Revision 18-2; Effective June 1, 2018

 

N-6100 Budgeting Concepts

Revision 11-3; Effective September 1, 2011

 

Medicaid Buy-In for Children (MBIC) has two budgeting concepts: family unit and budget group.

Family unit is used to determine the appropriate federal poverty level (FPIL) to use as an income limit. Budget group is used to determine the countable income of the family unit to compare to the FPIL for eligibility. Budget group is further defined in Section N-6340, Determining the Budget Group.

The total number of members in the family unit is used in eligibility income budgeting to determine the income limit for the family.

 

N-6200 Determining the Family Unit

Revision 15-4; Effective December 1, 2015

 

To determine a family unit, count the:

  • MBIC applicant or recipient, and
  • applicant's or recipient's parents living in the same household (see definition of parent in the Glossary), and
  • applicant's or recipient's siblings (eligible or ineligible) living in the same household (see definition of sibling in the Glossary).

For a stepparent to be included in the family unit and the stepparent’s income to be considered in the budget group, a stepparent must:

  • be the current spouse of a natural or adoptive parent, and
  • live in the same household as the MBIC applicant or recipient and the natural or adoptive parent.

If neither a stepparent nor the stepparent's income is considered because these criteria are not met, do not consider a stepsibling or their income.

 

N-6210 School or Job Training

Revision 11-3; Effective September 1, 2011

 

School or job training attendance must be verified before including an ineligible sibling between the ages of 18 and 22 in the family unit. If the family unit does not provide verification of school or job training attendance, don't count the ineligible sibling in either the family unit or budget group.

 

N-6220 Absences Due to Active Duty Military Assignments

Revision 11-3; Effective September 1, 2011

 

Consider absences due to active duty military assignments as temporary and consider that individual as part of the family unit and budget group.

 

N-6300 Eligibility Income Budgeting

Revision 13-4; Effective December 1, 2013

 

Eligibility income budgeting for Medicaid Buy-In for Children (MBIC) is different from other MEPD programs. As stated in the beginning of Chapter N, Medicaid Buy-In for Children, the family gross income must not exceed 300 percent of the FPIL. However, due to substantial income exclusions, the income limit used for eligibility is equal to or less than 150 percent FPIL for the family unit size. Each case may have a different income limit. See Appendix XXXI, Budget Reference Chart, for 150 percent FPIL and 300 percent FPIL amounts.

 

N-6310 Income Treatment

Revision 11-3; Effective September 1, 2011

 

Treat earned and unearned income the same in MBIC budgeting. Do not deduct:

  • the $20-general exclusion, or
  • the earned income exclusion of $65 plus one-half of the remaining income.

 

N-6320 MBIC Income Exclusion

Revision 11-3; Effective September 1, 2011

 

The MBIC income exclusion is $85 plus one-half of the remaining income and is deducted at the end of the budget calculation.

 

N-6330 Ineligible Sibling Exclusion

Revision 18-2; Effective June 1, 2018

 

Allow an exclusion from an ineligible sibling's income before counting the ineligible sibling's income in the eligibility budget. Allow this exclusion for each ineligible sibling in the family unit. Follow these steps to find the ineligible sibling exclusion:

  • Use 150 percent FPIL for a family of one.
  • Multiply that figure by 2.
  • Add $85.

The total amount from these steps is the ineligible sibling's exclusion amount. Effective March 2018, this amount is $3,121. Deduct this amount from the ineligible sibling's total income. Count in the budget the ineligible sibling's excess income after the exclusion. If the ineligible sibling's income is less than the total exclusion, disregard all of the ineligible sibling's income in the budget.

 

N-6340 Determining the Budget Group

Revision 15-4; Effective December 1, 2015

 

The budget group is determined by identifying the members of the family unit whose income is countable in the eligibility budget. The number of people in the family unit and in the budget group may be different.

Do not count any of the income of a family unit member that:

  • has needs-based income, such as veteran's pension or Supplemental Security Income (SSI); or
  • is a Medicaid-eligible person, such as another MBIC applicant/recipient in the household.

For a stepparent's income to count, the stepparent must:

  • be the current spouse of a natural or adoptive parent, and
  • live in the same household as the MBIC applicant or recipient and the natural or adoptive parent.

If a stepparent's income is not considered because these criteria are not met, do not consider a stepsibling's income either.

Reminders:

  • If school or job training attendance has not been verified for an ineligible sibling between ages 18 and 22, that sibling is not part of the family unit and, therefore, is not included in the budget group.
  • Consider absences due to active military assignments as temporary and include that individual in the budget group.

 

N-6350 Budgeting Steps

Revision 11-3; Effective September 1, 2011

 

Note: The Integrated Eligibility Redesign System (TIERS) will do the eligibility budgeting; however, Medicaid for the Elderly and People with Disabilities (MEPD) specialists must understand the policy.

Begin budgeting with these steps:

  1. Determine the family unit members.
  2. Use Appendix XXXI, Budget Reference Chart, to find the amount that is 150 percent of the FPIL for the family size that corresponds to the total number of family unit members. This is the income limit for this family. Example: There are five family unit members. The income limit is 150 percent of the FPIL for a family of five.
  3. Determine the budget group members.
  4. Determine the monthly gross countable income, if any, of the MBIC applicant or recipient.
  5. Determine the combined monthly gross countable income of the applicant/recipient's parents.
  6. For each ineligible sibling, determine any monthly gross countable income that exceeds the ineligible sibling's exclusion amount. If the exclusion amount is greater than the ineligible sibling's income, disregard all of that ineligible sibling's income.
  7. Total the income amounts determined in steps 4-6.
  8. Subtract $85 from the total in step 7.
  9. Divide the amount in step 8 by two.
  10. The remainder is countable income. Compare this to the income limit determined in step 2.

 

N-6351 Examples of Budgeting Steps

Revision 18-2; Effective June 1, 2018

 

The figures used in these charts are for example only and may not reflect the current FPIL limits or the deduction amounts that are based on FPIL.

Example 1

Determining Family Unit Members and FPIL Limit to Use

Household Composition Applicant — no income
Applicant's parent — gross earnings $1,400 monthly
Applicant's stepparent — gross earnings $3,000 monthly
Applicant's ineligible sibling, age 16 — no income
Applicant's ineligible sibling, age 19, non-student — gross earnings $800 monthly
Applicant's ineligible stepsibling, age 14 — no income
Children Employed None
Family Unit Members Applicant
Applicant's parent
Applicant's stepparent
Applicant's ineligible sibling, age 16
Applicant's ineligible stepsibling, age 14
Income Limit 150% FPIL for family size of 5

Note: Since the 19-year-old ineligible sibling is over age 18 and not a student, do not consider the sibling or the sibling's income.

Budget Group and Eligibility
Steps Amount
Applicant's monthly gross countable income $0
Add parents' monthly gross countable income $4,400
Add each ineligible sibling's gross countable income that exceeds $3,121 $0
Balance of budget group income $4,400
MBIC exclusion ($85 + one-half of remainder) $2,242.50
Total countable income $2,157.50
150% FPIL for family of 5 ≤ $3,678
Eligibility result Eligible

Example 2

Determining Family Unit Members and FPIL Limit to Use
Household Composition Applicant — Retirement, Survivors, and Disability Insurance (RSDI) $167
Applicant's parent — gross earnings $4,500 monthly
Stepparent, died one year ago
Applicant's ineligible sibling, age 16 — gross earnings $100 monthly
Applicant's ineligible sibling, age 20, student — gross earnings $400 monthly
Applicant's stepsibling, age 10 — no income
Children Employed 2
Family Unit Members Applicant
Applicant's parent
Applicant's ineligible sibling, age 16
Applicant's ineligible sibling, age 20 (student)
Income Limit 150% FPIL for family size of 4

Note: Since the stepparent is deceased, do not consider the ineligible stepsibling or the ineligible stepsibling's income.

Budget Group and Eligibility
Steps Amount
Applicant's monthly gross countable income $167
Add parent's monthly gross countable income $4,500
Add each ineligible sibling's monthly gross countable income that exceeds $3,121 $0
Balance of budget group income $4,667
MBIC exclusion ($85 + one-half of remainder) $2,376
Total countable income $2,291
150% FPIL for family of 4 ≤ $3,138
Eligibility result Eligible

Example 3

Determining Family Unit Members and FPIL Limit to Use
Household Composition Applicant — RSDI $88
Applicant's stepparent — gross earnings $5,925 monthly
Applicant's parent, died two years ago
Applicant's ineligible sibling, age 2 — no income
Applicant's ineligible sibling, age 19, non-student — gross earnings $800 monthly
Applicant's ineligible stepsibling, age 7 — no income
Children Employed None
Family Unit Members Applicant
Applicant's ineligible sibling, age 2
Income Limit 150% FPIL for family size of 2

Note: Since the natural parent died and the stepparent is no longer a current spouse of the natural parent, do not consider the stepparent and the ineligible stepsibling or their income. Since the 19-year-old ineligible sibling is over age 18 and not a student, do not consider the sibling or the sibling's income.

Budget Group and Eligibility
Steps Amount
Applicant's monthly gross countable income $88
Add parent's monthly gross countable income $0
Add each ineligible sibling's monthly gross countable income that exceeds $3,121 $0
Balance of budget group income $88
MBIC exclusion ($85 + one-half of remainder) $86.50
Total countable income $1.50
150% FPIL for family of 2 ≤ $2,058
Eligibility result Eligible

Example 4

Determining Family Unit Members and FPIL Limit to Use
Household Composition Applicant — RSDI $88
Sibling, age 7, also an applicant — RSDI $88
Applicant's parent — gross earnings $7,800 monthly
Applicant's other parent, died two years ago
Applicant's ineligible sibling, age 2 — no income
Children Employed None
Family Unit Members Applicant
Applicant's sibling, age 7, who is also an MBIC applicant
Applicant's parent
Applicant's ineligible sibling, age 2
Income Limit 150% FPIL for family size of 4

Note: If a sibling is also applying for MBIC, count this sibling in the family unit size, but calculate separate budgets since one "eligible" sibling's income is not counted in the other "eligible" sibling's budget group.

Budget Group and Eligibility
Use separate budgets when more than one child with disabilities in the same family unit is applying for MBIC.
Steps Applicant 1 Applicant 2
First applicant's monthly gross countable income $88 $88
Second applicant's monthly gross countable income N/A N/A
Add parent's monthly gross countable income $7,800 $7,800
Add each ineligible sibling's monthly gross countable income that exceeds $3,121 $0 $0
Balance of budget group income $7,888 $7,888
MBIC exclusion ($85 + one-half of remainder) $3,986.50 $3,986.50
Total countable income $3,901.50 $3,901.50
150% FPIL for family of 4 > $3,138 > $3,138
Eligibility result Not eligible Not eligible

Example 5

Determining Family Unit Members and FPIL Limit to Use
Household Composition Applicant — RSDI $88
Applicant's parent — RSDI $699
Applicant's ineligible sibling, age 2 — RSDI $88
Applicant's ineligible sibling, age 5 — RSDI $88
Children Employed None
Family Unit Members Applicant
Applicant's parent
Applicant's ineligible sibling, age 2
Applicant's ineligible sibling, age 5
Income Limit 150% FPIL for family size of 4

 

Budget Group and Eligibility
Steps Amount
Applicant's monthly gross countable income $88
Add parent's monthly gross countable income $699
Add each ineligible sibling's monthly gross countable income that exceeds $3,121 $0
Balance of budget group income $787
MBIC exclusion ($85 + one-half of remainder) $436
Total countable income $351
150% FPIL for family of 4 ≤ $3,138
Eligibility result Eligible

Example 6

Determining Family Unit Members and FPIL Limit to Use
Household Composition Applicant — no income
Applicant's parent — gross earnings $4,500 monthly
Applicant's other parent — $850 Veterans Affairs (VA) benefits with aid and attendance monthly; gross earnings of $300 monthly
Children Employed None
Family Unit Members Applicant
Applicant's parents
Income Limit 150% FPIL for family size of 3

 

Budget Group and Eligibility
Steps Amount Documentation
Applicant's monthly gross countable income $0  
Add parents' monthly gross countable income $4,500 VA income is needs-based, so none of the other parent's income is included in the budget.
Add each ineligible sibling's monthly gross countable income that exceeds $3,121 N/A  
Balance of budget group income $4,500  
MBIC exclusion ($85 + one-half of remainder) $2,292.50  
Total countable income $2,207.50  
150% FPIL for family of 3 ≤ $2,598  
Eligibility result Eligible