Ch . 11-AD FPL Flashcards
Who can be evaluated for the ADFPL share of cost program?
Hey, potentially ADFPL individual is aged or disabled, but not residing in a long term care facility.
Disabled children may be a valuated for this program .
Blind individuals may be eligible for the ADFPL programs, if they are linked as either aged or disabled
If a customer is receiving Medicare, but as a caretaker of a child, would they qualify for MAGI?
Yes, they may qualify under the parent caretaker group M3 Aid Code.
Who is counted for those that qualify for A/D?
Only the persons who are A/D and being evaluated will be counted when determining the household size to use for the FPL limit.
What automatic deductions are allowed for A/D?
Automatic deductions for earned income $65 from the gross income and then divide that by two. The other automatic deduction is $20 from (any income deduction) normally taken from unearned.
What other deductions are allowed for ADFPL applicants?
Other deductions include medical deductions, such as other health insurance premiums (OHC) and Medicare cost such as part B. Part B is $164.90.
What is the ping-pong affect?
The ping-pong affect was when a customer gets zero share of cost. They get a state buying which pays for the Medicare part B premium. Then the customer would go from no share of cost to getting the buy in which lead to them to losing their deduction, which intern let them to gaining and share of cost which caused him to lose their Buy-in
What is an allocation?
An allocation is given for the maintenance need level of the number of ineligible household members. This number is equal to the MNIL from the maintenance need chart.
What happens if a married couple fails to qualify for Medi-Cal?
They can be evaluated separately. They may qualify on their own because they are now eligible to receive the deduction for the allocation to the in-eligible member of the household as long as they are on the same case.
The income of the other spouse is still counted in the budget. The other spouse can still qualify for classic Medi-Cal with a SOC. -share of cost.
Spouses can also swap between programs if needed
How is an allocation determined for use?
An allocation is determined by using the MNIL for the number of people who are not evaluating for this program
When we are figuring out the medically needy SOC, what MNIL are we using for the whole MFBU?
Remember when we are figuring out the medically needy SOC we are using an MNIL for the whole MFBU not just the people we are evaluating for SOC.
What is NON-MAGI Medi-Cal?
 It is the umbrella term for Medi-Cal programs that are not MAGI.
When do we evaluate for eligibility to non-MAGI for applicant?
We evaluate for non-MAGI when the applicant is aged, blind, or disabled, or requests for an evaluation.
Is it good customer service to notify an applicant who is not receiving zero share of cost (SOC) MAGI Medi-Cal about their option to apply for non-MAGi?
It is a good customer service to notify an applicant who is not receiving zero share of cost. However, the state has stated that we are not required to do an evaluation unless the client is ABD or request evaluation.
How does a person qualify for non-MAGI?
They must have linkage. It’s like a bouncer only the bouncer will let those allowed into the party.
What is one of the linkages for non-magi?
Medically needy, a medically needy person can either be age, blind, or disabled, who meets one of the following conditions is not eligible for or does not want to receive assistance as a public assistance or other public assistance recipient or has an application pending for SSI/SSP
Or
A child or family member, who is both linked to AFDC and not eligible for or does not want to receive assistance as a public assistance or other public assistance recipient
Or
A caretaker relative who chooses to be included in a child’s MFBU and the caretaker relative establishes an AFDC language to a public assistance or other public assistance. Child in accordance with mpg article 8 section 5.
