS) agreed to inform the SSI/SSP applicants in a timely manner of their opportunity to seek retroactive Medi-Cal coverage for the three-month period prior to their SSI/SSP application month.

50.9.3 Informing Notices

The "Important Information for SSI/SSP Applicants" (MC 19A) adivses SSI/SSP applicants about the availability of retroactive Medi-Cal coverage prior to their SSI/SSP eligibility determination. Additionally, DHCS revised the "Important Medi-Cal Program Information for New Supplemental Security Income/State Supplementary Payment (SSI/SSP) Recipients" (MC 19).

50.9.4 MC 19A

Effective August 1, 2011, DHCS began mailing the MC 19A notice on a monthly basis to all California residents newly eligible for SSI/SSP benefits who are not receving Medi-Cal benefits in any one of the three months immediately prior to the month of SSI application. The MC 19A also includes a listing of all county offices



and telephone numbers as well as the "Multilingual Language Service" (MC 4034) notice which informs the individuals of their right to have interpreter services at no cost.

50.9.5 MC 19

The MC 19 was revised to reflect the changes mentioned above, as well as the following:

• A new paragraph entitled PAYMENT OF MEDICAL BILLS IN THE THREE MONTHS BEFORE THE MONTH OF YOUR SSI/SSP APPLICATION was added. This paragraph informs SSI/SSP recipients of the potential for retroactive Medi-Cal coverage and how to request it.

• Paragraph PAYMENT OF PRIOR MONTH MEDICAL BILLS has been replaced with HOW TO PAY FOR PAST MEDICAL BILLS SINCE APPLYING FOR SSI/SSP. This paragraph provides information onthe reimbursement process for medica/dental expenses incurred while waiting for SSA’s eligibility determination.

• The Wide Area Telephone system e-mail address and facsimile number were added for individuals to request the removal of their other health coverage.

50.10Ramos v Myers

50.10.1 Issue

A suit was brought against the Department of Health Services over the effect the discontinuance of SSI/SSP (Supplemental Security Income/State Supplemental Payment) cash grant has on a person's Medi-Cal coverage.

Procedures became effective January 1, 1982 and became obsolete effective June 30, 2002. The Craig v. Bontá lawsuit superseded the Ramos v. Myers court order



50.11 Court Orders: Lynch v. Rank - Pickle Amendment

50.12Overview

50.12.1 Background

The basis for the Title II Social Security (RSDI, formerly OASDI) income disregard is the 1976 Pickle Amendment to the Social Security Act. This amendment requires that zero share-of-cost Medi-Cal benefits be provided to any aged, blind or disabled (ABD) person or couple meeting ALL of the following conditions:

1. Currently receives RSDI benefits

2. Was eligible for and received RSDI and SSI and/or SSP benefits simultaneously in any month after April 1977

Note:If SSI/SSP benefits are awarded retroactively, Pickle eligibility may be determined from the first date of actual entitlement to SSI/SSP. When a person applies for RSDI and SSI/SSP simultaneously, sometimes SSI/SSP is granted first. RSDI will then be granted several months later, retroactive to the date of application. In these instances, the person may be required to reimburse the SSI/SSP program for any benefits received. However, he/she is still considered to have been eligible for and entitled to receive both RSDI and SSI/SSP in the same month. This provision does not apply to persons who are determined ineligible for SSI/SSP for reasons other than the receipt of RSDI benefits.

3. Was discontinued from SSI and/or SSP after April 1977

4. Received an RSDI cost of living adjustment (COLA) since being discontinued from SSI and/or SSP, and



5. Would be entitled to receive SSI and/or SSP benefits if the RSDI COLAs received after SSI and/or SSP ineligibility are disregarded.

Note:If a person loses his/her SSI/SSP eligibility as a result of an RSDI COLA, the specific RSDI COLA that caused the SSI/SSP discontinuance must be:

a. Counted as a “COLA received since SSI/SSP was discontinued,” and

b. Included in the RSDI COLA disregard computation.

Note:In 1983 the Lynch v Rank lawsuit invalidated the provisions of Title 22, California Administrative Code (CAC), Section 50564. Do not refer to that section when completing an eligibility determination under the Pickle Amendment.

50.12.2 SSI/SSP Standards and Regulations

Eligibility for Pickle individuals is determined by using SSI/SSP standards and regulations, not Medi-Cal standards. [Refer to “Disabled - Aid Code 6C,” page 50-69

50.12.3 Eligibility Determination Process

The Pickle eligibility process consists of the following steps:

Step Action

1. Screening for potential eligibility:

• Identify ABD-MN persons who meet potential Pickle eligibility criteria• Verify date of SSI/SSP discontinuance.

2. Completing the Disregard Computation to determine the amount of RSDI COLAs to be disregarded once the Screening Test is passed.

3. Determining financial eligibility:

• The first computation is a “Needs Test” which determines potential financial eligibility using the DHS 7075.

• The second computation is the actual Pickle budget using the DHS 7021.

(Chart page 1 of 2)



50.12.4 Pickle Forms

1. The client shall complete the following forms:

a. SAWS 1 - Application

b. MC 210 - Medi-Cal Mail-In Application/Statement of Facts

c. MC 13 - Statement of Citizenship, Alienage and Immigration Status, only if applicable

d. MC 210 PS - Property/Resources

e. DHCS 7044- Statement of Living Arrangements, In-Kind Support and Maintenance, (ISM).

Reminder:The “Important Information for Persons Requesting Medi-Cal” (MC 219) must be provided; however, the client is not required to sign and return the form. It must be documented in Case Comments that the MC 219 was provided and the date given.

Reminder:A face-to-face interview is not required for a potentially Pickle eligible person, including Disabled Adult Children (DAC) and Disabled Widow(er)s (DW).

2. When determining Pickle eligibility for persons who are potentially eligible for the IHSS Personal Care Services Program (PCSP):

• Either the IHSS form “Application for Social Services” (SOC 295) or the SAWS 1 may be used as the Pickle application form, and

4. Determining resource eligibility:

• SSI/SSP resource standards are used, which in many instances differ from Medi-Cal resource definitions/limits.

• Use the “Pickle Resource Worksheet”, DHCS 7037.

5. Recording potential Pickle eligibility or ineligibility in the MEDS Pickle Tickler System.

Step Action

(Chart page 2 of 2)



• The MC 210 or the SOC 310 may be used as the Pickle Statement of Facts form, both at initial application and for redeterminations.

3. The EW shall complete:

a. SC 1363 - Pickle Screening and Title II Disregard Computation Worksheet

b. DHCS 7037 - Pickle Resource Worksheet

c. DHCS 7075 - Financial Needs Test

d. DHCS 7021 - Pickle Budget Worksheet.

50.12.5 Pickle Aid Codes

The Pickle Aid Codes are:

Aid Code Description

16 Aged

26 Blind

36 Widow Pickle

66 Disabled

50.13Definitions

50.13.1 Actual Value (AV)

For determining ISM, the current market value (CMV) is divided by the number of people receiving support and maintenance minus any payment made out of an applicant's/beneficiary's own funds. If the applicant/beneficiary makes no payment, the AV and CMV may be the same amount.



50.13.2 Automobile

Any vehicle used to provide transportation, such as passenger cars, trucks, boats and special vehicles (e.g., snowmobiles, etc). This includes vehicles which are unregistered, inoperable or in need of repair. Recreational vehicles are not considered automobiles. They are to be evaluated as personal effects, unless they are the only source of transportation.

50.13.3 Burial Funds

Irrevocable burial contract, burial trust, other burial arrangement or any other separately identifiable fund which is clearly designated for burial expenses. This may include:

• Burial Contract - A legally binding contract with a funeral home to provide burial arrangements for the applicant/beneficiary and/or his/her spouse.

• Burial Fund (Separately Identifiable) - Separate and identifiable funds (maximum of $1500) designated as being retained solely to meet burial expenses of the applicant/beneficiary and/or his/her spouse.

• Burial Trust - A trust account held for the applicant/beneficiary by a third party with use subject to the conditions of the trustor.

50.13.4 Cash Surrender Value (CSV)

An insurance policy’s cash surrender value (CSV) is the amount of equity value the policy acquires overtime. The owner can obtain the CSV when the policy is cancelled or can borrow against the CSV.

50.13.5 Child

An applicant/beneficiary who is neither married nor the head of a household and who is:

• Under age 18, or

• Under the age of 22 and a student regularly attending a school, college or university or a course of vocational or technical training to prepare him/her for gainful employment. However, deeming of parental income and resources stops at age 21 even though the child is still a student and is still living in the household of his parent(s) or the spouse of a parent.



An eligible applicant/beneficiary, age 18 or older, who is not a student regularly attending school is not considered a “child” and is not subject to the deeming of parental income. Eligible individuals who fall into these categories may be charged ISM if they are living in the parental household and receiving in-kind support and maintenance from parents.

Note:Age/student status must be verified and documented in Case Comments.

50.13.6 Couple

When determining Pickle eligibility, the following are defined as a couple:

• Pickle eligible applicant/beneficiary living with an ineligible spouse.• Pickle eligible applicant/beneficiary living with an eligible spouse.• Ineligible parents of a Pickle eligible child.• Any two persons who are representing (“holding out”) themselves to the

community as a couple.

50.13.7 Current Market Value (CMV) or Current Market Rental Value (CMRV)

The amount for which an item would sell or rent on the open market. The CMV may be based on factors such as the assessed or appraised value. The CMRV may be affected by the size and location and the amount of rent paid by other tenants.

To determine the CMRV for ISM purposes, contact the owner of the property. Accept this statement as to the fair market value of the property. If the owner of the property either refuses to place a value or has no knowledge of its value contact a knowledgeable source. For this purpose, examples of knowledgeable sources are rental management agencies, real estate firms, trailer park proprietors, housing authorities, or individuals that rent facilities similar to the shelter occupied by the applicant/beneficiary.

50.13.8 Dependent Relative

For purposes of determining the principal residence exclusion, the following are considered as dependent relatives: son, daughter, grandson, granddaughter, stepson, stepdaughter, mother, father, in-laws, stepmother, stepfather, half sister, half brother, niece, nephew, grandparents, aunt, uncle, sister, brother, stepbrother, stepsister.



Verify the basis for the dependency (e.g., medical or financial), that the dependent continues to reside in the home and the relationship between the applicant/beneficiary by personal contact. Document findings on the CalWIN Maintain Case Comments window.

50.13.9 Discounted Amount

The current market value (CMV) of a negotiable contract, note, mortgage, etc.

50.13.10 Equity Value (EV)

The assessed actual value (AV) or current market value (CMV) of an item less any legal encumbrances on the item.

50.13.11 Excludable Equity Value

Equity value in a resource which may be excluded from resource limits.

50.13.12 Home

Any shelter in which the applicant/beneficiary (or spouse with whom the applicant/beneficiary lives) has an ownership interest, and which is used by the applicant/beneficiary (and spouse, if any), as his principal place of residence. [Refer to “Principal Place of Residence,” page 50-30.] The home may be either real or personal property, fixed or mobile, and located on land or water. The home includes all the land that pertains to it and the buildings located on such land. Home property may be separately or jointly owned or ownership may be in the form of a life estate.

50.13.13 Household Expenses

The only household expenses to be considered when determining ISM amounts are:

1. Food

Note:Documentary evidence is never required for the food expense. Accept the applicant/beneficiary's statement as documentation. Do not consider the value of food stamps as a household expense.



2. Mortgage (including property insurance required by the mortgage holder) or rental payments.

Note:Mortgage/Rental Payment - When there is no mortgage or rental payment, (e.g., a member of the household other than the applicant/ beneficiary owns the home and it is paid for) or there is no rental payment due to a rent subsidy provided by a government agency, the amount of ISM for this item is zero.

3. Real property taxes (less any tax rebate/credit).

4. Utilities - including: gas, electricity, heating fuel, water, sewer, garbage.

50.13.14 Immediate Family

An eligible applicant/beneficiary's minor or adult children, step-children, and adopted children; brothers, sisters, adoptive parents, and the spouses of these persons, but does not include members of an ineligible spouse's family. Dependency and living-in-the-same-household are not factors.

50.13.15 Independent Living Arrangement

A living arrangement in which an individual:

1. Is living in his/her own household, or

2. Is living in the household of another but is not receiving both food and shelter from someone within the household.

50.13.16 Ineligible Spouse

In the Pickle program, an “ineligible spouse” is one who does not meet the financial eligibility tests in the screening process and is, therefore, ineligible as a Pickle person.

50.13.17 In-Kind Support and Maintenance (ISM)

ISM is unearned income in the form of free or partially free food or shelter. This includes ISM provided to agricultural or domestic employees.



50.13.18 Institutionalization

In determining whether a principal residence can be excluded during an extended absence the following steps must be taken to verify institutional status:

1. Accept the applicant/beneficiary's or dependent relative's statement regarding dependency unless there is reason to question. [Refer to “Definitions,” page 50-23.]

2. A signed statement, from the applicant, the spouse, or the dependent relative indicating that the dependent relative or spouse resides in the home, must be obtained. If the applicant/beneficiary intends to return to the home, a signed statement from the applicant/beneficiary must be obtained. The statement must identify:

a. The reason for his/her absence from the home.

b. If he/she intends to return. This statement is accepted without challenge unless the statement is self-contradictory. If so, obtain clarification from secondary sources such as a physician, close relative or other knowledgeable person.

50.13.19 Items of Unusual Value

Items which have a significant resale value over an extended period of time. May include, but not limited to china, silver, glassware, art works, Oriental and similarly valued carpets, antiques, heirlooms, musical instruments, hobby collections, furs. CMV of over $500 establishes that the item is of unusual value. Equity value of these items is used in the resource determination.

50.13.20 Life Estate and Remainder Interest

A life estate conveys upon an applicant/beneficiary or individuals for his/her lifetime (irrevocable) certain rights in property. It's duration is generally measured by the lifetime of the owner of the life estate (life estate holder). The life estate holder has the right of property and the right to sell his/her life estate interest. However, the written contract establishing the life estate may limit some of these rights. He/she does not have title to the property if he/she does not have the right to sell the property.



Where the owner conveys property to another person for life (life estate holder) and to a second person (the remainder man) upon the death of the life estate holder, both a life estate interest and a remainder interest have been created.

50.13.21 Liquid Resources

Resources which are in cash or payable in cash on demand. The most common types are savings accounts, checking accounts, stocks, bonds, and mutual funds, promissory notes and mortgages. Liquid resources, except cash, are valued according to their equity value.

50.13.22 Nonliquid Resources

Anything not countable as a liquid resource including real and personal property. Nonliquid resources are evaluated according to their equity value.

50.13.23 Non-Medical Out of Home Care (NMOHC)

A protective living arrangement outside of the recipient’s home where he/she receives room and board, as well as personal non-medical care and supervision related to his/her individual needs.

50.13.24 Parent

A natural parent, an adoptive parent, or the spouse of a natural or adoptive parent.

50.13.25 Presumed Maximum Value (PMV)

An amount equivalent to one-third of the applicable Federal Benefit Rate (FBR) plus $20 (any income exclusion). The PMV rules apply to in-kind support and maintenance (ISM) which is countable as unearned income. The PMV never applies to earned income. Use of the PMV in determining an applicant's/beneficiary's countable income is rebuttable by documenting that the actual value of the ISM RECEIVED IS LESS THAN THE PMV. The lesser of these two amounts is always used, but never an amount greater than the PMV, regardless of the number of sources of such income or the variety of living arrangements in any given month.



50.13.26 Principal Place of Residence

Also [Refer to “Home,” page 50-26 and “Institutionalization,” page 50-28.]

Where an applicant/beneficiary has established his/her domicile. That is, the dwelling the applicant/beneficiary considers to be his or her fixed, established, or principal home, and to which, whenever absent, he/she intends to return. However, if the applicant/beneficiary leaves such dwelling and enters long-term care and his/her spouse or dependent relative still resides there the applicant/beneficiary's intent to return is irrelevant in determining principal place of residence. [Refer to “Dependent Relative,” page 50-25.]

Consider the following when determining the Principal Place of Residence:

1. A home owned by an applicant/beneficiary (or spouse living with him/her) is excluded if the home is the applicant/beneficiary's principal place of residence.

2. Only one home at a time may be excluded as the principal place of residence.

3. Absences from the home do not necessarily affect the determination of the principal place of residence. When the applicant/beneficiary is away from the home it continues to be his/her principal place of residence if:

a. The applicant/beneficiary intends to return to the home.

b. The applicant/beneficiary is in LTC and his/her spouse or dependent relative continues to reside in the home.

Effective the first day of the month following the month in which it is determined that the home is no longer the applicant/beneficiary's principal place of residence, the individuals equity in the home is a countable resource.

If there are multiple residences, verify the principal residence by voter registration, address for receipt of benefits or payments or mailing address for tax purposes.

When the applicant/beneficiary is living away from the home, intent to return must be confirmed unless absence is based on institutionalization and his/her spouse or dependent relative is living in the home. If no spouse or dependent relative resides in the home intent to return must be verified. [Refer to “Institutionalization,” page 50-28.]

Statements of intent to return or allegations of dependency are acceptable from authorized representatives in situations where the applicant/beneficiary is incapable of providing such information.



50.13.27 Property (Real or Personal), Essential to Self-Support

Property used in a trade or business and nonbusiness property which produces income either in cash or in-kind. Property in current use, or that will again be used within one year of its most recent use, for income producing purposes. Business property includes the necessary capital and operating assets of a business, (e.g., real property, buildings, inventory, equipment, machinery, livestock and necessary motor vehicles used in the trade or business). Income from this property is counted as earned income.

Nonbusiness, income producing property means land or nonliquid property which provides rental or other income, but is not used as part of a trade or business. This includes small apartment houses or other structures producing rental income, land which produces rents or other land use fees, (e.g., notes or mortgages, royalties, mineral rights) and similar types of real and personal property. Income from this property is counted as unearned income.

Non-home property previously referred to as other real property that is used in a business or non-business self-support activity is excluded when the applicant's (or spouse's) equity does not exceed $6000 and the activity produces a net annual return of at least six percent of the excludable equity value. Equity value for this purpose is the CMV minus any legal debts against the property.

A less than reasonable (six percent of the excludable equity value) net return is acceptable when all of the following conditions are met:

1. The property is used in a business or nonbusiness income-producing operation; and

2. Unexpected circumstances (e.g., a fire, street repair in front of business, etc.) cause a temporary reduction in the net rate of return; and

3. The annual net rate of return is reasonable in relation to the value of the property; and

4. The applicant expects the property to again produce a reasonable rate of return within 18 months of the end of the taxable year in which the unusual incident occurred. If at the end of the 18-month period the property is not producing a reasonable net return, the property becomes a countable resource.

50.13.28 Rebutting the PMV

The opportunity for the applicant/beneficiary to prove that the ISM he/she receives has a lesser value than the PMV.



50.13.29 Recreational Vehicle (RV)

Usually campers, motorhomes, trailers, boats, etc. This resource is treated as household goods and personal effects unless used as a principal residence or as the household’s only mode of transportation. It may also be excluded if used for self-support.

50.13.30 Rent-Free Shelter

Situations where no rent is being paid and there is no legal obligation for the applicant/beneficiary to pay. Rent-free shelter never exists when an applicant/beneficiary has ownership interest or has made an agreement to pay rent (rental liability). The maximum value of rent-free shelter is presumed to be one-third the applicable monthly FBR plus $20 (any income exclusion). Where the presumed value is rebutted, the CMV is divided among the number of household residents.

50.13.31 Resources

Those assets, including real and personal property that an applicant/beneficiary or couple owns. Resources include all liquid assets which are held singly, or jointly which can be accessed by the applicant (e.g., bank accounts, savings accounts, etc.) and all non-liquid assets which are real or personal property (e.g., automobile, land equipment, etc).

An item becomes a resource if retained after the month of receipt. In order to be considered as a resource, property or an interest in real or personal property must have a cash value that is available to the applicant/beneficiary upon disposition. In general, an applicant/beneficiary with legal title to property has the right to control and dispose of it. If property cannot be disposed of, it is not a resource.

Since resource determinations for Pickle eligibles are made as of 12:01 a.m. on the first day of each calendar month, resource increases during a month do not affect eligibility for that month although they may cause ineligibility in the following month. Conversely, if a person is ineligible, due to excess resources, at 12:01 a.m. on the first day of the month that a person remains ineligible for the entire month.

50.13.32 Sharing

When determining ISM, sharing exists when an applicant/beneficiary contributes within $5.00 of his/her pro rata share or an eligible couple contributes within $5.00 of household operating expenses of their combined pro rata shares. A finding of sharing means that no ISM is being received from anyone else in the household. A



pro rata share is determined by dividing the average household expenses by the number of household members. [Refer to “Household Expenses,” page 50-26

50.13.33 Successful Rebuttal

Evidence obtained that supports a finding that the current market value (CMV) or the actual value (AV) of ISM is less than the PMV. If the PMV is successfully rebutted, the CMV or the AV, whichever is less, is the amount of ISM to be charged.

50.13.34 Value of the One-Third Reduction (VTR)

A method of evaluating ISM. The value assigned, by law, for the ISM which an applicant/beneficiary receives while living in the household of another throughout the month. When VTR applies, no other ISM is chargeable. The VTR is equal to one-third the FBR (one-sixth the couple FBR for one member of an eligible couple). The VTR may not be rebutted.

50.14Pickle Screening Process

50.14.1 Who Must be Screened

All ABD-MN persons who are currently receiving Title II (RSDI) income.

Exceptions

The following persons do not have need to be screened for Pickle:

1. Persons in long-term care

Note:When a person leaves long-term care, he/she must be re-evaluated for potential Pickle eligibility.

2. Persons who were already determined NOT to be potentially Pickle eligible

3. Persons already determined to be Pickle eligible (Aid Codes 16, 26, 36, 66).



Note:Pickle eligibility must be re-evaluated at annual redetermination (RD) for persons who are already Pickle eligible.

50.14.2 When to Screen

To establish potential Pickle eligibility, all ABD-MN persons must be screened, except those exempted above, at:

1. Intake - during the initial application process

2. Continuing - in the month after an RSDI COLA

3. Whenever a client requests a Pickle determination.

50.14.3 How to Screen

Part I of the “Pickle Screening and Title II Disregard Computation Worksheet” (SC 1363) screens for Pickle eligibility. If completed, it must be scanned into IDM.

Example:Pickle Screening and Title II Disregard Computation Worksheet - Part I. Case Name: Case No. Individual Name: Verified Date last SSI or SSP Received.

Note:If SSI/SSP was never received or was last received prior to April 1977, do not continue. The person is not eligible as a Pickle person.

Part I - Screening Process:

1. Does this person currently receive Title II Benefits (RSDI, Social Security check)?

2. Since April 1977, has this person received both RSDI and SSI or SSP in the same month?

3. Has this person been discontinued from SSI and or SSP?

4. Has this person received an RSDI COLA increase in any month since SSI or SSP was discontinued?



a. If the answer to questions 1, 2, and/or 3 is NO, the person is not a potential Pickle person. The EW shall:

(1) Indicate the reason for ineligibility in Maintain Case Comments.

(2) Send a Pickle denial notice.

(3) Determine (or continue) eligibility for ABD-MN.

Note:If there is a break-in-aid, the applicant must be screened again for Pickle.

b. If the client meets all the Pickle criteria except for having received a COLA, there is potential Pickle eligibility after the next RSDI COLA. The EW shall:

(1) Deny Pickle eligibility at this time.

(2) The client is ‘potentially Pickle eligible’ and must be reviewed after each annual RSDI COLA. [Refer to “Pickle Tickler System,” page 50-79

(3) Verify the date the client was last eligible for and received SSI/SSP. [Refer to “Verification of SSI/SSP Termination Date,” page 50-36.]

(4) Determine (or continue) eligibility under ABD-MN rules.

c. If the client meets all Pickle criteria the applicant is a potential Pickle person, and the EW shall:

(1) Verify and document the date the client was last eligible for and received SSI/SSP. [Refer to “Verification of SSI/SSP Termination Date,” page 50-36.]

(2) Complete the disregard computation and the financial eligibility process.

d. When screening an ABD-MN couple, each person must be screened separately. One or both persons may qualify as potential Pickle eligibles.

(1) If both persons pass the screening process, they are potentially eligible as a Pickle couple. Combine their incomes and disregard amounts when computing the Needs Test.

(2) If both persons pass the screening process but are ineligible after completing the needs test for a couple, recompute the needs test for each individual using only his/her income and disregard.



(3) If one does not qualify, that spouse is termed an “ineligible spouse.”

50.14.4 Verification of SSI/SSP Termination Date

The date that the client last received and was eligible for SSI and/or SSP must be verified.

1. To verify the date SSI/SSP was last received, the EW shall use any of the following:

a. The date listed on the monthly Exception Eligibles Report/503 Leads Report

b. The “SSI-LAST-RECEIVED” date from the MEDS [INQE] screen or IEVS

c. The client's SSI/SSP discontinuance notice from the Social Security Administration

d. Any other verification that establishes the date of SSI discontinuance and that the client was covered by the “Craig v Bontá” court order.

Note:When the SSI/SSP discontinuance date cannot be verified by any of the methods listed above, use the SC 169 or SC1955 to specifically request the SSI/SSP discontinuance date from SSA.

Important:Do NOT use the State-issued LYNCH v RANK letter (Notice Type 52) to verify the date of SSI/SSP discontinuance.

2. An individual may have received an SSI/SSP approval and/or discontinuance NOA, but was never actually eligible to receive the SSI/SSP cash grant and he/she may have been required to repay SSA for the cash received.

Note:It may be necessary to check further if it appears the applicant may have never actually been eligible to receive SSI/SSP; e.g., an overpayment is currently being recouped from RSDI income. Send an SC 169 or SSA 1955 requesting specific information in these instances, as the client is not potentially Pickle eligible unless eligible for SSI/SSP and RSDI at the same time.

Exception:When a person applies for RSDI and SSI/SSP simultaneously, sometimes SSI/SSP is granted first. RSDI will then be granted several months later, retroactive to the date of application. In these instances, the person may be



required to reimburse the SSI/SSP program for any benefits received. However, he/she is still considered to have been eligible for and entitled to receive both RSDI and SSI/SSP in the same month.

3. Never deny Pickle eligibility based solely upon the reason for the SSI/SSP discontinuance.

Note:Pickle eligibility must be determined for all persons who have been discontinued from SSI/SSP for any reason, including a cost of living increase.

4. If both spouses are potentially eligible, their individual SSI/SSP discontinuance dates must be verified. Their discontinuance dates may be different.

50.15Title II Disregard Computation

Once a client has passed the initial screening test, complete the Pickle disregard computation.

The “disregard computation” determines the RSDI COLA amounts received by the ABD person since their SSI/SSP discontinuance, using the Pickle Disregard. [Refer to Chart Book, “Pickle Disregard Computation Chart,” page 5-41]

50.15.1 Disregard Computation for an Individual

Compute the disregard amount by multiplying the individual's current gross RSDI benefits by the multiplier which corresponds to the month and year that the client last received and was eligible for SSI/SSP.

Important:

If a person loses his/her SSI/SSP eligibility as a result of an RSDI COLA, the specific RSDI COLA that caused the SSI/SSP discontinuance must be considered as a “COLA received since SSI/SSP was discontinued.”

Example:A potential Pickle person who last received SSI/SSP in September 1991 will have his current (2007) RSDI check multiplied by 0.3462. The resulting amount is the Title II disregard amount.



Part II - Disregard Computation

Current RSDI Benefit Amount $941.00Multiplied by Disregard Multiplier (Obtain from current table)

X 0.3462 (from 2007 chart) = 325.77

Amount of Title II Disregard (rounded) $325.00

NOTE: Drop the cents.

Important:

Be careful to count decimal places correctly as many clients have a high disregard amount.

50.15.2 Disregard Computation for a Couple

Example 1:

An ABD-MN couple, both are potentially Pickle eligible.

1. Compute the disregard amount for each person separately, using two separate SC 1363 Screening Worksheets.

2. Each person may have a different date of SSI/SSP discontinuance, and thus, a different disregard multiplier. [Refer to “Court Orders: Lynch v. Rank - Pickle Amendment,” page 50-20

Example 2:

A couple, one spouse is potentially Pickle eligible and the other is an ineligible spouse who receives RSDI benefits.

1. Determine the disregard amount for the potential Pickle spouse.

2. Compute the ineligible spouse's disregard amount on a separate SC 1363 using either the date that:

a. The potential Pickle person's SSI/SSP was discontinued, OR

b. The date the ineligible spouse started receiving RSDI, WHICHEVER IS MOST RECENT.



50.16Treatment of Income

SSI income/property limits and rules are used when determining Pickle eligibility.

1. Always use the individual's gross RSDI benefit amount when completing a Pickle budget.

2. There is no income deduction given for a health insurance premium.

3. The amount of any income must be established on a monthly basis.

a. Do not average or approximate income.

Example:Mr. Jones, a salaried employee is paid $200 each Friday. His earned income for a month with four paydays is $800 and for a month with five paydays is $1000. Do NOT use $100 x 4.33, use actual.

b. Income received quarterly, twice a year, or annually is to be counted in the month of receipt and not averaged on an annual basis, except for net earnings from self-employment.

50.16.1 Earned Income

The treatment of earned income in the Pickle Program is similar to the treatment of earned income in “regular” Medi-Cal. [Refer to “Earned Income,” page 56-1 to determine the appropriate treatment of earned income EXCEPT for:

Earned Income Treatment Required Verification

Earned Income In-Kind

Exception: Farm laborers and domestics. (See Unearned Income- ISM.)

Earned income - Counted at current market rental value of the shelter and/or actual value of food.

Statement of current market rental value from provider or rent and food receipts.

Earned income tax credit payments.

Earned income, if received as an advance or refund. If tax credit only, it is totally excluded income.

Federal income tax return and signed statement from beneficiary.

Sheltered workshop payments.

Earned income. Pay stubs, statements from employer, or latest tax return.



50.16.2 Unearned Income

The treatment of unearned income in the Pickle Program is similar to the treatment of unearned income in “regular” Medi-Cal. [Refer to “Unearned Income,” page 57-1 to determine the appropriate treatment of unearned income EXCEPT for:

In-Home Supportive Services (IHSS) payments.

Earned income - Payment received for services provided to an eligible individual.

Exception: Exempt if paid to an ineligible spouse, parent or ineligible child.

Statement from agency providing payments.

Veteran’s Aid and Attendance payments.

Unearned Income Treatment Required Verification

Bureau of Indian Affairs General Assistance (BIAGA)

Unearned Income. $20 any income deduction does not apply.

Statement from the local agency that administers the BIAGA program re: amount and duration of award.

Child support payment received directly by or for the Pickle child.

Unearned income. One-third of total excluded.

Court records, canceled checks or D.A. records.

Civil Service and Federal Employee Retirement System (FERS) payments from the Office of Personnel Management (OPM)

Unearned income to the entitled retiree or individual survivor in the month received and property thereafter.

Statement from the ORG regarding the amount.

Inheritance. Unearned Income in the month received and property thereafter.

Statement from executor or authorized representative of the estate.

ISM provided to an individual or couple (includes farm laborer and domestics*)

*Determine living arrangement prior to counting ISM.

Unearned In-Kind Support and Maintenance (ISM) values from chart.

Required only if in-kind value is rebutted. Receipts for actual shelter costs and statement/receipts for food.

Money received for providing foster care to a “Pickle” ineligible child.

Unearned income if not formal placement. (See Excluded Income if formal placement.)

Statement from placement agency or Notice of Action indicating placement and amount of payment.

Earned Income Treatment Required Verification



50.16.3 Excluded Income

The treatment of excluded income in the Pickle Program is similar to the treatment of excluded income in “regular” Medi-Cal. [Refer to “Exempt Income,” page 54-1 to determine the appropriate treatment of excluded income EXCEPT for:

Office of Personnel Management (OPM)

Payments from Victims of Crimes Program

Unearned income. Exempt payments that are reimbursements for incurred medical expenses.

Statement from agency providing payments and medical bills if not third party payment.

Prizes and Awards Unearned income. (Exempt when not in the form of cash, an item of need, or item that can be converted or sold.)

Signed statement from beneficiary indicating CMV, date received, type and source of prize.

Proceeds of a Life insurance policy/death benefits.

When Medi-Cal beneficiary is beneficiary of policy: Actual expenses of last illness and burial, up to $1,500 is exempt. Remaining is unearned income.

When Medi-Cal beneficiary is beneficiary and owner of policy: Resource.

View insurance policy or obtain verification from insurance company.

Royalties Unearned income. Production costs may be deducted, but not income taxes.

Royalty agreements and receipts.

Excluded Income Treatment Required Verification

Child Support 1/3 of total payment received by a Pickle child is excluded. The remainder is unearned income.

Court records, canceled checks, DA records.

Federal Relocation Assistance

Excluded for 90 days, afterwards funds are considered property.

Statement from agency.

Disaster Assistance Excluded if for a presidentially declared disaster. (See Resources for additional information.)

Statement and public records of disaster, award letters, etc.

HUD or FMHA (Federal housing assistance)

Excluded Statement from local Housing Authority or owner/manager of home.

Unearned Income Treatment Required Verification



Foster care funds received for a “Pickle” ineligible child.

Excluded if formal placement. See Unearned Income, if informal placement.

Statement from placement agency or Notice of Action indicating placement and amount of payment.

Federal grants/loans to undergraduate students.

Portion used for tuition and fees is excluded. Portion used for room and board is unearned income.

Copy of grant/loan showing source, amount and type of assistance.

Grants, scholarships, fellowships.

Portion used for tuition, fees, books and materials, transportation and impairment related expenses necessary to operate school machines or equipment is excluded.

Copy of grant or award letter indicating name and address of grantor and written verification of all expenses.

Income Tax Refunds Excluded in month of receipt, counted as a resource thereafter.

Copy of check or tax return which shows amount of refund.

Infrequent or Irregular Income.

Exclude up to $20 per month of unearned income, and Exclude up to $10 per month of earned income.

Beneficiary’s statement.

Non-recurring lump sum Excluded in the month of receipt.

Retroactive SSI and RSDI payments are excluded for 6 months.

Beneficiary’s signed statement.

Allowance or reimbursements paid under Title VI of the Rehabilitation Act of 1973.

Excluded Statement from agency providing payment.

Proceeds of a loan. Payment of principal is excluded in the month received and property thereafter. Interest received on loan is unearned income.

View loan document or statement from borrower and lender.

Student’s earned income.

Up to $1,620 per year is excluded if under 22 years old, blind, or disabled and not married or head of household.

Statement from school that student was regularly attending one month of the current calendar quarter or is expected to attend one month of the next quarter. Statement from employer or paystubs which show dates and amount of earnings.

WIC Excluded None required.




50.17Financial Eligibility

50.17.1 When to Complete the Financial Eligibility Test

Once the screening process is passed, the individual or couple must next pass the two financial eligibility tests. The first, the Needs Test (Part A of the DHS 7021), determines potential eligibility for an individual or couple. The second, the financial eligibility test (Part B-F of the DHS 7021), determines the actual financial eligibility for the Pickle program.

The Pickle financial eligibility test must be completed for Pickle eligibility at:

1. Intake - During the application process.

2. Continuing - Whenever there is a change in the Pickle person's income.

Note:When the change in income is the result of an RSDI COLA, the Pickle budget shall be updated at the time of the regularly scheduled redetermination.

Third-party payment for a non-need item (i.e. car payment)

Excluded if made directly to a vendor. If for food, shelter or clothing count ISM subject to PMV.

Signed statement from provider of payment.

IHSS Payments Excluded if paid to:

• A Pickle eligible individual, or• A Pickle ineligible spouse,

parent, or child.


Veteran’s Aid and Attendance Payments

Excluded if paid to veteran or surviving spouse.

Excluded from deeming if paid to ineligible spouse or child for care of eligible individual.





50.17.2 Needs Test

The Needs Test compares the applicant's income, less RSDI COLA disregards, to the appropriate SSI/SSP payment level. If the net income is less than or equal to the SSI/SSP payment level, the individual/couple passes the Needs Test.

1. CalWIN will determine the total countable income for the Needs test. The DHS 7075 may also be used when processing an adult.

2. Enter all earned and unearned income of the potential Pickle individual/couple, including in-kind support and maintenance (ISM), if applicable.

a. When both members of a couple pass the Screening test, their incomes and disregard amounts are combined for the Needs test, and the SSI/SSP payment level for a couple is used.

b. If only one spouse passes the screening test, the Needs Test is completed only for the individual who passed the screening.

Note:The ineligible spouse's income is not considered in the Needs test, and the SSI/SSP payment level for an individual is used.

3. Allow the $20 Any Income Deduction, and the $65 plus 1/2 deduction if the individual/couple has earned income.

4. Transfer the total countable income to the DHS 7021, Pickle Budget Worksheet, Part A, line 1.

5. Subtract the disregard amount, obtained in the screening process, from the total countable income.

6. If income on line 3 exceeds the appropriate SSI/SSP payment level for the individual/couple, evaluate each individual separately by completing the Needs Test for each person. If the individual or couple is not Pickle eligible:

a. Send a Pickle denial NOA.

b. Determine (or continue) eligibility for ABD-MN or A&D FPL.

Note:Any adverse action resulting from ineligibility for Pickle requires a 10-day notice of action.



7. If income on line 3 is equal to or less than the appropriate SSI/SSP payment level, continue to complete the Financial Eligibility Worksheet, DHS 7021.

50.17.3 Financial Eligibility Worksheet

The “Financial Eligibility Worksheet” (DHS 7021, Part B-E) is used to determine actual Pickle eligibility for an individual or a couple when one spouse is ineligible. The appropriate SSI/SSP payment level used in the financial eligibility test is usually the “Independent Living Arrangement” or the “Non-Medical Board and Care” level. [Refer to “In-Kind Support and Maintenance (ISM),” page 50-48 to determine income from ISM, where an individual/couple is receiving free or partially free housing, utilities, food or clothing from someone who has no financial responsibility to provide these items. Also, if Pickle resource eligibility is questionable, complete the DHS 7037, Pickle Resource Worksheet before doing the budget.

Potential Pickle Eligible Individual

1. Complete only Part A and F of the DHS 7021.

2. If the individual's total countable income is less than the current SSI/SSP payment level, he/she is Pickle eligible.

3. If eligible, send Pickle approval NOA or continue Pickle Medi-Cal benefits.

4. If not Pickle eligible:

a. Deny or discontinue, using appropriate Pickle NOA.

b. Determine eligibility for the individual for A&D FPL or ABD-MN SOC.

Couples, Both Potential Pickle Persons, e.g., both have passed the screening test.

Complete only Part A and F of the DHS 7021:

1. Use the income of both spouses on the Pickle budget.

2. Deduct both of their disregard amounts from their combined unearned income.

3. Allow only one $20 general income exclusion.



If the couple's total countable income is less than the current SSI/SSP payment level for a couple, they are Pickle eligible.

4. If eligible, send Pickle approval NOA or continue Pickle Medi-Cal benefits.


a. Deny or discontinue, using appropriate Pickle NOA.

b. Determine their eligibility for A&D FPL or ABD-MN SOC.

Couples, Only One Potential Pickle Eligible, e.g., only one spouse passed the screening test.

DefinitionFBR refers to the Federal Benefit Rate. [Refer to Chart Book, “Federal Benefit Rate (FBR),” page 5-24 for FBR amounts determined annually.] These amounts are used when allocating and/or deeming income from the ineligible spouse to his/her children and/or Pickle eligible spouse.

1. Complete ALL sections of the DHS 7021 to determine if there is any allocation to the children and/or deeming from the ineligible spouse to the potentially Pickle eligible spouse.

Note:Public Assistance income or income that is either counted or excluded in computing the PA payment is never counted when deeming income from an ineligible spouse.

2. If the ineligible spouse receives RSDI benefits, a COLA disregard is allowed for the ineligible spouse. [Refer to Chart Book, “Pickle Disregard Computation Chart,” page 5-41] for disregard computation.]

3. Compute allocation for ineligible child(ren).

a. If a non-Pickle child's income is less than the couple FBR minus the individual FBR, income of the ineligible spouse is allocated to the child.

b. This allocated income is not used in determining the Pickle person's eligibility.

4. If the ineligible spouse's income, after the allocation to the child(ren) is less than the difference between the FBR for a couple and the FBR for an individual, there is no deeming to the Pickle spouse.



a. If the ineligible spouse's income is not deemed to the Pickle spouse, do not use ineligible spouse's income in Part E, and use the individual SSI/SSP payment level in Part F.

b. If income is deemed, use ineligible spouse's income in Part E, (after allocations to child(ren), and use the couple SSI/SSP payment level.

Note:It is only the potential Pickle spouse who may become Pickle eligible.

5. Deeming does not apply when the Pickle person or the ineligible spouse are living in an institution, even if sharing a room. [Refer to “Institutionalization,” page 50-28.]

6. If one spouse is Pickle eligible:

a. Send Pickle approval NOA or continue Pickle Medi-Cal benefits for eligible spouse.

b. Determine Medi-Cal eligibility for remaining family members.


a. Deny or discontinue Pickle spouse, using appropriate NOA.

b. Determine eligibility for ABD-MN and Medi-Cal for remaining family members.

Establishing Medi-Cal Eligibility for a Pickle Person's Family.

1. A Pickle beneficiary is treated as a PA recipient, except that any of his/her gross earned/unearned income in excess of the current SSI/SSP payment level is allocated to the family.

2. The allocated amount is entered on the MC 176M in Column I or II, Line 4, as “Pickle Income Available.”

3. The Pickle person is not listed as a member of the family's MFBU and none of his/her medical expenses are to be used in meeting the family's share of cost.



50.18In-Kind Support and Maintenance (ISM)

50.18.1 Definition

The value of in-kind support and maintenance is counted for a Pickle person when he/she receives free or partially free housing, utilities, and/or food from someone who has no financial responsibility to provide these items unless received from an excluded source. [Refer to “Excluded Types of ISM,” page 50-52.

1. ISM may be provided by persons either living in the same household or living elsewhere.

2. The value of in-kind support and maintenance is counted in the month following the month of receipt.

3. There are two types of ISM calculations:

a. VTR - Value of One Third Reduction. [Refer to “VTR - Value of One Third Reduction,” page 50-48.

b. PMV - Presumed Maximum Value. [Refer to “PMV - Presumed Maximum Value,” page 50-49.

50.18.2 VTR - Value of One Third Reduction

Definition

VTR, value of one third reduction, is computed by taking one-third reduction of the current Federal Benefit Rate (FBR). This calculation is reflected in the SSI/SSP payment level titled “Living in the Household of Another.”

When to Use VTR

VTR applies when the Pickle client and/or spouse:

• Lives in another person's household for one full calendar month, and• Receives food and shelter from the person in whose household he/she lives.• Lives with a person other than a spouse, child, or an ineligible person whose

income may be deemed to the individual.


Note:Living in another person's household means that the Pickle person does not own or rent the property in which he/she resides.

Do NOT apply VTR if the Pickle client:

• Lives alone, or• Lives with a minor child or a responsible relative, or• Is separately consuming or purchasing food.

SSI/SSP Payment Levels

If the VTR applies, do not calculate any other ISM. Instead, compute the Pickle budget using the SSI/SSP payment level for persons “Living in the Household of Another.” [Refer to “Prior SSI/SSP Payment Standards,” page 6-15.]

50.18.3 PMV - Presumed Maximum Value

Definition

Instead of determining the actual dollar amount of any food or shelter received by the Pickle applicant/beneficiary, it is presumed to be worth a maximum value. This maximum value is one-third reduction of the applicable FBR plus the $20 any income deduction. This value is counted as unearned income to the recipient.

The PMV amounts to be counted as unearned income when the client receives ISM change when there is a COLA. [Refer to “In-Kind Support and Maintenance (ISM),” page 50-48 The PMV never applies to earned income.

When to Apply the PMV

The PMV may apply when the applicant/beneficiary receives partial or total support from someone who is not a legally responsible relative, and the applicant/beneficiary:

• Has ownership interest in or rents his/her place of residence, or• Is sharing food or shelter, or• Does not receive both food and shelter from someone else, or• Lives in a board and care facility, and someone else pays all or part of the

monthly charges.



50.18.4 The DHS 7044, Statement of Living Arrangement

The DHS 7044 must be completed by the Pickle applicant/beneficiary when any of the following situations are declared:

1. Free or partially free housing, utilities, or food received from someone who has no legal responsibility to provide these items.

2. The client lives in a dwelling owned by his/her parent, stepparent, or adult child.

3. The client shares housing with anyone other than a spouse, a minor child, or a responsible relative.

50.18.5 Rebutting the PMV

The applicant/beneficiary has the right to prove that the actual value of the ISM received is less than the PMV.

1. The lesser of actual value or PMV shall be counted as unearned income.

2. The applicant/beneficiary must be advised of his/her right to rebut the PMV.

3. When the applicant/beneficiary intends to rebut the PMV, the EW must allow him/her ten days to provide proof of the actual value of ISM.

50.18.6 Examples of VTR and PMV:

1. Pickle applicant lives in a duplex, her parents own the duplex, they live elsewhere.

a. If the Pickle client does not pay or owe rent and her parents provide all food, then this is a VTR case.

b. If she has no rental liability and she buys her own food then this is a PMV case.

c. If she has a rental liability and buys her own food then neither VTR nor PMV apply.

2. Pickle client, age 25, lives in mother's home. Mother provides free food and shelter.

• Use VTR rules.



50.18.7 Sharing

When determining ISM, sharing exists when an applicant/beneficiary contributes within $5.00 of his/her pro rata share of household operating expenses or an eligible couple contributes within $5.00 of their combined pro rata shares.

1. A pro rata share is determined by dividing the average household expenses by the number of household members.

2. if “sharing” is established, no ISM is being received from anyone else in the household.

Note:ISM may still apply when the individual is receiving support from someone outside of the household.

50.18.8 ISM Values

The VTR and PMV amounts are found in the Chart Book. [Refer to “Presumed Maximum Vale (PMV),” page 5-42 [Refer to “Value of One-Third Reduction (VTR),” page 5-42

The VTR is the payment level to be used in situations 1 and 2 below. The PMV is the unearned income amount to be added in other situations. The following chart provides the method that must be used for determining Pickle eligibility for individuals and couples in various living arrangements.

Household Situation (Living Arrangement) Policy

1. Living in household of another throughout a month and receiving both food and shelter from someone in the household.

VTR applies. Use the SSI/SSP payment level for a person “Living in the Household of Another.”

2. Living in household of another who is providing both food and shelter and also receiving ISM from a third party.

VTR applies. Use the SSI/SSP payment level for a person “Living in the Household of Another.” Do not count any additional ISM.

3. Living with a responsible relative in the “Household of Another” who is not a responsible relative but is supplying both food AND shelter

Add VTR to the deemed income from the responsible relative and add to other unearned income.

4. Living with a responsible relative in the “Household of Another” who is not a responsible relative but is providing food OR shelter.

Add PMV to the deemed income from the responsible relative and add to other unearned income.



50.18.9 Excluded Types of ISM

The following ISM is not counted for the Pickle person.

1. ISM specifically excluded by federal law, e.g., HUD

2. ISM which meets the criteria for infrequent or irregular unearned income

3. ISM which has no current market value

4. ISM received under a governmental medical or social service program

5. ISM which is assistance based on need from a state or political subdivision

5. Living in own household or household of another (ownership or rental liability) and receiving ISM from someone outside the household.

Add Presumed Maximum Value (PMV) to other unearned income.

6. Living in noninstitutional care* situation or group home and receiving ISM from someone outside the household, e.g. board and care.

Add Presumed Maximum Value (PMV) to other unearned income.

7. Living in household of another and sharing partial or total household expenses.

If pro rata share is contributed we use the SSI/SSP payment level for a person in an “Independent Living Arrangement.“If pro rata share is not contributed add PMV to other unearned income.

8. One member of an eligible couple lives in the household of another and receives both food and shelter from the householder while the second member lives in his/her home or a non medical institution.

1/6 of the FBR for a couple for the person living in his/her own household. (VTR) not rebuttable.

1/6 of the FBR for a couple for the person living in the household of another. (VTR) not rebuttable.

9. If the noninstitutionalized spouse lives in any other situation.

1/6 of the FBR for a couple plus $10.00.

10. Paying less than Current Market Rental Value (CMRV) for shelter.

Add PMV to other unearned income unless criteria for earned/unearned income is met. [Refer to “Definition,” page 50-48.]

*All non medical institutions including those for education or vocational training.

Household Situation (Living Arrangement) Policy



6. ISM provided by other members of a public assistance household, i.e., CalWORKs household

7. ISM from a responsible relative (e.g., spouse, parent)

8. Temporary shelter provided while waiting for completion of repairs or for replacement of an exempt principal residence

9. ISM which is excluded under an SSA approved plan for self support

10. ISM resulting from payments made under the terms of a credit life insurance or credit disability insurance policy

11. The receipt of the use of land without a dwelling does not constitute ISM. Similarly, third party payments of property tax, rent or mortgage on land alone are not counted as ISM

12. One-third of the amount of child support received as ISM is excluded from income. The remaining two-thirds is subject to the PMV

13. Exclude ISM food and/or shelter provided homeless persons by non-profit community organizations supported by any state or local assistance agency (i.e. subsidized meal program, Food Stamps). ISM of “no value” is excluded. “Food of no value” includes discarded or surplus food. “Shelter of no value” means the individual is sleeping in an abandoned building or in an automobile.

Reminder:Food/Shelter not otherwise excluded even if provided to homeless persons is PMV (i.e. food provided free for a week from a relative is PMV).

50.19Resource Determination

Those persons determined potentially eligible in the Screening Process and the Financial Eligibility Tests must complete a Supplement to the Statement of Facts, Property/Resources (MC 210 PS). The EW shall use information from the MC 210 and MC 210 PS to complete the Pickle Resource Worksheet (DHS 7037) and determine resource eligibility.



50.19.1 Resource Limits

For a Pickle individual or couple, use the resource limits for Medi-Cal, one or two persons. [Refer to Chart Book, “Property Limits,” page 5-1.]

Note:Pickle persons must be within the resource limit at 12:01 a.m. on the first day of the month for which eligibility is being determined. If a person is not eligible on the first, he/she is not eligible for the entire month.

50.19.2 Determining Value of a Resource

Equity value, the current market value less encumbrances, shall be used when determining the value of a resource.

50.19.3 Resource Limits for Couples

Both spouses potentially Pickle eligible:

1. Use the resource limit for two persons, and

2. Count the community and separate resources of both persons.

Ineligible spouse, income deemed:

1. Use the resource limit for two persons, and

2. Count the community and separate resources of both persons.

Ineligible spouse, income not deemed:

1. Count the separate property of the potentially Pickle eligible spouse, and

2. Count all of the couple's community property, and

3. Use the resource limit for one person.

Note:Do not count the separate property of the ineligible spouse. It is the applicant's responsibility to prove separate property.



50.19.4 Excess Resources

If individual/couple has excess resources:

1. Deny/discontinue Pickle eligibility.

2. Determine (or continue) eligibility for ABD-MN.

Note:A 10-day notice must be given whenever a client will be adversely affected by Pickle eligibility.

50.19.5 SSI Treatment of Resources

SSI resource rules and regulations are used when establishing Pickle eligibility.

Resource Treatment Required Verification

Automobile

NOTE: Does not include RVs.

Treat vehicles as follows:

1. One vehicle shall be excluded regardless of its use or value.

2. A second vehicle shall be excluded if CMV is $4,500 or less. Any amount in excess of $4,500 shall be included as a resource.

3. A third or other vehicle shall be included as a resource using equity value.

NOTE: A vehicle may be exempt if determined to be Property Essential to Self-Support.

Determine value using low or wholesale Blue Book amounts.

Burial Contracts, if issued by a funeral director/mortuary.

Exclude up to $1,800 if irrevocable Verify same as Medi-Cal. View copy of contract.

Burial Trusts [Refer to “Burial Funds,” page 50-24

Exclude up to $1,800 if irrevocable.

NOTE: A burial trust does not include a contract with a funeral director or mortuary.

Verify same as Medi-Cal. View copy of trust agreement.



Separately Identifiable Funds for Burial

If not specified as irrevocable, exclude up to $1,500. If funds are commingled with other resources the burial fund exclusion does not apply.

If funds are used for another purpose, the amount used must be counted as liquid resource in the month following the month in which the funds were expended.

NOTE: $1,500 limit is reduced by the amount(s) applicant/ beneficiary has in:

• Face value of life insurance if CSV is excluded, and/or

• Amount of any irrevocable burial trust/contract that would cause the total burial funds to exceed $1,800.

Existing or Newly Acquired Accounts: The funds must be clearly designated as set aside for burial. If not designated on account, but are separately identifiable and client states funds are intended for burial, obtain signed statement. Funds may be excluded the first day of the month in which statement is signed if designation on account is completed within 30 days of the statement.

Burial Insurance Exclude if can be used exclusively to pay burial expenses. If policy has no CSV, count the same as life insurance.

Verify same as Medi-Cal View Policy.

Burial Plots, Vaults, Crypts

Excluded if for immediate family member.

Applicant/beneficiary statement.

Cash, Checking, Savings, Credit Union Accounts

Counted. (SSA & SSI Lump Sums not counted for six months.)

If applicant or responsible relative has unrestricted access to the funds in a joint checking account, all of the funds in the account are presumed to be the resources of the applicant. This presumption may be rebutted.

Applicant's/beneficiary's statement if total countable resources are $1,000 or less and not more than $500 of that amount is liquid resource. Otherwise, verify same as Medi-Cal.

Contract of Sale, Notes, Mortgages, Trust Deeds, and Loans

Counted, if negotiable. Use amount of outstanding principal balance or the discounted amount.

View document(s). Negotiability and value must be verified by a bank, real estate broker, or other financial institution.




Home (Principal Residence)

The dwelling plus any appertaining buildings and land used as a home by the applicant/ beneficiary and his/her spouse or the parents with whom an eligible child is living does not count as a resource.

• PR remains exempt so long as the applicant/beneficiary intends to return home.

• Only one PR may be exempt at any time.

None if applicant/beneficiary resides in PR. If questionable that land appertains to PR, verify with tax statement, assessor's office, deed, title, etc.

(Proceeds from the sale of an excluded principal residence.)

Excluded if used or obligated to be used to purchase another excluded home within the last day of the third full month following the month of receipt. If the home is not replaced within this time period the proceeds are counted as a resource beginning the month following the month of receipt. This exclusion does not apply to interest earned on the proceeds of the sale.

Applicant's/beneficiary's statement and copy of contract of sale. Statement from real estate broker or officer in lending institution.

Household Goods and Personal Effects (i.e., furniture, applicances, electronic equipment, clothing, jewelry

Excluded regardless of value.

NOTE: Items acquired or held due to their value or as an investment are not considered household goods or personal effects for purposes of this exclusion.

N/A

Income Tax Refund Counted as a resource the first day of the month following the month of receipt.

NOTE: Excluded as income in the month of receipt.

Copy of tax return.

Items of unusual value: e.g., china, silver, antiques, heirlooms, etc.

Excluded N/A

Keough, IRA, Pension Accounts, Time Deposits

Counted. Deduct penalty for early withdrawal.

If verified that funds cannot under any circumstances be withdrawn, the funds are excluded until maturity.

Examine time deposit certificate or statement from financial institution.




Keough, IRA, Pension Accounts of a Pickle Ineligible Parent

Exclude from potentially eligible Pickle child.

None.

Life Insurance Exclude if total face value (FV) of all insurance policies on any person do not exceed $1,500 (do not count term insurance). If total FV is over $1,500, count all cash surrender value(CSV) of all policies.

Verify same as Medi-Cal.

(Proceeds of a Life Insurance Policy and Other Death Benefits.)

Exclude if applicant/beneficiary is both the beneficiary and the owner of the policy and the policy has previously been excluded as a resource.

Counted if applicant/beneficiary is both the beneficiary and the owner of the policy and the CSV of the policy has not previously been excluded as resource.

NOTE: If applicant/beneficiary is not the owner of the policy, the proceeds are treated as unearned income.


Life Estate Counted unless PR. Value determined by Life Estate and Remainder Interest Tables. If power to dispose of property is retained or life estate is revocable use CMV.

View life estate document. If joint ownership, divide CMV by number of owners.

Livestock and Poultry Exempt if for personal use. Applicant/beneficiary statement.

Loans which Require Repayment

Counted, if retained more than 30 days from date of receipt. Exempt the first 30 days.


Major Disaster Assistance

If excluded from income, also exclude nine months from date of receipt as a resource. Possible nine month extension.

Must not be commingled with other resources. If person is applicant, allow 30 days to establish separately identifiable account for these funds.

Accept applicant's/ beneficiary's statement re: source of funds.




Nonrecurring Lump Sum

Counted. SSI/SSP and RSDI retro active payments are excluded for six months following the month of receipt.

Applicant's/beneficiary' statement.

Property (Real or Personal Essential to Self-Support)

Excluded if all of the following criteria are met:

1. Used in a trade or business or is otherwise producing income: and

2. Equity value does not exceed $6,000; and

3. The activity is producing a net annual return of 6% of the excludable equity value.

Exception: $6,000/six percent limits do not apply to property that represents governmental authority to engage in an income producing activity (i.e., commercial fishing permit, liquor license).

CMV must be verified by:

1. Most recent tax assessment.

2. Signed, dated estimate from a knowledgeable source. Legal description or address of property must be included.

Income tax return; Schedule C, E, F, or SE, or Form 1065.

Recreational Items and Vehicles (boats, campers, motor homes, trailers, etc).

Count as household goods and personal effects, unless used as principal residence or as the only mode of transportation.

Applicants/beneficiary's statement and records.

Retirement Funds Counted, if available for lump sum withdrawal (i.e., not as monthly payment).

Statement from retirement fund or financial institution.

Royalties and Mineral Rights.

Excluded if equity value is $6,000 or less and is producing a net annual return of six percent of excludable equity value or if they cannot be sold.

Tax assessed value from brokerage firm, holding company, etc.

Stocks, Bonds, Mutual Funds

Counted. Use the closing price on the date eligibility determination is being completed.


Trust Funds (Includes Court Ordered Trusts)

Excluded if access to principal is restricted (e.g., only the trustee or court, etc. has access) even if providing income. Interest is counted as unearned income unless it is reinvested in the trust.

Review trust document. Petitioning the court to break the trust is not required.

U.S. Savings Bonds Counted on the earliest date that it can be cashed.





50.20Pickle Eligible Child

A child is rarely eligible for Pickle benefits. However, when a child passes the Pickle screening test, the following regulations shall be applied:

50.20.1 Title II Disregard Computation

1. Compute the disregard computation only for the child's RSDI COLA's.

2. There is no disregard allowed for the parent's RSDI COLA's.

50.20.2 Needs Test

A Needs Test is not required for the potentially Pickle eligible child.

50.20.3 Financial Eligibility

Complete the DHS 7019, Financial Eligibility Worksheet - Eligible Child with Ineligible Parent(s). Do not use the DHS 7021 or DHS 7075.

1. Both the income of the parent(s) of the Pickle child and the income of the Pickle child are used to determine eligibility.

2. Amounts for the needs of the ineligible parent(s) and of the non-Pickle children in the family are allowed in the budget calculation.

3. The final net income is compared to the appropriate SSI/SSP payment level, e.g., Disabled Minor level.

50.20.4 Resource Eligibility

In determining the amount of resources to be deemed to a potential Pickle eligible child, allow the parent(s) all of the resource exclusions for which they would be eligible if they were the applicants.

After the exclusions are applied, the remaining countable resources are deemed to the potentially eligible child.



There is no increase in the resource limit for Pickle ineligible children.

Examples:

Resource limits effective 1/1/89:

• Two parents and one Pickle child = $5000.00 ($3000 + 2000)

• One parent and one Pickle child= $4,000.00 ($2000 + 2000)

• Pickle couple with Pickle child= $5,000.00 ($3000 + 2000)

50.20.5 Financial Eligibility Worksheet (DHS 7019) Instructions

Follow these steps to complete the Financial Eligibility Worksheet (DHS 7019) for a Pickle child:

Step Action

1 Complete Part I. Ineligible Parents Unearned Income

Line 1. Enter the ineligible parent's unearned income.

Line 2. (If no ineligible siblings, enter zero in I-2c.)

• Enter the first name of any ineligible child(ren) in the box provided. • On line 2a, enter the allocations for any ineligible child(ren) not on public assistance. • On line 2b, enter any income for each of the children, excluding $1,620 per year of

student income. • Subtract line 2b from 2a. • Enter the remainder for each child, and total the allocations for all siblings on line 2c.

Line 3. Subtract line I-2c from I-1 (unearned income) and enter the difference. This is the remaining unearned income amount unless the allocation amount (line I-2c) exceeds line I-1 (unearned income). In the latter case, the negative figure on line I-3 is carried over to line II-2 (unused portion of allocation).



2 Complete Part II. Ineligible Parent's Earned Income

• Enter the parent's earned income. • Enter the amount of any allocation for ineligible children that is not offset by unearned

income (line I-3 minus line I-1). If line I-1 is greater than line I-3, enter zero in line II-2. • Subtract the allocation amount on line II-2 from line II-1 (gross earned income) and

enter the difference. • Add lines I-3 and II-3.

NOTE: If, at this point (after the allocation for ineligible children), there is no income remaining either earned or unearned, there is no income available for deeming to the eligible child(ren). In this case, proceed to Part IV. If there is earned and/or unearned income remaining, complete both Parts III and IV.

3 Complete Part III. Combined Incomes - Parent's Allocation

• Enter the remaining unearned income from Part I, line 3 to Part III, line 1. • Enter the remaining earned income from Part II, line 3 to Part III, line 4. • Follow the instructions on each line.

The entry from Part III, line 15, is carried over to Part IV, line 1.

4 Complete Part IV. Pickle Eligibility Calculation

• Enter the deemed income from the last line in Part III. The deemed income is treated as unearned income.

• Enter the applicant's OASDI income. • Enter any Title II cost-of-living increases that the applicant has received since being

discontinued from SSI/SSP. (Use disregard Computation Worksheet.) • Subtract line III-3 from III-2 and enter difference. • Enter any other unearned income of applicant. • Enter the $20 any income exclusion. • Add together the amounts in lines IV-1, IV-4, and IV-5; and then subtract the $20 any

income exclusion (line IV-6) to obtain the total countable unearned income amount. • Enter the applicant's countable earned income (i.e., earned income after exclusions

including the $65 work expense exclusion and 1/2 the remainder). • Add the amounts in lines IV-7 and IV-8 to obtain the total countable income. • Enter the current SSI/SSP payment level.

NOTE: If parent(s) have Title II income, their cost-of-living increases are not subtracted. Also, there is no allocation to a parent who is receiving public assistance.

Step Action



50.21COBRA - Widow Pickle

50.21.1 Background

Certain disabled widow(er)s were discontinued from SSI/SSP because of a change in computation factors that occurred in 1983, which resulted in an increase in their RSDI, widow(er)s Social Security benefits. In some cases, the increase in their RSDI benefits was enough to raise their incomes above the SSI payment level, thus their SSI check and Medi-Cal were discontinued. There are very few persons eligible for Widow Pickle benefits. Eligible persons are in Aid Code 36.

Important:

Widow Pickle applications must have been filed between July 1, 1986 and July 1, 1988. Applications filed after July 1, 1988 are not eligible for consideration.

50.21.2 Widow Pickle Screening Test

To be eligible for Widow(er) Pickle benefits, a person must meet all of the following criteria:

• Was under age 60 when he/she first began receiving RSDI, Social Security benefits; and

• Is now receiving RSDI and has received it continuously since December, 1983; and

• Received Social Security Disabled Widow(er)s benefits in January, 1984; and

• At any time, received both SSI/SSP and RSDI in the same month; and

• No longer receives SSI/SSP due to the 1983 increases in Widow(er)s benefits.

Once the initial screening test (above) is passed, compute Pickle eligibility:

• Title II Disregard Computation• Needs Test• Financial Eligibility Test• Pickle Resource Determination.



50.22Disabled Widow(er)s

50.22.1 Background

Federal regulations under Section 9116 of OBRA '87 have established a new group of persons who are potentially eligible for Pickle Medi-Cal, effective July 1, 1988. These persons are widow(er)s, age 60 through 64, whose SSI payments have been discontinued due to entitlement to, or an increase in, RSDI widow(er)s benefits. Eligibility continues under these provisions until they become eligible for Part A of Medicare.

Section 5103(d) of OBRA '90 expanded the Disabled Widow(er)s program to include certain disabled widow(er)s and surviving divorced spouses ages 50 through 59.

There are few individuals who are affected by these provisions.

50.22.2 Definitions

The term “widows” collectively refers to widows, widowers and surviving divorced spouses.

The term “disabled widows” collectively refers to disabled widows, disabled widowers and disabled divorced surviving spouses who are eligible for the Disabled Widow(er)s (DW) program.

50.22.3 DHCS Actions

Disabled Widow(er)s are listed on the monthly Exception Eligibles report as one of the SB 87 categories under the Craig v. Bontá court order.

50.22.4 DHS 7089, Screening Worksheet

EWs shall use the “Screening Worksheet - Disabled Widow(er) Checklist” (DHS 7089) to screen for Disabled Widow(er) program benefits.



50.22.5 Criteria

To be eligible for Disabled Widow(er) Pickle benefits, a person must meet all of the following criteria:

• Is between age 50 and 64, and

• Is eligible for and currently receiving widow(er)s benefits under Title II (RSDI), Section 202(e) or 202(f), or under any other provisions of Section 202 if he/she is also eligible under Subsection (e) or (f) of the Act. Title II Section 202 benefits include:

• Old-age/retirement insurance benefits• Wife's insurance benefits• Husband's insurance benefits• Child's insurance benefits• Widow's insurance benefits• Widower's insurance benefits• Mother's and father's insurance benefits

(RSDI disability benefits are not included under Section 202. Disability benefits are awarded under Section 223.) and

• Is not entitled to Medicare Part A (hospital insurance), and

• Has become ineligible for SSI/SSP benefits because of the receipt of Title II benefits under Section 202 of the Act.

50.22.6 Verification Requirements

Individuals who apply under OBRA 87 Disabled Widow(er)s provision must have evidence of their current Title II (RSDI) benefit amount.

The EW shall:

1. Determine if the widow(er) is currently receiving Title II (RSDI) for disability.

Note:Use an SC 169 or SC 1955 to request the information from SSA, if necessary



2. Verify current Title II benefits being received by the individual for reasons other than disability (for example, widow[er]s benefit amount), or

3. Obtain an award letter which clearly distinguishes the reason that the Title II benefit is being paid.

50.22.7 Budgeting

Once the screening test (above) is passed, compute Pickle eligibility as follows:

1. Amount to be disregarded:

• If the widow(er) is receiving Title II benefits for any reason other than disability, disregard the entire Title II amount and the widow(er)s benefit.

• When the individual currently receives Title II as a disabled person, disregard only the widow(er)s portion of the benefit award.

2. Complete Needs Test, Pickle Budget and Pickle Resource Worksheet.

3. Use the SSI/SSP payment standard which is in effect for the month eligibility is being determined.

4. Send an approval or denial NOA if the person passed the screening test.

5. Individuals who are eligible under these provisions are identified with Aid Code 36.

50.22.8 Annual Redetermination (RD)

At annual redetermination (RD), EWs must:

• Verify receipt of Title II widows insurance benefits,• Verify any other income, and• Determine that the individual would be SSI/SSP eligible if all Title II Section 202

benefits are disregarded.

50.22.9 Ineligibility

Once Medicare begins, the recipient is no longer eligible as a disabled widow. Remind clients to immediately report when Medicare begins.



50.23Disabled Adult Child (DAC)

50.23.1 Background

Effective November 1986, Section 6 of Public Law 99-643 amended the Social Security Act to provide no share-of-cost Medi-Cal to Disabled Adult children. DAC eligibility is not determined solely based on a cost of living increase. DAC procedures provide that if an individual would be eligible for SSI/SSP were it not for either the person's Title II benefits, or the increase in those benefits, the individual will continue to be eligible for zero share-of-cost Medi-Cal. There are very few persons who are eligible under these provisions. These cases are currently being processed by the Craig EWs at VMC.

50.23.2 DAC Screening Test

To be Pickle eligible, a Disabled Adult Child must meet all of the following criteria:

• Must be at least 18 years old,

• Have previously received SSI/SSP on the basis of blindness or a disability which began before reaching age 22, and

• Must currently be receiving RSDI benefits based on blindness or disability, and

• Must have been discontinued from SSI/SSP as a result of becoming entitled on or after July 1, 1987 to RSDI child's benefits (paid on the basis of a disability which began before age 22) or because of an increase in those child disability benefits.

Note:Persons who are discontinued from SSI/SSP due to admission to a long-term care facility are not eligible under these DAC provision. A regular Medi-Cal determination is required in these cases. DACs are listed in the monthly Craig v. Bontá Exception Eligibles Report.

If the initial screening test is passed, compute Pickle eligibility as described below.

The amount of RSDI benefits to be budgeted must never be greater than the amount that the person was receiving at the time his/her SSI/SSP was discontinued.



Note:For anyone discontinued after January 1987, the Disregard Computation is not necessary since the actual RSDI amount a the time of the SSI/SSP discontinuance should be the current amount received. If the person was discontinued prior to January 1987, a disregard computation is needed.

50.23.3 DHS Actions

Disabled Adult Children are listed on the monthly Exception Eligibles report as one of the SB 87 categories under the Craig v. Bontá court order.

50.23.4 Budgeting

A Pickle Screening (SC 1363) is not required for DACs.

When determining a Pickle financial eligibility computation for DACs, the EW shall:

• Disregard the entire RSDI amount received as child’s benefits.

• Disregard any subsequent cost-of-living increases when completing the “Financial Eligibility Worksheet” (DHS 7021).

• Include all income from any other sources when completing the Pickle Budget, for example, VA, in-kind, etc.

Determine if the person meets all other Pickle income/resource eligibility criteria.

Note:In most cases, none of the DAC’s current RSDI benefits will be budgeted. This is a special limited category of Pickle Medi-Cal.

50.23.5 Verification

Verify the current Title II benefit amount by:

• An award letter,• IEVS Abstract,• Verification from the Social Security Administration, or• Viewing the check, or direct deposit statement.

Note:The SC 169 or SC 1955 may be used to request the information from SSA.



50.23.6 Aid Codes

Persons who are found eligible under these provisions are identified as follows:

• Blind- Aid Code 6A• Disabled - Aid Code 6C

50.24Persons Who Were Pickle (or IHSS) Eligible in the Month Prior to SSI/SSP Reductions

50.24.1 Background

1993 SSP Reduction

The California SSI/SSP payment level was reduced by 2.7% effective September 1, 1993. Many persons who were receiving small SSI/SSP checks were discontinued due to this decrease. It was not the intent of the state legislature to eliminate or reduce Medi-Cal benefits due to the reduction in SSI/SSP payment levels.

It has been determined that persons who were eligible for no-share-of-cost Medi-Cal benefits under Pickle or IHSS in August 1993 should not be adversely affected by the 2.7% SSI/SSP reduction. This provision is included in Welfare and Institutions Code Section 14005.21.

1994 SSP Reduction

The SSI/SSP payment level was again reduced by 2.3% effective September 1, 1994. The same provision applies. Those who were Pickle or IHSS eligible prior to the SSI/SSP reductions will be treated as if the reductions never occurred. Section 14005.21 applies ONLY to the limited group of persons who were already Pickle or IHSS eligible in August 1993 and/or August 1994.

1995 SSP Reduction

Effective December 1, 1995, Chapter 307 of the Statutes of 1995 (Assembly Bill 908, Brulte) reduced the SSP benefit levels to the minimum amounts allowed by federal law up to a maximum of 4.9% of the total SSI/SSP payment standard. It



also stipulated that these SSP reductions are not to change the share of cost (SOC) for any individual receiving benefits prior to the SSP reduction. Therefore, in 1/96, Pickle beneficiaries who would have lost Pickle eligibility due to the 12/95 reduction are to be grandfathered into Aid Codes 14, 24 and 64 with no SOC if they have excess income for Pickle using the 1996 SSI/SSP payment standards.

Procedure, 8-93/8-94 SSP Reduction

An Ad Hoc listing which identified August 1993 Pickle eligibles was distributed to EWs in 3/94. (This Ad Hoc report must be kept in the permanent verifications section of the casefolder in IDM.) Persons who were Pickle (or IHSS) eligible in August 1993 are entitled to the higher, August 1993 SSI/SSP payment level when determining their ongoing Pickle eligibility.

The August 1994 SSI/SSP payment level must continue to be used to determine Pickle eligibility for those persons who were:

• Pickle (or IHSS) eligible in August 1994, AND• Adversely affected by the 8-93/8-94 rollback.

Note:If an individual was Pickle eligible in August 1993 and August 1994, then the 1993 SSI/SSP payment level applies.

• Use the 8/93 (or 8/94, as appropriate) SSI/SSP payment level when completing the “Financial Eligibility Worksheet” (DHS 7021), Part F, Line 1.

• The prior SSI/SSP payment levels for aged or disabled persons in independent living was:

8/93 8/94

Individual $620 603.40

Couple $1140 1109.22



Procedure, 12/95 SSP Reduction

For persons who lost Pickle eligibility in 12/95 due to the SSP reduction, compute ongoing Pickle eligibility using the 1996 SSI/SSP payment standards.

IF... THEN...

Ineligible for Pickle with the 1/96 SSI/SSP Payment Standards,

Compute Pickle eligibility using the 11/95 SSI/SSP Payment Standards (if higher) and follow the steps on the next page to continue no share of cost Medi-Cal under Aid Code 14, 24 or 64 if Pickle eligible.

Eligible for Pickle with the 1996 SSI/SSP Payment Standards,

Continue eligibility under the “Pickle” Aid Code (16, 26 or 66).

After completing the DHS 7021 the client's income exceeds both the 11/95 and 1/96 SSI/SSP payment level,

Discontinue Pickle with a 10-day NOA and approve ABD-MN with a share of cost.

Charts

[Refer to Chart Book, “Prior SSI/SSP Payment Standards,” page 6-15] if the SSI/SSP payment levels for other categories and living arrangements are needed.

Pickle Eligible

If there is ongoing Pickle eligibility using the 8/93, 8/94, or 11/95 SSI/SSP payment levels (as appropriate), the EW must:

Step Action

1 Discontinue Pickle.

2 Continue no-share-of-cost Medi-Cal benefits.

1. Use the appropriate no-share-of-cost ABD-MN Aid Code (below):

• 14 Aged • 24 Blind • 64 Disabled

NOTE: Eligibility for any month back to September 1993 can be corrected if there would have been Pickle eligibility using the old (8/93) SSI/SSP payment levels and there were medical expenses.

3 Issue an appropriate Pickle notice of action.

NOTE: The change to no-share-of-cost ABD-MN Aid Codes for these cases is required by the state. A new Aid Code may be designated by the state in the future.



Additional Clarifications

The 8/93 (or 8/94, 11/95) SSI/SSP payment level procedures must be used to determine ongoing Pickle eligibility for anyone who was Pickle (or IHSS) eligible in 8/93, 8/94, or 11/95 including:

• Persons who would have remained Pickle eligible using the new (reduced) SSI/SSP amounts (as it could make a difference in the future if their income increases).

• When redetermining Pickle eligibility after a break in Medi-Cal benefits (or Pickle eligibility); for example, client loses Pickle eligibility due to excess income or property.

• When determining Pickle eligibility for persons who are no longer eligible for IHSS.

Exception

Due to the increase in SSI/SSP payment levels effective January 1995, do not use the 8/94 payment level in the following situation:

If a person eligible for Pickle or IHSS in 8/94 (2.3% individual) has income between $603.40 (8/94 SSI/SSP level) and $614.40 (1/95 SSI/SSP level), use the higher $614.40 amount.

Reminder:Persons with income less than $634.40 ($614.40 + $20 disregard) should be eligible for SSI/SSP.

Pickle Ineligible

If, after completing the Pickle “Financial Eligibility Worksheet” (DHS 7021), the client's income exceeds the 8/93, 8/94, or 11/95 SSI/SSP payment level:

• Discontinue Pickle as soon as a 10-day adverse notice of action can be given.• Approve ABD-MN with a share of cost.

50.24.2 SSI/SSP Payment Standards

Persons who were Pickle eligible (or eligible for IHSS) in August 1993 must be evaluated for ongoing Pickle eligibility using the SSI/SSP payment levels that were in effect in August 1993. Likewise, persons who were Pickle (or IHSS) eligible in



August 1994 must be evaluated for ongoing Pickle eligibility using the SSI/SSP payment levels that were in effect in August 1994. Persons who lost Pickle eligibility due to the 12/95 SSP reduction shall be evaluated for Pickle using the current year’s SSI/SSP Standards; and if ineligible, apply the 11/95 SSI/SSP Standards. [Refer to “Background,” page 50-69, for full explanation and procedures.]

Note:[Refer to “Prior SSI/SSP Payment Standards,” page 6-15 and [Refer to “,” page 6-17 for SSI/SSP Payment Standards information.

50.24.3 Annual Redeterminations

Per state directive (EMC2 DHS #97044), annual redeterminations are waived for Pickle beneficiaries that were “grandfathered” into the “Pickle” program in 1993, 1994 and 1995 until further notice. The state is developing special procedures for these cases, therefore, RDs will not be required until new instructions are issued.

In the interim, when a annual redetermination comes due for a “grandfathered” Pickle case, the EW must:

• Change the RD due date to the following year.• Document the RD waiver information on the Maintain Case Comments window.Example:

“5/97 annual redetermination not completed due to state directive to waive redeterminations for “grandfathered” Pickle beneficiaries. Next RD due (date).

50.25Instructions, DHS 7021, Financial Eligibility Worksheet

CalWIN is programmed to evaluate for Pickle eligibility based on SSI information entered in the Data Collection windows. The steps for completing a manual determination using the DHS 7021 are outlined below:



50.25.1 PART A. Needs Test

Enter the applicant's total countable income. This is obtained by completing an MC 176 M - Part I -using only the applicant's earned and unearned income. Subtract the applicable Title II COLA disregard amount.

If the applicant’s total countable income is... And the applicant... Then...

Above the current SSI/SSP payment level for an individual,

Has/does not have an ineligible spouse

The applicant is NOT eligible as a Pickle person. Do not proceed to Parts B through F.

Equal to or below the SSI/SSP payment level for an individual,

Has an ineligible spouse, Complete Parts B through F.

DOES NOT have an ineligible spouse,

Complete Part F only.

50.25.2 Part B. Ineligible Spouse's Unearned Income

Do not include any public assistance income.

Step Action

1. Enter the ineligible spouse's unearned income.

2. a. If ineligible spouse has Title II income, subtract all Title II cost of living increases received since the applicant was discontinued from SSI/SSP.

b. Use amount from Disregard Computation Work Sheet (step 2, line 3)

3. Subtract line B-2 from line B-1 and enter the difference.

4. If there are no children, enter zero on line B-4c.)

a. Enter each Pickle ineligible child's first name in boxes provided.

b. On line 4a, enter the maximum allocation for any ineligible child(ren) not on public assistance.

c. On line 4b, subtract from 4a any income of each of the children, excluding $1,620 per year of student income.

d. On line 4c, enter the remainder for each child, and the total allocation to be subtracted from the ineligible spouse’s unearned income.

NOTE: Do not make any entry in this area for a Pickle eligible child.

(Chart page 1 of 2)



50.25.3 Part C. Ineligible Spouse's Earned Income

Step Action

1. Enter the ineligible spouse's earned income.

2. a. Enter any portion of the allocation for ineligible children that was not offset by countable unearned income (line B-5 minus line B-3).

b. If line B-3 is equal to/greater than line B-5, enter zero on line C-2.

3. Subtract the remaining allocation amount on line C-2 from line C-1 (gross earned income) and enter the difference.

50.25.4 Part D. Ineligible Spouse's Total Income After Allocations

Add amounts in lines B-5 and C-3 to determine the total income after allocation

Note:If the total income after allocations (Part D) is less than the difference between the Federal Benefit Rate (FBR) for a couple and the FBR for an individual, there is no income available for deeming to the applicant. In this case, use only the applicant's income in Part E and the current SSI/SSP payment level for an individual in Part F. If the total income after allocations (Part D) is in excess of the difference between the FBR for a couple and the FBR for an individual, use the amounts from lines B-5 and C-3 in Part E and the current SSI/SSP payment level for a couple in Part F.

5. Subtract line B-4c from line B-3 (countable unearned income) and enter the difference. This is the remaining unearned income amount. If the allocation amount (line B-4c) exceeds the countable unearned income (line B-3), the negative figure on the B-5 is carried over to line C-2 (unused portion of allocation).

Step Action

(Chart page 2 of 2)



50.25.5 Part E. Combined Income

Step Action

1. Enter the applicant's gross unearned income (including any applicable ISM from the DHS 7044). (If VTR, ISM is zero, use “household of another” SSI/SSP payment level in F-1.)

2. Enter the applicant's Title II cost of living (COLA) Disregard amount.

3. Subtract the COLA from the applicant’s unearned income and enter the difference (line E-2 from E-1).

4. Enter the ineligible spouse's unearned income from line B-5, unless the total income amount in Part D is less than the difference between the FBR for an individual and the FBR for a couple, in which case, enter zero in line E-4.

5. Enter combined unearned income of applicant(s) (line E-3) and/or ineligible spouse (line E-4).

6. Enter the $20 any income exclusion.

7. Subtract line E-6 from line E-5 and enter the difference. (If line E-5 is less than $20, enter zero in line E-7.)

8. Enter the combined earned income of applicant(s) and ineligible spouse. Use line C-3 for spouse's income, unless the amount on Part D is less than the difference between the FBR for a couple and the FBR for an individual. In that situation, enter only the applicant’s earned income in line E-8.

9. Enter unused portion of the $20 any income exclusion not offset in line E-7.

10. Subtract line E-9 from line E-8 and enter difference.

11. Enter the $65 work expense exclusion.

12. Subtract line E-11 from line E-10 and enter the difference.

13. Enter 1/2 of the amount of line E-12

14. Subtract line E-13 from line E-12 and enter the difference.

15. Add lines E-7 (combined unearned income) and E-14 (combined earned income) and enter total. This is the amount of income to be considered in determining Pickle eligibility. Enter on line F-2.



50.25.6 Part F. Pickle Eligibility Calculation

Step Action

1. a. Enter the current, applicable SSI/SSP level from chart.

b. If the applicant is blind, resides in the home of another or somehow fits into one of the payment categories other than an individual, use the applicable payment level.

2. a. Enter total countable income. Use the figure on Line A-3 if the Pickle applicant is an individual or couple with no ineligible spouse or the figure on Line E-14 if the applicant is an individual with an ineligible spouse.

b. If line F-2 (total countable income) is equal to or less than F-1 (current SSI/SSP payment level), the applicant(s) is/are categorically needy and entitled to a zero share-of-cost Medi-Cal card (Pickle Person). If both members of a couple meet the eligibility criteria, they are both eligible.

c. If line F-2 is more than F-1, the applicant is ineligible. Enter in the MEDS Pickle Tickler System. NOTE: In a situation where there is a potentially eligible child and parent with an ineligible spouse, determine the eligible parent's financial eligibility using this work sheet. If the parent is eligible, determine the child's financial eligibility using Part IV of the DHS 7019 (Pickle Child). Use the eligible child's countable income only.



50.26Instructions: DHS 7037, Pickle Resource Worksheet

Step Action

1. Real Property - Enter total equity value of all nonexcluded property.

2. Personal Property

a. Enter total cash on hand.

b. Enter total cash in financial institution (checking, savings, bonds, etc.)

c. Enter amount in excess of $1,500 in separately identifiable burial fund. *(The total of c + e may never exceed $1,800.)

d. Enter total CSV of life insurance if total face value exceeds $1,500 per individual. Enter 0 if CSV is excluded.

e. Enter total amount in excess of $1,800, plus accrued interest, in an irrevocable burial trust or contract. (If $1,800 or less, enter 0.)

f. Enter current market value (CMV) of nonexcluded vehicles. NOTE: Exclude one automobile with the highest equity value per household regardless of its value.

g. Enter other Personal Property held or acquired because of value or investment purposes.

h. Enter total value of nonexcluded personal property.

3. Enter total value of nonexcluded resources. (Sum of Part I and II)

4. Enter resource limit for Pickle FBU. [Refer to “SSI Treatment of Resources,” page 50-55.]

5. Compare Parts 3 & 4. Is Pickle person resource eligible? (check Yes/No.)



50.27Annual Pickle Review Requirements

With the implementation of the Craig v. Bontá court order on 7/1/03, all individuals discontinued from SSI/SSP (including potentially Pickle eligibles) are:

• Automatically transferred by DHCS into one of the Craig v. Bontá Aid Codes; 1E, 2E or 6E, AND

• Will continue receiving Medi-Cal benefits until the SB 87 eligibility redetermination process is completed by the county, AND

• Listed on the monthly Exception Eligibles Report in one of the Craig Aid Codes. For potential Pickle beneficiaries, DHCS places a code of “C” in the Pickle Type field on MEDS to identify this unique population. An eligibility determination for the Pickle program must be completed as part of evaluating the individual under the SB 87 process.

50.28Pickle Tickler System

50.28.1 Overview

The Lynch v Rank court order requires that all potential Pickle eligible persons be recorded in the Pickle tickler system in order to allow for future notification and review of Pickle eligibility. On January 1, 1987, a state-wide automated MEDS Pickle tickler system was implemented in order to:

a. Establish a permanent means of identifying and tracking the status of potential Pickle eligibles via a Pickle tickler code on the MEDS database.

b. Provide EWs with an annual listing of persons whose cases must be reviewed for Pickle eligibility at the time of the RSDI COLA. [Refer to “Annual Redetermination (RD),” page 50-66.]

c. Enable EWs to update or correct potential Pickle status in the MEDS tickler system on an ongoing basis.



6. With the implementation of the Craig v. Bontá court order on July 1, 2003, DHCS automatically transfers ABD potential Pickle beneficiaries to one of the Craig Aid Codes 1E, 2E or 6E. A code of “C” is placed in the Pickle Type field on MEDS to identify this population.

7. EWs must ensure potential Pickle eligibility is recorded on MEDS. A manual online transaction may be required to record or change potential Pickle status on MEDS if necessary. [Refer to “MEDS Coding Requirements,” page 50-81.

50.28.2 Coding Requirements

All ABD-MN cases not currently in LTC, must be appropriately screened and coded for Pickle. (Aid Codes 14, 17, 24, 27, 64 and 67.)

Note:Current Pickle eligible beneficiaries are exempt from all coding requirements. (Aid Codes 16, 26, 36, and 66.)

1. Potential Pickle eligibles are ABD-MN persons who are currently receiving RSDI and who were eligible for and received RSDI concurrently with SSI/SSP benefits in any month since April 1977, including persons who:

a. Do not pass the Pickle financial eligibility test (excess income), or

b. Have not received a COLA since their SSI/SSP discontinuance, or

c. Fail to provide essential information for the Pickle eligibility determination, (e.g., refuse to complete the DHCS 7044), or

Note:Beneficiaries who refuse to complete the Pickle review may remain eligible for Medi-Cal as ABD-MN. However, they must be offered Pickle again annually, unless they specifically request no further contact.

d. Are denied Medi-Cal for some reason other than not meeting the Pickle criteria.

2. All ABD-MN persons exempt from further Pickle reviews must be identified including persons who:

a. Are not currently receiving RSDI, or

b. Did not receive SSI/SSP and RSDI concurrently since April 1977, or



c. Specifically request no further Pickle reviews.

Note:Document this information in the Maintain Case Comments window.

50.28.3 MEDS Coding Requirements

Persons Discontinued from SSI/SSP after 1/1/87

Persons whose SSI/SSP is discontinued after 1/1/87 will automatically be coded as potentially Pickle eligible (Code P1) on MEDS by DHCS.

Persons Discontinued from SSI/SSP after 7/1/03

Person’s whose SSI/SSP is discontinued after 7/1/03 will automatically be transferred to one of the Craig Aid Codes 1E, 2E or 6E. A code of “C” will be placed in the Pickle Type on the MEDS record to identify this population.

Recording Potential Pickle Eligibles on MEDS

If an on-line request (using the SC 1296) is necessary to record potential Pickle status, the EW shall:

1. Complete case identifying information.

2. Check the “Other” box and write in the comments section, “Record potential Pickle eligibility code “P” and Pickle status code “1.”

3. Enter the effective date that potential Pickle eligibility was discovered.

4. Obtain EW supervisor signature.

5. Give a screen print of the CalWIN Inquire on Case Information window [Case Members] tab and the white and yellow copies of the SC 1296 to the MTO clerk for processing.

6. Once the MTO completes the transaction and returns the SC 1296, it must be scanned into the IDM system along with the attached screen.

7. Document on the Maintain Case Comments window, that potential Pickle eligibility has been recorded on-line.



Changing/Correcting Potential Pickle Eligibility on MEDS

Complete the SC 1296 as stated above to update the Pickle status code in the following situations:

• Beneficiary has requested no further contact. (Code 2)• Loss of contact, whereabouts unknown. (Code 3)• Not Pickle eligible, or, previous information was incorrect or erroneous. (Code 7)• Deceased. (Code 9)

Note:This change does not need to be recorded on MEDS when the entire case is discontinued due to death, using discontinuance code 001.

50.28.4 Pickle Tickler Process

Each January, at the time of the RSDI COLA, DHS sends a Pickle Tickler notice) to potential Pickle eligibles who:

• Currently receive Social Security Title II Retirement, Survivor’s and Disability Insurance (RSDI) benefits,

• Have been discontinued from Supplemental Security Income/State Supplemental Payment (SSI/SSP) in the last 3 years (for any reason), and

• Were determined ineligible during the Pickle screening process.

Any person who has a Pickle Tickler Code “1,” on MEDS, “Recipient is a potential Pickle eligible,” will receive a “Lynch v Rank Tickler Notice” (Notice Type 52) from DHCS for three consecutive years.

The notice advises clients to contact their local county welfare department if they wish to apply for no share of cost Medi-Cal benefits under the Pickle amendment.

Pickle Tickler Report

In January of each year EWs will receive a listing of persons who received the notice and who must be reviewed for Pickle eligibility. The listing is titled PICKLE TICKLER REPORT.

• The Pickle Tickler report only lists potential Pickle eligibles for the last 3 years.



• EWs are required to determine if the persons included on the Pickle tickler reports are Pickle eligible by the month following the COLA, and send a Notice of Action, whether the person is Pickle eligible or i ineligible.

EWs must change the Pickle Tickler Code on MEDS if it is determined that an individual should not be included on the listing; e.g., deceased, client requests no further contact, not potential Pickle (erroneous information). [Refer to “Pickle Tickler System,” page 50-79 for Pickle Tickler information.]

Stuffers

The permanent injunction in the Lynch v Rank lawsuit requires that stuffers be sent annually in December for three consecutive years for this specific population. Pickle stuffers are not sent to the group of recipients who were discontinued from SSI/SSP due to the 2.7% and 2.3% reductions.

The EW must evaluate and explain Pickle eligibility when clients who have received the stuffer have questions regarding this program. This includes other Title II disregard programs such as the Disabled Adult Child Program.

Approvals

When the client is determined to be Pickle eligible, send an approval notice by the end of the month following the COLA.

Ineligibility

Should the client be determined ineligible for Pickle at this time, Medi-Cal under ABD-MN with a share of cost can be established with an adequate and timely 10-day NOA.



50.29Court Orders: Reese through Hunt

50.30Reese v Kizer

50.30.1 Issue

Whether the community property share of income of a spouse in an LTC facility should be made available to the spouse at home.

50.30.2 Decision

This court order took effect in part on April 29, 1985, to the extent that the counties were ordered to divide community income only if requested to do so by the applicant/beneficiary.

AB 987 was subsequently enacted in September 1985. It required counties to automatically divide community income as of the date one spouse entered LTC or any medical facility. The first month that counties were required to use the new income amounts was December 1985.

[Refer to “Ownership of Income,” page 53-1 for Division of Community Income Procedures.]

50.31Saldivar v McMahon

50.31.1 Issue

Whether the Department of Social Services may provide “adequate” though not necessarily “timely” notices to applicants/beneficiaries of their appeal rights.



50.31.2 Decision

As a result of this court order, beneficiaries will now submit written requests for state hearing directly to the counties. The effect of this court order is a more timely issuance of aid paid pending and more efficient scheduling hearings.

50.32Ball v Swoap

50.32.1 Issue

The issue was whether penalties should be assessed when Medi-Cal final hearing decisions are not issued within 90 days from the date of request for a hearing, and whether beneficiaries whose state appeals were granted, wholly or in part, and whose decisions were not timely, should be entitled to a penalty payment of $100 for each month of delay.

50.32.2 Decision

A stipulation and order was issued on June 23, 1986, with an effective date of October 1, 1986.

50.32.3 Treatment of Payments

Beneficiaries must list these payments as income in the month received.

The payments are exempt as both property and income with no time limit.

50.33Disabled Rights Union v Kizer

50.33.1 Issue

A temporary restraining order has been issued by the Disabled Rights Union v Kizer lawsuit requiring that counties shall not discontinue Medi-Cal for any DDSD eligible beneficiary who is later denied SSI/SSP due to lack of disability.



1. Federal regulations required the State to discontinue all DDSD Medi-Cal beneficiaries who were subsequently denied SSI/SSP due to lack of disability, stating that the SSI/SSP decision was final.

2. EWs received a listing in January 1987 of DDSD approved Medi-Cal beneficiaries who were later denied SSI/SSP due to lack of disability.

3. Any beneficiary discontinued as a result of this listing must be reinstated.

50.33.2 Effective Date

This order was received February 11, 1987 and is effective January 1, 1987.

50.34LTC Prejudice Cases

50.34.1 Issue

AB 987 established the “automatic” division of community property when one spouse enters long-term care (LTC). The law became effective September 29, 1985 and required the Department of Health Services (DHS) to immediately issue a notice to all LTC patients informing them of the new law. However, DHS did not publish this notice until March, 1986.

1. Certain persons may have been eligible for retroactive Medi-Cal for the period September, 1985 through April, 1986 if the division of community property regulations had been applied.

2. On April 18, 1988, DHS mailed a notice to all LTC patients known to MEDS from September, 1985 through 1986 which informed them that they may apply for retroactive Medi-Cal for this period, as they may have been disadvantaged by the delay.

3. EWs were required to review LTC cases in order to identify potentially eligible persons for retroactive Medi-Cal for the period September, 1985 through April, 1986. The case review period was 8/1/88 through 8/31/89.



50.35Hunt v Kizer

50.35.1 Issue

The issue was whether old, unpaid medical bills could be used to meet a current month's share of cost.

50.35.2 Decision

As a result of a preliminary injunction issued by the U.S. District Court, a current or future month's share of cost may be reduced by any unpaid medical bill provided the beneficiary remains legally liable for the bill. Proper documentation of the bill must be provided.

50.35.3 EW Instructions

[Refer to “Hunt v. Kizer (Applying Old Medical Bills to the Share of Cost),” page 63-1 for EW instructions.]

50.36Court Orders: Sneede v Kizer

50.36.1 Background

Effective April 1, 1991, the United States District Court ruled in the case of Sneede v Kizer that Medi-Cal regulations governing MFBU composition violate federal law.

Federal law limits financial responsibility for medical care to:

• Spouse for spouse, and• Parent for child.

This means that the income and property of an adult can be used only to determine eligibility and share of cost for him/herself, his/her spouse, and his/her natural or adopted children.



Therefore, the property and income of persons who are not financially responsible for one another cannot be combined when it will result in either:

• A denial for excess property, and/or• A share of cost.

The Sneede procedures were modified by the November 16,1995 Gamma v. Belshe lawsuit. The court ruled that the original Sneede deeming procedures violated federal law. The Gamma lawsuit challenged the validity of Sneede procedures that required the income of a responsible relative to be deemed without first allowing a sufficient amount of that income to be retained by the responsible relative to meet his/her needs. Implementation of the mandated change which allowed a $600 income deduction for his/her needs began 7/22/96.

50.36.2 Definition “Sneede Case”

A “Sneede case” is one in which the MFBU has either:

• Excess property, or• A share of cost,

AND includes at least one of the following Sneede class members:

• A stepparent, or• An unmarried couple with at least one mutual child, or• A child with his/her own nonexempt property and/or income, or• A caretaker relative, other than a parent, who chooses to be in the same MFBU

with the child(ren) for whom care is provided.

50.36.3 Not Optional

When an MFBU meets the criteria of a “Sneede case” (above), the family does not have the choice to not apply Sneede procedures, remaining in a single MFBU, should Sneede procedures be to their disadvantage. For example, Sneede could result in a higher share of cost for some family members.

Note:The family may, however, choose to exclude a child with his/her own income or property.



50.36.4 Examples

Child with separate income

The MFBU includes a mother who receives $740 per month, Social Security disability benefits, and her child, who receives $370 per month Social Security, based on his mother's disability. Together, they have a share of cost. This is a Sneede case because the child's Social Security is considered to be his own separate income.

Stepparent case

A mother, her son, a stepfather, and their mutual child are applying for Medi-Cal. Mother has medical expenses. The stepfather is fully employed. Mom has UIB and the MFBU has a share of cost.

Sneede rules apply. The stepfather is responsible for himself, his wife and their separate child, but not for his stepson.

Nonparent Caretaker Relative

Two children live with their 55 year old grandmother. Grandma has no spouse nor children of her own living in the home. She is not disabled, and chooses to be in the MFBU. AFDC-MN linkage exists through the absent parent deprivation of the grandchildren. Grandma is employed part time and she receives $400 per month child support from the absent father of the grandchildren. Since the MFBU has a share of cost, Sneede rules apply. Each person's income must be separated:

• Grandmother with her earnings.• Child 1, with only his/her share of child support.• Child 2, with only his/her share of child support.

Grandmother has no financial responsibility for her grandchildren. The siblings are not combined, even though they receive equal amounts of support, as they are not financially responsible for each other. If there were no SOC, then all of their income would be combined in one MFBU.

50.36.5 Separate Determinations

Sneede property and income determinations are two separate and independent determinations.



Sneede may apply only when evaluating a family's property, or only when determining income, or to both.

When a Sneede class member meets property limits but has a SOC under existing regulations, Sneede procedures must be applied, but only to the SOC determination.

Example:A stepparent household is requesting Medi-Cal for all family members. The entire MFBU is within the property limit; therefore Sneede property regulations do not apply. A budget is completed, which includes the entire MFBU. A share of cost results; therefore, Sneede regulations are applied only to this family's income.

When a Sneede class member would have no SOC but is ineligible under standard regulations due to excess property, Sneede procedures are applied only to the property determination.

When a Sneede class member has both excess property and a SOC under existing Medi-Cal regulations, Sneede procedures are applied first to the property determination and then if eligibility is established, Sneede is applied to the SOC determination

50.36.6 Denial or Discontinuance of Sneede

NoncooperationJust as the Sneede decision limits financial responsibility to spouse-for-spouse and parent-for-child, denial/discontinuance actions for noncooperation are limited to the noncooperative individual and those for whom he/she is responsible. Those members of the MFBU who are not the responsibility of the noncooperative individual may not be denied or discontinued.

Status reportsOnly those MFBU members subject to the Midyear Status Report (MSR) requirement are discontinued for failure to submit the MSR.



50.36.7 General Procedures

EWs are to apply these general procedures for cases which meet Sneede criteria:

Step Procedure

1 Identify new applicants and current recipients who meet the potential Sneede class member criteria.

• Complete the Sneede Property Screening form whenever an MFBU has excess property.

• Appropriate relationship identifiers and person-specific income will identify cases with Sneede class members and a share-of-cost and will apply Sneede rules to the eligibility determination.

2 Continue to evaluate the entire MFBU to determine if family members have Medi-Cal linkage.

3 Determine Relative Responsibility.

• This step identifies which members of the MFBU will receive property and/or income allocations from their spouse or parent(s).

• Property and income allocations are only from spouse to spouse and parent to natural/adoptive child.

4 Determine property and/or income allocation.

1. Ownership of income and property must be verified and clearly documented on a Sneede case.

2. Each person in the MFBU, for whom the parent or spouse is responsible, will receive an equal share of their responsible relative's property and/or income.

3. Property/income can be allocated only one way, from a parent and/or spouse to:

a. Self b. Spouse (in home) c. Child(ren), but NOT unborns.

NOTE: A parent cannot allocate income to him/herself as revised by Gamma v Belshe in 11/95. [Refer to “Income and Property Allocations, General,” page 50-94 for Allocation Rules.]

5 Complete Sneede Property Worksheet and/or Income Determination (budget) when eligibility is determined manually.



50.36.8 Implementation Date

Sneede procedures apply to all new and pending applications effective April 1, 1991.

Sneede procedures are also to be applied to each of the three retroactive months, if Retro is requested.

50.37Sneede Screening

Screening new applicants and current recipients is STEP 1 of the Sneede eligibility determination process.

50.37.1 Property

• Sneede property determinations are completed by the CalWIN system.

6 Determine the “Mini Budget Units” (MBUs) within the family. An MBU determination is NOT the same as a responsible relative determination (Step 3).

1. Mini Budget Units are separated out from the initial MFBU in order to prevent the incorrect commingling of property and/or income of persons who are not financially responsible for each other. MBUs are based on:

a. Family relationships, andb. Whether a child has his/her own separate nonexempt property or income.

2. There can be several MBUs within a single family.

7 Determine if each MBU is within the property limit and/or if the MBU has a share of cost.

• Some MBUs may be property ineligible and others eligible.

• Some MBUs may have no share of cost (SOC), while others have a SOC. Or, there can be different SOC amounts for each MBU.

8 If an MBU has a share of cost (Step 7) and includes a pregnant woman or a child under 19, determine eligibility for the appropriate special or Property Waiver Federal Poverty Level Programs (100/133/200%).

Step Procedure



• If an MFBU has excess property and includes child(ren), the “Sneede v Kizer Property Screening Questions” (MC 175-P) may be completed for manual determinations.

• If the answers to all questions are “NO”, STOP. The family is ineligible due to excess property.

• If any answer is “YES”, continue with a Sneede property determination.

50.37.2 Income

• If an MFBU has a share of cost (SOC) and includes children, the appropriate relationship Identifiers and person specific income will automatically identify cases which meet Sneede income criteria and do Sneede budgeting.

• If an MFBU meets any of the screening criteria:

• The 100/133/200% Programs are applied after a Sneede budget is completed.

• Adjustments for unpaid medical bills (Hunt v Kizer) are applied after the Sneede budget is completed, if a SOC still remains.

50.38Responsible Relative Determination

The responsible relative determination is Step 2, once an MFBU meets any of the Sneede screening criteria.

50.38.1 MC 175-2

• The “Sneede v Kizer Responsible Relative Determination” (MC 175-2) is completed in order to correctly allocate property and/or income from:

• Spouse to spouse, and• From a parent to a natural or adoptive child.



• Identify and add together all of the family members in the MFBU for whom each parent and/or spouse are financially responsible:

• Only one responsible relative determination is needed for each Sneede case, or for a Sneede property determination.

50.39Income and Property Allocations, General

50.39.1 General Allocation Rule

Net nonexempt property and income can only be allocated in one direction.

50.39.2 Property Allocation Rule

The net nonexempt property of a spouse or parent must be equally divided within the MFBU among one’s:

• Self• Spouse • Natural/adoptive child(ren)

Note:The allocation is not reduced by the amount of the spouse’s or child’s own property.

50.39.3 Income Allocation Rule

The net nonexempt income of a spouse or parent (less a $600 income deduction for his/her needs) must be equally divided within the MFBU among one’s:

• Spouse• Natural/adoptive child(ren)

List: Do Not List:

Eligible persons Unborns

Ineligible persons PA recipients (e.g.CalWORKs, SSI)

Excluded child(ren) Other PA recipients (e.g. IHSS)



Note:The income allocation from a parent to themselves was eliminated by the Gamma v Belshe court decision in 11/95. (Each parent is allowed a $600.00 income deduction for his/her needs prior to equally allocating income to their spouse and/or children.)

50.39.4 Property and Income

Eligible, ineligible, and excluded family members receive an equal allocation of property/income.

50.39.5 Allocations Not Allowed

The following rules explain when property and income allocations cannot be allowed.

• A child’s own separate property/income cannot be allocated to his/her parent(s) or siblings.

• If parents are unmarried, they cannot allocate property/income to each other.

• There is never an allocation from anyone other than a spouse or a natural/adoptive parent.

Example:A non-parent caretaker relative is in the MFBU. If Sneede applies, the caretaker relative’s property/income is never allocated to the child(ren), as s/he is not financially responsible for them.

• Never allocate to an unborn.

• A parent may not allocate income to him/herself as revised by Gamma v. Belshe in 11/95, but is allowed a $600 income deduction for his/her needs prior to equally allocating income to his/her spouse and/or child(ren).

50.39.6 Allocation Example

An MFBU of 5 with a share of cost includes the following persons:



Father, mother, their mutual child, their unborn, and mother’s separate child.

• Father’s income (less a $600 income deduction for his needs) is divided by 2, and equally allocated to mother, and their mutual child.

• Mother’s income (less a $600 income deduction for her needs) is divided by 3 and equally allocated to her husband, their mutual child, and to her separate child.

• The unborn does not receive an allocation from either parent. However, the unborn will later be included in the Mini Budget Unit which includes the mother.

50.39.7 Property/Income are Separate

Sneede property and income allocations are independent of each other.

• Apply property allocation rules only when the MFBU has excess property.• Apply income allocation rules only when an MFBU has a share of cost.• Do not apply allocations to both property and income unless the MFBU first has

excess property, and then has a share of cost.

50.39.8 Treatment of Children

The following chart summarizes the treatment of children in a Sneede case.

Parent/Spouse Father Mother

Others for Whom Each Parent/Spouse is Responsible

Spouse (Mom) Spouse (Dad)

Mutual Child Mutual Child

2 persons Separate Child 3 persons

Sneede Children

Receive Income/Property Allocation from Parent(s)

Included in Maintenance Need and Property Limit

Link Other Family Members in MFBU

Unborns No *Yes, include in mother’s MBU

Yes

*An unborn may be included in its father’s MFBU/MBU if the mother is PA/Other PA; for example, she is receiving AFDC or SSI.



50.40Mini Budget Unit Determination

50.40.1 Definition

“Mini Budget Units” (MBU) are separate sub-units within a family, which are derived from the initial MFBU in order to prevent the incorrect commingling of property and income of persons who are not financially responsible for each other.

• MBUs are based on family relationships (relative responsibility), and whether a child has his/her own separate nonexempt property or income.

• A single family may have several MBUs.

• An MBU determination is not the same as a responsible relative determination.

50.40.2 Property/Income MBUs are Separate

If a Sneede case has both excess property and a share of cost, the MBU composition for property may not be the same as the MBU composition for income. For example, a child may have separate income (child support), but no separate property, or a stepparent may or may not have both property and income.

Eligible Children Yes Yes Yes

Ineligible Children Yes Yes, if in the same MBU

No

Excluded Children Yes No No

Sneede Children

Receive Income/Property Allocation from Parent(s)

Included in Maintenance Need and Property Limit

Link Other Family Members in MFBU

*An unborn may be included in its father’s MFBU/MBU if the mother is PA/Other PA; for example, she is receiving AFDC or SSI.



50.40.3 Rules for All Cases

The following rules apply to all MBU determinations:

• Each family member in an MFBU can only be included in one Mini Budget Unit.• Ineligible family members are included in MBUs.• Unborns are always included in their mother's (including a minor mother's) MBU.

Exception:If the pregnant mother is not in the MFBU because she is PA/Other PA (for example, CalWORKs, SSI), the unborn is included in the father's MFBU/MBU.

• Excluded children are NOT included in any MBU.

• Married couples, and their MUTUAL child(ren) with no countable income/property of their own, are together in one MBU.

• Stepchildren are never included in an MBU with their stepparent.

• Each child with nonexempt income/property of his/her own is in a separate MBU.

• Separate child(ren) (with no income or property) of a PA/Other PA parent who is not in the MFBU are in a separate MBU with full maintenance need.

50.40.4 Specific MBU Determinations

This section defines who is included in each Mini Budget Unit, depending on family relationships and who has income and/or property.

Married Couple and Mutual Children (No Stepchildren)

• Married spouses are in a single (primary) MBU.

• Include all mutual children with no countable income/property of their own in their parent's MBU.

• A separate MBU is established for each child who has his/her own separate nonexempt income/property.



Married Spouses (Stepparent), Mutual and Separate Children

• Married spouses are in a single (primary) MBU.

• Include all of their mutual children with no countable income/property of their own in the parent's MBU.

• All of the father's separate children with no countable income/property of their own are in a separate, single MBU.

• All of the mother's separate children with no countable income/property of their own are in a separate, single MBU.

• Each child with nonexempt income/property of his/her own must be in a separate MBU.

Example:An MFBU with a SOC includes a married couple with one mutual child. Their mutual child has no income. They each have a separate child. Mother receives $200 per month child support from the absent parent. The child support is considered to be the child's separate income.

Married Parents, Only the Separate Children of One Parent Want Medi-Cal

• The MFBU consists of the child's parent (as an ineligible person) and only his/her separate child(ren) who want Medi-Cal. [Refer to “Stepparents,” page 60-31 for treatment of this situation.] If after following those procedures for a “Stepparent Case”, the MFBU has excess property and/or a share of cost, follow these MBU rules if at least one of the children has his/her own separate property and/or income.

• Include the ineligible parent and his/her separate chid(ren) with no countable property/income in a single MBU.

MBU “A” (Primary) MBU “B” MBU “C”

Father Father's Separate Child (No income)

Mother's Separate Child (child support)

Mother

Mutual Child



• Establish a separate MBU for each child who has separate nonexempt income or property.

Single Parent, Children

• The single parent and all of his/her children with no countable income or property of their own are included in one MBU.

Note:Full and half siblings can be included in the mother's MBU, as long as they have no countable separate income/property.

• Each child who has nonexempt income/property of his/her own is in a separate MBU.

Example:The MFBU includes an employed mother and 3 children. She receives $600 per month child support from the absent parent for all 3 kids. The family of 4 has a share of cost. Four separate MBUs would then be established: Mother is given a $600 needs allowance under Gamma. Each child is in his own MBU with 1/3 of mother's net nonexempt earnings and his/her share of the child support.

Unmarried Parents, Mutual and Separate Children

• Each parent is in his/her own MBU.

• All of their mutual children with no countable income or property of their own are in a separate MBU from either parent.

• All of father's separate children with no countable income/property of their own are in their father's MBU.

• All of mother's separate children with no countable income/property of their own are included in their mother's MBU.

• Each child with nonexempt income/property of his/her own must be in a separate MBU.



Example:An MFBU of 7 persons with a share of cost includes unmarried parents with 2 mutual children. The mutual children have no income. Father has 2 separate children, one has nonexempt income. Mother has a separate child with no income.

Minor Mother With Child(ren), Living With Her Parent(s)

Note:If all individuals are requesting Medi-Cal, it may be necessary to establish a separate case for each separate MFBU.

50.40.5 Parent(s)' MBU

If Sneede applies to her parent(s) case:

• Include the minor mother as an eligible person in her parent(s)' MBU if she has no income/property of her own.

• Establish a separate MBU for her if she has separate nonexempt income/property.

50.40.6 Child(ren)s' MBU

If Sneede applies to her child(ren)s' case:

• The minor mother is an ineligible person in her child(ren)s' MBU, if the child(ren) have no countable separate property/income.

• Establish a separate MBU for each child with separate nonexempt property/income.

• If all of the minor mother's children have their own nonexempt income or property, establish separate MBUs for the minor mother and for each child.

MBU “A” (Primary) MBU “B” MBU “C” MBU “D”

• Unmarried mother • Unmarried father 2 mutual children (with no income)

Father's separate child (with his own income)

• Mother's separate child (no income)

• Father's separate child (no income)



50.40.7 Non-Parent Caretaker Relative Households

Linkage Rules

Note:These rules apply to all Medi-Cal cases, regardless of whether or not Sneede applies to the MFBU.

• A caretaker relative who lives with his/her spouse and/or children can choose to be in the same MFBU with the child for whom he/she is caring unless he/she requests otherwise and has his/her own linkage (ABD). The caretaker can also be in the same MFBU as his/her spouse and or children.The caretaker who is also a spouse or parent may be in two separate MFBU’s.

Example:Grandpa (age 62) and Grandma (age 60) have care and control of their 14 year old granddaughter. One of the nonparent caretakers (Grandpa or Grandma) can establish linkage through the absent parent deprivation of their grandchild. The remaining spouse is ineligible for Medi-Cal, unless he/she has other linkage (ABD-MN). The relative caretaker and the granddaughter are together in one MFBU.

• A caretaker relative with or without a spouse/children of his/her own:

• Can choose to have Medi-Cal linkage through the absent parent deprivation of the child for whom care is provided.

• If s/he has other linkage, for example, is ABD-MN, can choose to be in his/her own MFBU or establish AFDC-MN linkage through the child(ren) for whom care is provided, whichever is most advantageous.

MBU Determinations

• If the caretaker relative chooses to be in the same MFBU with the child(ren) and there is excess property or a share of cost:

• The caretaker relative is in a separate MBU.

• Establish a separate MBU for all child(ren) with no countable income or property of their own.

• Establish a separate MBU for each child with his/her own nonexempt separate property/income.



Example:Two children reside with their aunt. One child receives $350 per month Social Security (RSDI) due to his deceased father. The other child has no income. Their aunt is age 57 and is employed part time. She has no spouse nor children of her own living in the home and she wishes to have Medi-Cal. Together, the MFBU has a share of cost, so Sneede procedures must be applied.

Note:Aunt retains her AFDC-MN linkage, even though she is now in her own “MBU”.

• If only the child(ren) are in the MFBU and there is excess property or a share of cost:

• Establish one MBU for all children with no countable property/income.

• Establish a separate MBU for each child with his/her own nonexempt separate property/income.

50.40.8 MC 175-4

Once the Sneede property and/or income determination is completed, the MC 175-4 may be used to complete “Mini Budget Units” determinations manually.

The MC 175-4 is used for both Sneede property and income determinations.

If both excess property and a share of cost exist, two separate MC 175-4 forms need to be completed.

MBU “A” MBU “B” MBU “C”

Aunt Nephew with RSDI Nephew with No Income

Step Action

1 List each person by name or person number in only one MBU according to the rules contained in this section.

2 Designate the primary MBU. The primary MBU includes the parent(s) and any mutual child(ren) with no countable income/property.

3 Enter each person's share of net non-exempt income or property, (from the MC 175-3I or MC 175-3P).

4 Total the income or property for each MBU.



50.41Maintenance Need Income Levels and Property Limits

50.41.1 General

Allow each MBU to have either the full or prorated Maintenance Need or property limit depending upon:

• Who is included in the MBU, and• The number of persons in each MBU.

CalWIN will determine the correct Maintenance Need for the MBU depending on the relationship identifiers and the person specific income.

50.41.2 Full Amount

The following MBUs receive the full Maintenance Need or property limit:

• Any MBU that includes an adult.

Note:An ineligible minor parent is considered to be an adult in her child(ren)'s MBU.

• Each MBU in a non-parent caretaker relative household.

5 Enter the Sneede Maintenance Need Level or Property Limit, either:

• The full standard limits, or

• The prorated income or property limit if the MBU contains only child(ren). [Refer to “Maintenance Need Income Levels and Property Limits,” page 50-104.]

6 If an MBU has excess property, check to see if linkage still exists for other family members. Determine eligibility for the appropriate Federal Poverty Level (FPL) Property Waiver Program for children under 19.

7 If an MBU has a share of cost, determine eligibility for the appropriate Federal Poverty Level Programs (100/133/200%) for children under 19.

8 Establish “Mini Budget Units” as applicable.

Step Action



• An MBU which consists only of the separate child(ren) of a parent who is PA/Other PA, even though the child(ren) have no income or property of their own.

50.41.3 Prorated Amount

An MBU which includes only children receives a prorated Maintenance Need or property limit based on:

• The number of children in the MBU, and• Whether one or both of the child(ren)s' parents are in the home.

50.41.4 Formula

Use the Chart Book to determine the correct prorated Maintenance Need or property limit for each MBU. [Refer to “Sneede Maintenance Need Income Levels (MNIL) and Property Limits,” page 5-43.]

The prorated amounts were computed as follows:

Example:An MBU consists of 2 children. Both of their parents are in the home. 1. Full Maintenance Need for 4 = $1,100 2. $1,100 divided by 4 = $275 3. Multiply $275 by 2, which is the number of children in the MBU = $550 Prorated Maintenance Need for an MBU of 2 children with 2 parents in the home = $550

Step Procedure

1 Determine the full Maintenance Need or property limit for:

• The total number of children in the MBU, PLUS

• The number of natural/adoptive parents in the home, one or two.

2 Divide by the total number of persons in Step 1.

3 Multiply the result in Step 2 by the number of eligible and ineligible children in the MBU.

4 Round up the result in Step 3 to the nearest dollar.



50.41.5 Prorated Maintenance Need Income Levels and Property Limits

Use the Chart Book to determine the Prorated Maintenance Need Income Levels and Property Limits for MBUs Which Contain Only Child(ren). [Refer to “Sneede Maintenance Need Income Levels (MNIL) and Property Limits,” page 5-43.]

Note:The child(ren) must be living with natural/adoptive parent(s). If the child resides with another caretaker relative, allow the full Maintenance Need and property limit for each MBU. Do not count an SSI/SSP parent when determining the number of parents for a child's MBU Maintenance Need level.

50.42Property Determination

50.42.1 General

This section contains special requirements that apply to Sneede property determinations.

After Sneede procedures are applied, some family members may be property eligible, while others are ineligible due to excess property.

• If one or more MBUs are ineligible due to excess property, determine if linkage still exists for other family members.

• Do not reallocate property once an MBU is determined to be ineligible for excess property.

50.42.2 Property Allocations

Follow these rules when allocating net nonexempt property:



Married Couple With Only Mutual Children

• Combine the couple's total property.• Allocate equal portions to each spouse and each mutual child.

Stepparent Household

• Each spouse owns:

• His/her separate property, and• One half of their community property.

• The property of each spouse is then equally allocated to:

• Self.• Spouse.• Natural/adoptive children.

Unmarried Couple With Mutual Children

• An unmarried couple has no community property.• Each parent's separate property is equally allocated to:

• Self, and• His/her children.

50.42.3 When Only One Property Exemption Applies

Whenever property regulations specify that only one item can be exempt (e.g., a car), and the MFBU owns more than one, the client may choose which to exempt.

• Under Sneede, it may not be to the MFBU's advantage to exempt the item of greatest value, depending on ownership, who the property will be allocated to, and which child(ren) have their own separate nonexempt property.

• If a different exemption would allow certain individuals to be eligible, the client will have to determine which to choose.

• If the client doesn't choose, the EW shall exempt the item of greatest value.



50.42.4 Exemptions for Unmarried Couples

Each unmarried partner receives a full set of property exemptions because unmarried persons have no financial responsibility for each other.

• For example, each person can exempt one motor vehicle and the first $6000 of utilized other real property.

• Each unmarried partner is allowed one principal residence exemption.

• An unmarried parent may give his/her property exemptions to his/her separate or mutual child if the parent doesn't want or need the exemption.

• A mutual child is not allowed two sets of exemptions.

50.42.5 Exemption for Single/Married Parent(s)

A single parent or a married couple is allowed only one set of exemptions.

50.42.6 Exemptions for Other Caretaker Relative

A nonparent caretaker relative in the same MFBU with the child(ren) for whom care is provided is allowed one set of exemptions.

Note:The caretaker relative cannot give this exemption to the child(ren), as no financial responsibility exists.

The children (all together) are allowed only one set of exemptions.

50.42.7 Changing Exemptions

Usually, a request to change exemptions is effective the month following the month of request. However, if an MFBU or MBU becomes property ineligible and requests a change of exemptions within 10 days of the mailing date of the NOA, the change may then be effective the first month in which the adverse action occurred.



50.42.8 Jointly Held Assets

Determining ownership of jointly held assets within and outside of the MFBU can be critical to certain Sneede property determinations.

Presume equal ownership of property which is owned jointly with other members of the MFBU.

If the client who holds legal title to the property (either solely or jointly) claims that the property belongs to someone else (either within or outside of the MFBU):

• The client must provide evidence which clearly substantiates his/her claim.• Signed affidavits alone are NOT sufficient evidence.• When the joint owners are in the same MFBU, it is not necessary to transfer

legal title to the actual owner.

Example 1:

A child has a bank account which the parents established for the child's future education. The parents are listed on the account with the child; there is no trust document to govern use and access to the funds. Since all three members of the MFBU have access to the bank account, presume equal ownership of the funds and divide it equally among the three of them. The presumption of equal ownership may be rebutted.

Example 2:

The MFBU includes a father and his teenage son. On the MC 210 they list the son as the sole owner of a second car. However the car registration lists only the father's name. The father states that his son paid for the car with his own money, but for insurance purposes the car is only registered in the father's name. They present a bill of sale which shows that the son purchased the car; and, a bank statement which shows the withdrawal from the son's savings account. The verification clearly establishes that the son is the actual owner. The EW will copy all proof and document the case to show that the son's sole ownership of the car is established.

Note:There is no need to actually transfer this car to the son's name, as he has established it is his own property. To do so would be disadvantageous to the MFBU. This only applies to property owned within the MFBU.



50.42.9 Procedure

Follow these steps to complete a manual Sneede property determination:

Example 1

Unmarried Parents

Unmarried parents, Bob Bates and Sharon Wilkes, are applying for Medi-Cal for themselves, their mutual child, Randy Bates, and Sharon's separate son, Tom Wilkes. Together, the family has excess property:

Step Procedure

1 Complete the “Property Screening” form, MC 175-P.

2 Complete the “Responsible Relative Determination” (MC 175-2) ONLY when the MFBU includes a parent.

3 Determine ownership of property, then complete the “Sneede v Kizer Property Worksheet” (MC 175-3P).

• Section I Determine property allocation from parent/spouse. (Skip if nonparent caretaker relative.)

• Section II Complete spouse to spouse allocation, only if couple is married.

• Section III Enter net nonexempt property of each child or the non-parent caretaker relative.

4 Complete the “Mini Budget Unit Determination” (MC 175-4), entering each person's net nonexempt property from Step 3.

5 Add the net nonexempt property for each MBU and compare the total to the correct property limit for the MBU.

6 If any MBU has excess property:

• Reevaluate property exemptions to see if a different exemption will affect eligibility.

• Check to see if linkage still exists for other family members.

• Deny only those persons who are determined to be ineligible.

Bob and Sharon's joint checking account $1,800

Bob's separate savings account 1,700

Sharon's separate savings account 300

Cash on hand, $25 (Sharon), $50 (Bob) 75



Example 2

Stepparent Household

A married couple, Richard and Paula Lewis, apply for Medi-Cal. They have two mutual children, Jennifer and Michael. Paula has a separate child, Kathy Austin, age 18. Paula currently needs Medi-Cal and is linked through the absent parent deprivation of her daughter. Richard, the PWE, is employed full time and has no linkage. Together, they exceed the property limit:

Sharon's '91 Toyota 150

'96 Ford ($3,000) jointly owned, exempted 0

TOTAL $4,025

Property Limit (4) -3,300

Excess Property $725

MBU “A” MBU “B” MBU “C” MBU “D”

Sharon Bob Randy Tom

• 600• 300• 25• 150

• 600• 850

• 600• 850

Joint checking account $900

Joint savings account 1,600

Cash on hand 100

'88 Chevy (parent's) 3,500

'89 Dodge (Kathy's) $4,200 (exempted) 0

Kathy's checking account 200

TOTAL $6,300

Property Limit (5) -3,450

Excess Property $2,850



Kathy's car was paid for by her father. By exempting the vehicle of highest value (Kathy's), Kathy is the only one eligible when Sneede procedures are applied. However, if the parent's car is exempted, the Lewis' are property eligible, but Kathy is not. And, there would still be no linkage for Paula Lewis, as an ineligible or excluded child cannot establish linkage. The family must then decide which children are to receive Medi-Cal and whether or not to spenddown.

Step 1 - Property Screening Questions (MC 175-P)

Step 2 - Responsible Relative Determination (MC 175-2)

Step 3 - Property Worksheet (MC 175-3P)

Step 4 - Mini Budget Units and Property Determinations (MC 175-4)

50.43Income Determination

50.43.1 General

This section contains special requirements that apply to Sneede income determinations. When Sneede procedures are applied, the MFBU is divided into “Mini Budget Units” (MBUs). Some family members may then have no share of cost, while others have a share of cost. Or, each MBU may have a different share of cost.

• Ownership of income must be verified for a Sneede case.• Income is the “name on the check rule”.Exception:

Certain checks are intended for more than one person. For example, a check from an absent parent may include spousal and child support. Social Security benefits for minors are paid to an adult, etc.

• Allocate only net nonexempt income.• Applicable income deductions are applied to the child's own gross income before

it is added to the net nonexempt income allocated from his/her parents.

50.43.2 Support Payments

Child support payments are treated as the child's separate income.



• Obtain court order whenever possible.

• When there is no court order or when the amount being paid is different from the court-ordered amount, the client must attempt to get a written statement from the absent parent which clarifies for whom the payments are intended and how much.

• If not provided, accept the client's statement about how the payments are to be allocated; or, if the client doesn't know, equally prorate the support payments.

Note:When a parent receives “back child support” for an adult (a child who is now over 18 years), the income is counted as “other unearned” income TO THE PARENT because it is considered a reimbursement for money spent in the past. The child support deduction is allowed from the other unearned income.

50.43.3 Unearned Income In-Kind

Income-in-kind is treated somewhat differently when doing a Sneede budget. These rules apply:

• Unearned income in-kind which is provided by a member of the MFBU is exempt.

Example:An MFBU which includes mother, father, their mutual child and mother's separate child has a share of cost. Mother wants Medi-Cal. Sneede rules apply, as this is a stepparent household. Father has earnings and pays all household expenses. No one else has income. Mother's separate child is in his own MBU. Income in-kind from the stepfather is not counted, as the stepfather is a member of the MFBU. If the whole MFBU received income in-kind, for example, free rent, from someone else, then it would be counted.

• Unearned income in-kind received by the entire MFBU is equally prorated among the members of the MFBU.[Refer to “Stepparent Case Income Determination,” page 60-33].

Example:Unmarried parents and their mutual child receive free rent from a relative. Income in-kind for 3 is $225. Each person's separate prorated share is $75. The child's share of income in-kind is considered his separate income.



• Unearned Income in-kind which is only received by certain members of the MFBU is income only to the persons who receive it. [Refer to “Stepparent Case Income Determination,” page 60-33.]

Example:Unmarried parents and their mutual child reside with the mother's aunt. The aunt provides free housing for her niece and the baby. The child's father pays $100/month rent for himself only. Income in-kind for 2 is counted, $206. Mother and baby each receive half, $103.

• Unearned income in-kind received by a parent is not allocated to that parent's child(ren).

Note:The parent's prorated share of in-kind income is subtracted out (on the MC 175-3I) before the parental allocation is totalled.

Example:The MFBU consists of a married couple and their 2 mutual children. The family receives free rent and utilities. Income in-kind for 4 is $277. Each person's share is $69.25. The parents' share is not allocated to their children.

50.43.4 Earned Income In-Kind

Earned income in-kind is treated as earnings to the wage earner.

Example:John is married and has two children. In addition to other income, he manages an apartment complex and receives free rent. In-kind housing for 4 persons is considered to be his earnings. It is then equally allocated to those persons in the MFBU for whom he is responsible.

50.43.5 $50 Child/ Spousal Support Deduction

Only one $50 child/spousal support deduction is allowed per MFBU. Therefore, the $50 deduction must be prorated equally among the persons for whom support payments are intended.



Example:A working mother receives child support for her 3 children. Since child support is considered to be the child's separate income and the MFBU has a share of cost, this is a Sneede case. Each child receives a $16.66 child support deduction.

50.43.6 Dependent Care Deduction

The child care deduction, or the cost for care of an incapacitated person, shall be deducted from the earned income of the person who pays it. The expense must be for a person who is in the MFBU in order for it to be an allowable deduction.

50.43.7 Other Health Coverage Premium

The Other Health Coverage Premium shall only be deducted from the income of the family member who actually pays it.

50.43.8 ABD-MN Deductions

When a Sneede case includes an ABD-MN person:

Married Couple

When one or both spouses is ABD, or is the parent of a blind/disabled child, they EACH receive FULL ABD-MN income deductions, (the $20 any income deduction, and, if applicable, the $65 + 1/2 remainder earned income deduction).

Note:This is a departure from regular budgeting rules, intended for ease of administration.

Unmarried Couple

Unmarried persons are not financially responsible for one another. Each unmarried person who is ABD-MN, or who is the parent of a blind or disabled child, receives FULL ABD-MN income deductions.

Blind/Disabled Child

A blind or disabled child always receives FULL ABD-MN income deductions.



50.43.9 Income Determination Procedure

Follow these steps to complete a Sneede income determination for month(s) which are not on MACB:

Step Procedure

1 Complete “Income Screening Questions”, MC 175-I.

2 Complete the “Responsible Relative Determination” (MC 175-2) ONLY when the MFBU includes a parent.

3 Complete the “Net Nonexempt Income Determination” (MC 175-3I):

• Be careful to keep each person's income listed in the column directly under his/her name.

• Section I - Enter name of each person in the MFBU in a separate column. Do not list an unborn. Use the Continuation Sheet (MC 175-3I.1) if there are more than 2 children in the MFBU.

• Section A - Enter each person's net nonexempt unearned income. If child/spousal support is received by more than one person, prorate the $50 deduction among the persons who receive it, then enter each person's net support on line 3. Show computation at the bottom of page. (This area is also used to show an income in-kind proration.)

• Section B - Complete only when there is an ABD-MN person in the household AND s/he or the spouse/parent of the ABD-MN has earned income.

• Section C - Enter net nonexempt earned income of AFDC-MN/MI individuals after completing deductions on the MC 176W, Part IV.

• Section D - Enter each person's total countable earned and unearned income.

• Section E - Enter other deductions. Note: Subtract the health insurance premium only from the income of the person who pays it.

• Section F-Deduct the $600 Parental/Spousal Allocation (Gamma) and compute the allocation from the parents to his/her natural/adoptive children. Skip if no parent in MFBU. Refer back to the MC175-2 to determine the number of persons that each person is responsible for.

Reminder: Unmarried persons cannot allocate to each other and parents cannot allocate to themselves.

Note: As revised by Gamma v Belshe (11/95), a parent cannot allocate to himself.

4 Complete the “Mini Budget Unit” determination (MC 175-4), entering each person's net nonexempt income from Step 3. [Refer to “Mini Budget Unit Determination,” page 50-97.]



50.43.10 PA/ Other PA

There are additional budgeting considerations under Sneede when one of the following persons is a responsible relative in a family which is applying for Medi-Cal (and there is a share of cost):

• SSI/SSP recipient• IHSS recipient• A person in long-term care• A person in board and care

Any income which is not being used to determine the PA/Other PA, or LTC/BD & Care, recipient's eligibility, is income available to the other family members.

The income is equally prorated among the persons that the individual is responsible for.

Should this occur:

• First complete the “Allocation/Special Deduction Worksheet” (MC 176 W), section II. or III., as appropriate.

• Then complete the MC 175-6, “Responsible Relative Determination and Computation for SSI/SSP or IHHS Recipient, or LTC and Board and Care Person”, in addition to all other Sneede income determination forms.

5 Add the total net nonexempt income for each MBU and compare the total to the correct Maintenance Need Income Level for the MBU.

MBUs which contain only children receive a prorated Maintenance Need.

If any MBU has a share of cost and includes a child who is potentially eligible for one of the Federal Poverty Level (FPL) Programs, complete form MC 175-5.

6 Generate NOAs.

NOTE: If any MBU has a share of cost, [Refer to “Federal Poverty Level and Property Waiver Programs (100%/133%/ 200% Income Disregard),” page 50-118 for specific Sneede procedures for determining eligibility for the Federal Poverty Programs.] [Refer to “Share of Cost Considerations/NOAs,” page 50-120] for share of cost rules specific to Sneede cases, including the application of old, unpaid medical bills under Hunt v Kizer.

Step Procedure



50.44Federal Poverty Level and Property Waiver Programs (100%/133%/ 200% Income Disregard)

50.44.1 General

If an MBU has a share of cost after a Sneede income determination is completed, then eligibility for the special Federal Poverty Level Programs must be completed whenever the MBU includes:

• A pregnant woman, or• A child under age 6, or• A child age 6-18.

The process used to determine 100%/133%/200% Income Disregard eligibility for Sneede households is different because the income of persons who are not financially responsible cannot be used.

The MC 175-5, “Sneede v Kizer Federal Poverty Level Programs...” worksheet must be used for a Sneede case.

50.44.2 Family Size

The “family size” for the Federal Poverty Level (FPL) equals the total number of persons in the MFBU.

50.44.3 Income

Only the income of the poverty level person and his/her spouse or parent(s) is compared to the FPL level according to household size.

Use the full net nonexempt income (not the allocated amounts) of:

• The pregnant woman or the child, and• His/her responsible relatives.

Note:Add back the health insurance premium if already deducted and do not allow ABD-MN deductions.



50.44.4 Property

If there is excess property, only the property of the poverty level person and his/her spouse or parent(s) is used. If the MBU has excess property of property information is not provided/verified, children under 19 must be evaluated under Property Waiver Program rules.

50.44.5 Procedure to Determine FPL Eligibility

Follow these steps to determine eligibility for the Federal Poverty Level Programs using the MC 175-5:

50.44.6 Examples

[Refer to “Sneede Budget Examples,” page 50-123 for examples of Sneede Federal Poverty Level Program determinations.]

Step Procedure

1 Complete an MC 175-5 for EACH otherwise potentially FPL-eligible pregnant woman or child when his/her MBU has a share of cost.

2 Section A - Net Nonexempt Family Income Determination

1. Enter name of potential FPL Program eligible person(s).

2. Enter name of Responsible Relative #1.

3. Enter name of Responsible Relative #2.

4. Enter all net nonexempt income of the potential FPL Program eligible person.

5. Enter all net nonexempt income of Responsible Relative #1.

6. Enter all net nonexempt income of Responsible Relative #2.

7. Total lines 4, 5 and 6.

3 Section B - Eligibility Determination

1. Carry over names (from Step 2).

2. Check the FPL Program for which the person is potentially eligible.

3. Enter total net nonexempt family income (from Section A, 7).

4. Determine if family income is less than or equal to the FPL.

• If yes, approve for FPL Program.

• If no, deny FPL Program for excess income and approve with a SOC, if applicable.



50.45Share of Cost Considerations/NOAs

50.45.1 Multiple Shares of Cost

Under Sneede, it is possible that a case can have multiple Shares of Cost for a single month.

• Some MBUs may have no share of cost (SOC), while others have a SOC.• Each MBU may have a different SOC.

The system will show that each person in the individual “MBU” has met his/her share of cost.

Example:Parents are not Medi-Cal eligible until the SOC in their own MBU is met, and they are not required to wait until their child with income (in his own separate MBU) meets his SOC.

If Sneede procedures result in a higher SOC for some persons, the family does not have the option of remaining together in one MFBU.

50.45.2 Responsible Relative's Medical Expenses

Parent(s) are included in the MBUs as responsible relatives (RR) of their eligible children who are in a separate MBU. There medical expenses may be used to meet the children’s SOC.

Medical expenses of a responsible relative can be split up and used to meet:

• The SOC in his/her own MBU, or• The SOC in his/her child's MBU, or• The SOC in both.However, a medical expense, or portion of a medical expense, cannot be used more than once.



50.45.3 Children's Medical Expenses

A child's medical expenses can only be applied to the SOC of the MBU which includes the child. His /her medical expenses cannot be applied to the parent(s)' SOC unless the parent(s) are in the same MBU as the child.

50.45.4 Required Informing

When Sneede applies and at least one MBU has a SOC, the client must be informed of the option to apply medical expenses:

• When the initial SOC is determined, and• At redetermination.

50.45.5 Example of Medical Expenses

The MFBU has a SOC and includes a married couple and the wife's separate child. Her husband has no linkage. The wife and her child need Medi-Cal. Each MBU has a SOC.

In this example, mother may apply her medical expenses to MBU A, MBU B, or a portion of her medical expenses to both MBUs. Her child's medical expenses can only be used to meet the child's SOC. The stepfather's medical expenses, if any, can be applied to his wife's SOC.

50.45.6 Hunt v Kizer

If an MFBU with a Sneede class member has a share of cost, old unpaid medical expenses must be deducted AFTER Sneede procedures are applied to the case. Then, if any of the MBUs have a SOC, the old unpaid medical bills may be used to reduce the SOC.

A responsible relative's (RR) old unpaid medical bills can be applied to:

• His/her own MBU,• His/her child(ren)'s MBU,• Or to both.

MBU “A” MBU “B”

Wife (Aid Code 37) Child (Aid Code 37)

Husband (I.E.) Mother (RR)



Reminder:A medical expense (or portion of a medical expense) can only be used once to reduce a share of cost.

Note:An “other” caretaker relative's old unpaid medical expenses can only be applied to his/her own SOC, as there is no financial responsibility for the children.

50.45.7 Adjusting the SOC

When income or other changes are reported which affect an MBU's share of cost, adjustments are to be made based on whether or not the change is reported timely, within 10 calendar days following the date that the change occurred. [Refer to “Change in the Share of Cost (SOC),” page 62-3 for information on when and how to do a share of cost adjustment.]

If a SOC is retroactively reduced and an MBU requests a future SOC adjustment, the reduction may be applied to the future SOC of the MBUs as follows:

Situation 1

Change in income reduces the entire MFBU's SOC to zero:

When an MFBU no longer has a SOC, discontinue the Sneede MBUs and establish a regular MFBU.

Apply the reduction to the future SOC of any MBU which contains a member of the MFBU, even if the MBU compositions are no longer the same.

Situation 2

Change in income reduces an MBU's SOC, but Sneede procedures still apply because the MFBU has a SOC:

Apply the SOC adjustment to any MBU which includes a member of the original MBU for which the SOC is being adjusted.

50.45.8 Sneede NOAs

Sneede approval notices of action will be generated for each MBU based on relationships and person specific income are entered.



Whenever shelf stock is used, or a denial/discontinuance is being sent to a Sneede household, EWs must add “Sneede v Kizer” at the bottom of the notice where other regulations are cited.

Issue only one notice of action when denying or discontinuing the entire family.

50.46Sneede Budget Examples

50.46.1 Example 1

Stepparent Household with Pregnant Woman

A married couple, Donald and Alice Doyle, are applying for Medi-Cal. Alice is pregnant, and she has a separate child, Nancy Jacobs, age 4. Together they have a share of cost:

50.46.2 Example 2

Unmarried couple, mutual child, separate children, and excluded child

Robert Simon and Lois Lee, an unmarried couple are applying for Medi-Cal. They have a mutual child, Bonnie Simon, age 2. Lois also has a separate child, Janet Lee, age 4, who receives $150/month child support. Robert has a son, Stanley, age 17, who is not in school and is employed part time. Robert chooses to exclude Stanley, and he does not want to provide verification of Stanley's income. The MFBU has a share of cost, so Sneede rules apply.

Donald ($2,300 gross earnings - $90 WRE) = $2,210.00

Alice (UIB $183 x 2.167) = 396.56

Nancy (child support $175 - $50) = 125.00

Total $2,731.56

rounded $2,732.00

– Maintenance Need (4) 1,100.00

Share of Cost $1,632.00



Robert Simon, $330 UIB every 2 weeks Lois Lee, $1,250 monthly gross earnings Janet Lee, $150/month child support

Note:This example illustrates why, when applicable, separate 100/133/Income Disregard Program determinations must be completed for each person.

50.46.3 Example 3

Other Caretaker Relative in MFBU

Cheryl (age 10) and Cindy Bradford (age 12) are residing with their grandmother, Wanda Lewis, age 59. Wanda is applying for Medi-Cal for the children and wishes to be included in the MFBU. Wanda is employed part time and receive $900 gross per month, but has no medical coverage. She also receives a $260 gross monthly retirement pension. The absent father contributes $400 per month child support. Wanda has no spouse, nor children of her own in the home.

Together they have a share of cost, so Sneede rules apply.

$810.00 net earnings ($900 - $90 WRE)

260.00 pension

350.00 net child support ($400 - $50)

$1,420.00 Net Nonexempt Income

–934.00 Maintenance Need

$486.00 Share of Cost



50.47Sneede Maintenance Need Income Levels (MNIL) and Property Limits

Sneede v KizerMaintenance Need Income Levels (MNIL) and Property Limits Effective: 1/1/90

MNIL and Property Limits

MNIL/Property Limits for Adults - No Children in Mini Budget Unit

Person Type MNIL Property

Single Parent 600 2,000

Single Parent with Unborn 750 3,000

Married Couple (two adults) 934 3,000

Married Couple with an unborn 934 3,150

Unmarried Couple-for each unmarried partner 600 2,000

MNIL/Property Limit for Mini Budget Unit (MBU) Which Contains Parent(s) and Child(ren)- May include an unborn.

Allow the full standard/non-Sneede MNIL/property limits for the MBU based upon the number of persons in the MBU.

MNIL/Property Limit for Caretaker Relative Household

Caretaker relative in same MFBU with children for whom care is provided. Each MBU receives full standard, non-Sneede MNIL/property limit based on the number of persons in each MBU. If there is a pregnant minor in MFBU, include unborn in pregnant minor's MBU.

MNIL/Property Limit for Mini Budget Unit Which Contains Only Child(ren) Living With Natural/Adoptive Parent(s). Do not include parents who are not in the MFBU. May include unborn of pregnant minor if unborn is the same MFBU.

No. of Children in MBU

One Parent Two Parents

MNIL Property MNIL Property

1 375 1,500 312 1,050

2 623 2,100 550 1,650

3 825 2,475 756 2,070

4 1,008 2,760 945 2,400

5 1,181 3,000 1,108 2,679



50.48Court Orders: Radcliffe through Pettit v. Bontá

50.49Radcliffe v. Coye, et al

50.49.1 Issue

This lawsuit was filed to ensure that all Medi-Cal applications based on disability be determined timely, which is within a 90-day period. If delays do occur, all Medi-Cal applicants, including those who simultaneously have a pending disability case at the Social Security Administration, must be informed of any delays that may occur in the processing of their disability based Medi-Cal application via a status letter.

50.49.2 Decision

The following actions are required as a result of the settlement agreement:

6 1,329 3,215 1,269 2,925

7 1,481 3,413 1,420 3,150

8 1,623 3,600 1,568 3,360

9 1,764 3,780 1,615 3,436

10 1,794 3,818 1,656 3,500

11 1,822 3,850 1,694 3,554

12 1,848 3,877 1,728 3,600

13 1,872 3,900 1,759 3,640

Sneede v KizerMaintenance Need Income Levels (MNIL) and Property Limits Effective: 1/1/90

MNIL and Property Limits



• The state will continue to monitor the number of days DDSD applications are pending for a period of time and report that information to the plaintiffs.

• DDSD referral packets must be sent to DDSD no later than ten calendar days after the receipt of the Statement of Facts or other statement of disability is received, except in the event of a delay due to circumstances beyond the control of the EW.

• DDSD must send a 90-day status letter to the customer when the case is in their possession and a disability decision will not be reached within 90 days.

• The EW must send a “90-Day DDSD Status Letter” (MC 179) when the DDSD packet has not been submitted to DDSD by the 80th day.

[Refer to “DDSD — EW Procedures,” page 30-1.]

50.50Sawyer v Shalala, Anderson, Belshe, Gould

50.50.1 Issue

AFDC MN/MI recipients must be allowed the earned income disregards against Temporary Worker's Compensation (TWC) and Temporary Disability Indemnity (TDI).

50.50.2 Decision

This change is effective 1/1/96 on all AFDC-MN/MI (not ABD-MN) cases with TWC and TDI.

50.50.3 Retroactivity

The retroactive portion of this claim is effective from January 1, 1991 through December 31, 1995.



50.51Tinoco v Belshe

50.51.1 Issue

AFDC-MN/MI recipients must be allowed the earned income disregards against State Disability Insurance Benefits (SDI/DIB).

50.51.2 Decision

This change is effective 4/1/96 on all AFDC-MN/MI (not ABD-MN) cases with DIB.


The retroactive portion of this claim is effective from January 1, 1991 through March 31, 1996.

50.52Gamma v Belshe

50.52.1 Issue

A suit was brought against the State Department of Health Services (DHS) which challenged the deeming of income from a financially responsible relative to a child in a separate MBU without allowing the relative to keep a sufficient amount of income to meet his or her own needs.

Certain individuals who had their Share of Cost (SOC) determined under Sneede rules ended up with the total of all the mini budget units’ SOC being higher under Sneede budgeting procedures than under pre-Sneede rules.



50.52.2 Decision

Effective November 1995, in order to allow each parent a deduction for his/her needs prior to the allocating of income to the remaining family members for whom they are responsible, rules were changed to:

• Allow each parent a $600 deduction (Maintenance Need income level for 1) income deduction for his/her needs before equally allocating any remaining income to the family members for whom he/she is responsible (excluding him/herself).

Note:The parent may not allocate any portion of any remaining income to him/herself.


The retroactive portion of Gamma is effective from November 1995 through July 1996.

50.53Ramirez v. Belshe

50.53.1 Issue

On June 6, 1996, the Los Angeles Superior Court ruled that previously issued regulations regarding Authorized Representatives were invalid.

50.53.2 Decision

The following actions are required as a result of the settlement agreement:

• EWs must accept any form of written authorization that an applicant or beneficiary signs and dates that permits another individual to assist them in the application for and attainment of Medi-Cal benefits. The forms are valid for one year from the date signed. The “Appointment of Representative” (MC 306) may continue to be used, but is no longer required and may be substituted with any authorization form of the Authorized Representative’s (AR) choice.



• Any individual who has been designated as an AR is permitted to review the applicant’s or beneficiary’s case record with or without the applicant or beneficiary being present. Copies of documents which the client has submitted may be made for the AR if requested.

50.54Latino Coalition for a Healthy California v. Belshe

50.54.1 Issue

Whether or not an applicant or beneficiary for Medi-Cal who is in possession of a Border Crossing Card or short-term Visa is to be automatically considered a non-resident of California.

On February 4, 1999, the San Francisco Superior Court ruled that previously issued regulations regarding California Residency and possession of a current and valid Border Crossing Card or short-term Visa were invalid.

50.54.2 Decision

Possession of a current and valid non-immigrant visa that allows entry into the United States for a period of less than one year is NOT, by itself, evidence that the person possessing such a document is not a resident of California.

The following actions are required as a result of the Latino Coalition v. Belshe settlement agreement:

1. A person’s declaration on the “Statement of Facts for Medi-Cal” (MC 210) or on the “Statement of Facts for Cash Aid, Foodstamps, and Medi-Cal” (SAWS 2), together with evidence of residency must be accepted for purposes of establishing residence, UNLESS THERE IS EVIDENCE TO THE CONTRARY.

2. The EW must determine California residency based on the preponderance of evidence produced by the applicant.

• The EW may determine that a person with a valid Border Crossing Card or short-term Visa is a resident of California if a preponderance of credible evidence produced by the customer supports this finding.



• If the preponderance of credible evidence produced by the customer does NOT support a finding of California residency, the individual must be denied or discontinued from Medi-Cal.


The retroactive portion of this claim for Santa Clara County is effective from April 1, 1997 through July 31, 1999.

50.55Pettit v. Bontá

50.55.1 Decision

This lawsuit settlement mandates the Medi-Cal Program to allow persons in Board and Care residential facilities the ability to apply incurred expenses for personal care services to their share of cost. All individuals in licensed Board and Care residential facilities are to be allowed a Standard Personal Care Services Income Deduction of $315. This amount is in lieu of the Unavailable Income Deduction for residential care and support as indicated in Title 22, California Code of Regulations. If the Unavailable Income Deductions allows for a lower SOC than the Standard Deduction of $315, then the Unavailable Income Deduction is to be used.


Effective April 1, 2000, clients determined to be entitled to a lower SOC have the option of:

• Having future SOC adjusted; or

• Request reimbursement from the provider(s) for amounts paid or adjustment for amounts obligated.

Note:Clients whose future SOC is zero before an adjustment is applied, must be advised that the only recourse is to seek reimbursement from the provider utilizing the “Share of Cost Medi-Cal Provider Letter” (MC 1054).


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