9. Budgeting · page 9-2 Medi-Cal 9. Budgeting Page 9-2 Update #19-22 Date Received/Expected to be...

Medi-CalMedi-Cal 9. Budgeting

9. Budgeting

Medi-Cal (MC) budgeting is determined prospectively. When entering income into CalWIN it is important to enter the income into the correct income specific windows. Entering income into CalWIN is not dependent on a specific program; it is dependent on the type of income. CalWIN automatically treats income differently depending on the rules for each program and program hierarchy.

9.0.1 Income at Application

At initial application EWs must use the client’s actual pay frequency when entering income in CalWIN. When the client reports an income change the frequency must be converted to monthly.

Date Received/Expected to be Received

The Date Received/Expected to Be Received used at initial application must be the first paycheck received in the application month.

To have an accurate budget for MC and APTC, refer to “Bounce Back Rule,” page 9-9 for how to correctly enter income in CalWIN.

9.0.2 Income Change Reported

Regardless of the actual pay frequency, any time new/changed income is reported after application EWs must convert the income to monthly. This is done by manually calculating the monthly income amount using the appropriate multipliers.

Update #19-22Page 9-1

2Medi-Cal 9. Budgeting

Date Received/Expected to be Received

Table 52: Date Received/ Expected to be Received

If And Then the date received/expected to be received

The client will be MAGI or Non-MAGI eligible based on the new income

The income change reported is beneficial Must be the first of the month in which the change was reported and verification was provided timely.

The change reported is not beneficial Must be the first of the month in which a timely NOA can be provided

The client will be APTC eligible or the bounce back rule applies

N/A Must be the first of the month following when the change actually occurred

This will avoid incorrect tax credits from being granted, apply bounce back rule, and ensure the correct annual income is budgeted.

Example 1 On January 18, 2019 Quinten, active on MAGI MC, reports a decrease in income from 4C’s. His first check with a decreased amount has a pay date of January 12, 2019. Because the change is beneficial and he reported the change timely, the Date Received/Expected to Be Received must be January 1,2019.

Example 2 On March 22, 2019 Janaya reports that she began working less hours and her income has decreased. Her first check with decreased income was received on November 16, 2018. The Date Received/Expected to Be Received must be March 1, 2019 because the change was not reported timely and there was no good cause.

Example 3 On May 5, 2019 Rafika reported an increase in income from Target. Her first check with increased income was received on April 27, 2019. Due to the increase in income the client will lose MAGI eligibility and she will qualify for APTC. The Date Received/Expected to Be Received must be May1, 2019 to ensure the correct annual income is calculated for tax credits however, do not reevaluate the current or past months. APTC should be approved for June and on.

Note:Note:If Rafika had remained eligible for MAGI MC with the income increase, the income would be entered for June 1, 2019 since tax credits would not be a factor.

Note:



Example 4 On April 3, 2019 Ethan reported that his income from Barnes and Noble increased. His first pay check with the increased amount was received on July 29, 2018. Based on the new income Ethan will no longer be MAGI eligible. Since he will be APTC eligible the Date Received/Expected to Be Received must be August 1, 2018.

Note:Note:If Ethan had remained MAGI MC eligible the income would be entered for May 1, 2019 since tax credits would not be a factor.

Example 5 On April 15, 2019 Marcus, a Non-MAGI recipient with a SOC, reported that his income from Mark’s Hot Dogs decreased. His first pay check with the decreased amount was received on April 12, 2019. Based on the new income Marcus will no longer have a SOC. The Date Received/Expected to be Received must be April 1, 2019.

Example 6 On May 25, 2019 Lynn, a Non-MAGI recipient with a SOC, reported an increase in her pension. Her first payment with the increased amount was received on February 1, 2019. Based on her new income Lynn’s SOC will increase. The Date Received/Expected to be Received must be July 1,2019 to meet the adverse action 10 day timely NOA requirement.

Example 7 On February 23,2019 Gavin reported a new job at Big 5 Sporting Goods which he started in December of 2018. Based on Gavin’s new income he is still eligible for MAGI MC. The Date Received/expected to be Received must be January 1, 2019.

Note:Note:If Gavin’s income made him eligible for APTC, the Date Received/Expected to be Received must be January 1,2019. This would ensure the CMI and PAI were budgeted correctly.

9.1 Treatment of Income for MAGI and Non-MAGI

9.1.1 Actual Income

Income is considered available in the month received unless it is apportioned over a period of time (i.e. teacher’s salary).

9.1.2 Treatment of Apportioned Income

Apportioned income is income that is earned and received in more than 8 but less than 12 months under an annual contract of employment. It must be prorated over the period of the contract beginning with the first month of the contract.



Example:

Teacher's contracts are annual and income must be apportioned over the 12 months of the contract, even though teachers may work only 9 or 10 months.

Income Received other than Monthly or Semi-Monthly

1. If income is received weekly, bi-weekly, quarterly or bi-monthly, AND

a. Client wants MC for three or more months, and

b. Client will receive the income for a full month, and

c. Income is not fluctuating, THEN

2. Convert to monthly income as follows:

a. Multiply weekly income by 4.33.

b. Multiply income received every two weeks by 2.167.

c. Divide quarterly income by 3.

d. Divide income received every two months by 2.

Example 1 Client receives DIB of $265 every two weeks. Calculate as follows to arrive at a monthly amount:$265 x 2.167 = $574.26/mo.

Example 2 Client receives earnings of $350 gross every week. His/her gross amount does not fluctuate. Calculate as follows to arrive at a monthly amount:$350 x 4.33 = $1,515.50/monthly.

3. If client wants MC for one or two months only, use actual income.

Self-Employment Income

Income of self-employed persons is an estimation of the net profit of the annual net income for the current year based on the federal tax return filed for the previous year. In the Display Self Employment Detail window in CalWIN, the full gross self employment income must be entered in the Collect Income Received Detail window and the expenses must be entered under the Collect Income Expense Detail window. If there is no tax return or there is evidence that using the tax return would give an inaccurate estimation of income, current business records must be used. [Refer to “Self-Employment Income”, page 15-17 and “Self-Employment Income”, page 20-21]


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap20.pdf#search=exempt%20unearned%20income#page=21https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap15.pdf#page=17https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap15.pdf#page=17


Note:

The Standard radio button can be selected in the Display Self Employment Detail window, in addition to entering the actual expenses, to count the 40% standard deduction for other programs.

Loans

A loan must be considered income and apportioned over the time period for which it is intended if:

• It does not require repayment, and

• It is not exempt, and

• It is specified in the loan statement the period of time it is intended to cover.

Interest Income

• Interest income received less frequently than monthly and not exempt must be apportioned by dividing interest received by the number of months in the interest period. Consider the converted monthly amount as income in each of the months of the next interest period.

• Interest income received from a deed of trust or contract of sale must be apportioned by determining the annual interest and dividing by 12.

Note:

Be sure to evaluate whether interest income could be exempt as irregular or infrequent income. [Refer to “Exempt Income”, page 20-5]

9.1.3 Apportionment of Income Exemptions and Deductions

Any exemptions or deductions pertaining to apportioned income must be apportioned in the same manner as the income.

Example:

Client receives $375 gross earnings every week and pays $30 every week for dependent care. Income and deductions are: $375 x 4.33 = $1,623.75 gross income; $30 x 4.33 = $129.90 dependent care.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap20.pdf#search=exempt%20unearned%20income#page=5


Reminder:

Dependent care deductions only apply to Non-MAGI MC budgeting. Dependent care deductions are limited to maximum allowable amounts (i.e. $175 or $200 based on the age of the child).

9.1.4 Fluctuating Income

For combo cases the income must follow the rules and regulations of that program (i.e. CF/MC, GA/MC, etc.) methodology.

For MC only cases, if the client provides pay stubs showing different amounts, the income must be averaged and entered into CalWIN as monthly income. The multipliers must not be used.

Example:

Client provides 8 pay stubs for January and February. Each stub shows different amounts and he/she gets paid weekly. Do NOT enter each pay stub into CalWIN as CalWIN considers the most current pay stub information and uses the frequency multiplier. The EW must manually add the 8 pay stubs and divide it by 2 and enter the averaged income into CalWIN as Monthly.

Per regulations, the client is only required to provide one pay stub, whether the income is stable or fluctuating. If a client only provides one pay stub and income is determined to be fluctuating income, compute the monthly income amount using the multiplier. The EW must thoroughly document in the Search Case Comment window on how the income is calculated or determined.

If the pay stub provided includes overtime, the EW must clarify with the client if the overtime is expected to continue. If not, explain to the client if he/she can provide additional pay stub if averaging the income is more advantageous.

9.1.5 CalWIN

Income information (earned or unearned) is entered into CalWIN as follows:

• Actual Income - Income that meets the definition of actual income is entered as monthly income.

• Apportioned IncomeIf the apportioned income is for a period of 12 months, divide the yearly amount by twelve and enter the averaged amount as monthly income.

Example:

Teacher’s annual contract is $72,000. The EW should enter the monthly income as $6,000.



• Specific FrequencyIncome that is received weekly, bi-weekly, semi-monthly, bi-monthly, etc. - must be calculated as monthly by using the appropriate multiplier (i.e., 2.167 for bi-weekly, 4.33 for weekly, etc.) and entered in CaWIN as a monthly amount.

9.1.6 Ending Income

Collect Income Received Detail

If employment has terminated, add a new line with the same amount as the previous line or the verified final pay amount and enter Yes in the Income Terminated [Y/N] field.

Example:

Mr Flanders reported on October 5, 2019 he stopped working for Popeye’s Chicken on September 28, 2019 and received his last pay stub on October 4, 2019. He provided all applicable verifications of the employment ending. The eligibility worker completes the following entries in CalWIN to end date the income and employment.

Important:Do not enter a check amount of zero.



Collect Earned Income Detail

If employment has terminated, an Effective End Date must be entered on this window.

Collect Employment History Detail

If employment has terminated, enter the End Date, clear the Monthly Amount Earned and Estimated Average Hrs/Week fields and complete the Employment Termination group box.

Note:

When available, use the actual date the employment ended in the End Date Field on the Collect Employment History Detail. If the date is not available, use the date-stamped/ date reported.



Reminder:

When adding or end dating employment, the Display Individual Attributes Summary window must be updated accordingly.

9.1.7 Documentation Requirements

It is very important to document the treatment of estimated, apportioned and fluctuating incomes. Documentation must indicate how the non-exempt unearned/earned gross income figure was calculated. Verification or proof that income was verified must be recorded in IDM.

[Refer to Chapter 10, Section 10.8.4 "Printed Verification for IDM,” page-60]

9.2 Bounce Back Rule

MAGI MC and APTC calculate income and household size differently. MAGI MC income is based on Current Monthly Income (CMI) and APTC income is based on Projected Annual Income (PAI). Both programs determine household size based on individual tax filing status, however, APTC households do not include unborn child(ren), or non-dependent child(ren)/relatives living with the tax filer.

Due to the calculation differences between the two programs, a client could be found over the CMI limit for MAGI and under the PAI limit for APTC causing them to bounce between the two programs. To prevent this, Federal rules allow those below 100% FPL PAI to be MAGI MC eligible and those at or above 100% FPL PAI to be APTC eligible. This is called the Bounce Back Rule. Individuals eligible for MAGI under Bounce Back follow APTC household size rules, so household size may differ between individuals on the same case.

Eligibility under the Bounce Back Rule only applies to the current calendar year in which case eligibility is being determined (at application or new employment in the middle of the year). Starting January 1st of the new year, the individual may no longer be eligible under the Bounce Back Rule. The EW must



review the case at the end of the current calendar year to ensure correct eligibility is being determined for January of the new year. Cases that are over 138% FPL monthly will likely go to APTC unless someone has potential Non-MAGI MC eligibility, then he/she will be placed on Soft Pause.

INTAKE Bounce Back Rule Examples

Example:

Babar had no income for the first 6 months of the year and then he gets a job at the Elephant Bar. His CMI determines him as over income for MAGI MC. When he is determined for APTC financial eligibility, his PAI, which includes the 6 months of zero income, is below 100% FPL using the APTC eligibility methodology. Babar is financially eligible for MAGI MC for the entire year until MC RD or Change in Circumstance (CIC), whichever occurs first.

Example:

Juliette applies for MC on July 10, 2018. Her application states that she started work at Shake & Speare’s Bookstore on July 1, 2018 and she earns $1,400 monthly. After the EW completes all other Data Collection windows and runs EDBC to call the BRE, CalHEERS will grant Juliette MAGI MC appropriately.

• Collect Employment History Detail

• Effective Begin Date: 07/10/2018• Begin Date: 07/01/2018• Complete all other applicable fields.

• Collect Earned Income Detail

• Effective Begin Date: 07/10/2018• Frequency: Monthly• Type: Earnings, Wages, Salaries, Bonuses, Commissions, Military Pay

• Collect Income Received Detail

• Date Received/Expected to be Received: 07/10/2018• Pay Period Begin Date: 07/01/2018• Pay Period End Date: 07/31/2018• Gross Amount: $1400• Complete all other applicable fields.•

• Collect Individual Attributes Detail• Effective Begin Date: 07/10/2018• Complete all other applicable fields.



Juliette’s monthly income is over 138% FPL; however, her annual income ($1,400 x 6 months = $8,400) is below 100% FPL for her first year of employment based on her employment start date. Therefore, CalHEERS will appropriately grant her MAGI MC instead of APTC/CSR; the Bounce Back Rule applies to her case. If EDBC is run any time after January 1, 2019, Juliette will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA.

Note:

If Juliette’s income does not change, she will be eligible for APTC/CSR starting January 1st. Her income will be calculated for 12 months ($1,400 x 12 = $16,800) which will be over 138% FPL monthly and over 100% FPL annually.

Example:

Aurora applies for MC on July 13, 2018. Her application states that she started work at Beauty’s Mattresses on January 25, 2018 and she earns $1,600 monthly. After the EW completes all other Data Collection windows and runs EDBC to call the BRE, CalHEERS will grant Aurora APTC/CSR appropriately.


• Effective Begin Date: 07/13/2018 • Begin Date: 01/25/2018• Complete all other applicable fields.




• Date Received/Expected to be Received: 02/01/2018• Pay Period Begin Date: 01/01/2018• Pay Period End Date: 01/31/2018• Gross Amount: $1,600• Complete all other applicable fields.

• Collect Individual Attributes Detail

• Effective Begin Date: 07/13/2018• Complete all other applicable fields



Aurora’s monthly income is over 138% FPL ($1,600 x 11 months = $17,600) for the entire year. Therefore, CalHEERS will grant her APTC/CSR, not MAGI MC. Aurora’s income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to her case.

CONTINUING Bounce Back Rule Examples

(All examples in this section refer specifically to the budgeting aspect of MC eligibility. There may be examples that occur when the client will not immediately transition from MC to APTC or from APTC directly to MC. [Refer to “Transitions (MAGI/Non-MAGI/APTC),” page 8-1] for more information on Carry Forward and Soft Pause.]

Example:

Mr. Sanders reports a timely CIC on January 28, 2018. He started working at Kentucky Cluckies on January 18, 2018. He earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly). In CalWIN, the EW enters the job information as follows:






• Date Received/Expected to be Received: 02/01/2018• Gross Amount: $1502.51• Complete all other applicable fields.



After the EW completes all other Data Collection windows, as necessary for CIC, and runs EDBC to call the BRE, CalHEERS will grant Mr. Sanders APTC/CSR appropriately. Mr. Sanders monthly income is over 138% FPL; ($347/weekly x 4.33 = $1,502.51/monthly), and over 100% for the year



($347/weekly x 4.33 = $1502.51/monthly x 11 months = $16,527.61/annually). Therefore, CalHEERS will grant him APTC/CSR, not MAGI MC. Mr. Sanders income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to his case.

Example:

Taylor is currently receiving MAGI MC. She submits the June 2019 MC RD on June 14, 2019; however, it is processed July 8, 2019. She started working at Swift’s Karaoke on January 4, 2019. She earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly). In CalWIN, the EW enters the job information as follows:






• Date Received/Expected to be Received: 02/01/2019• Gross Amount: $1502.51• Complete all other applicable fields.



After the EW completes all other Data Collection windows and runs EDBC to call the BRE, CalHEERS will grant Taylor APTC/CSR appropriately (There is no potential eligibility for Non-MAGI MC, therefore she is not entitled to Soft Pause). Taylor’s monthly income is over 138% FPL; ($347/weekly x 4.33 = $1,502.51/monthly), and over 100% for the year ($347/weekly x 4.33 = $1502.51/monthly x 11 months = $16,527.61/annually). Therefore, CalHEERS will grant her APTC/CSR, not MAGI MC. Losing MAGI MC is considered a life changing event and she is eligible for Special Enrollment. Her APTC Eligibility begins August 2019.



Note:

Due to the 10 day timely NOA requirement, EW’s must not re-evaluate the current or any past months in this continuing scenario. Taylor’s income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to her case.

Example:

Nala reports a Change in Circumstance (CIC) on September 9, 2018. She started working at the Zoo on August 22, 2018. She earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly). In CalWIN, the EW enters the job information as follows:






• Date Received/Expected to be Received: 09/01/2018• Gross Amount: $1,502.51• Complete all other applicable fields.



After the EW completes all other Data Collection windows, as necessary for CIC, and runs EDBC to call the BRE, CalHEERS will continue to grant Nala MAGI MC appropriately. Nala’s monthly income is over 138% FPL; ($347/weekly x 4.33 = $1,502.51/monthly), but less than 100% for the year ($347/weekly x 4.33 = $1502.51/monthly x 4 months = $6,010.04/annually). Therefore, CalHEERS will grant her MAGI MC initially, not APTC/CSR because the Bounce Back Rule applies. If EDBC is run anytime after January 1st 2019, Nala will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA.



Nala’s income will be calculated for 12 months ($1502.51 x 12 = $18,030.12) which will be over 138% FPL monthly and over 100% FPL annually.

Example:

Lawrence Hopper reports a CIC on September 9, 2018. He started working as a soccer referee on August 22, 2018. He earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly). Lawrence also reported that he ended his 2-year job as a piano teacher on July 27, 2018 where he earned $150 weekly [Refer to “Ending Income”, page 9-7]. In addition, the EW makes new entries for the new job (soccer referee) information as follows:






• Date Received/Expected to be Received: 09/01/2018• Gross Amount: $1,502.51• Complete all other applicable fields.

After the EW completes all other Data Collection windows, as necessary for CIC, and runs EDBC to call the BRE, CalHEERS will continue to grant Lawrence MAGI MC appropriately. Starting in September, Lawrence’s monthly income is over 138% FPL ($347/weekly x 4.33 = $1,502.51/monthly) due to his new job, but less than 100% for the year between both jobs.

• Soccer referee ($347/weekly x 4.33 = $1502.51/monthly x 4 months = $6,010.04/annually) • Piano teacher ($150/weekly x 4.33 = $649.50/monthly x 8 months = $5196.00/annually).

Since his total annual income is $11,206.04. CalHEERS will grant him MAGI MC initially, not APTC/CSR because the Bounce Back Rule applies. If EDBC is run anytime after January 1, 2019, Lawrence will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA. Lawrence’s income will be calculated for 12 months ($1502.51 x 12 = $18,030.12) which will be over 138% FPL monthly and over 100% FPL annually.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7


Example:

Chastinne Bubbly is currently receiving MAGI MC and has been working as a movie extra earning $250 paid weekly for the past two years. She reports a CIC on November 8, 2018. She started working as an Election Specialist at Voter Registration on October 1, 2018. She earns $5900 monthly. Chastinne also reported that she ended her job as a movie extra on September 7, 2018 [Refer to “Ending Income”, page 9-7]. In addition, the EW makes new entries for the new job (Voter Registration) information as follows:

Note:

Because the change was not reported timely, the income will be entered the first of the month that the client reported the change.






• Date Received/Expected to be Received: 11/01/2018• Gross Amount: $5900• Complete all other applicable fields.

After the EW completes all other Data Collection windows, as necessary for CIC, and runs EDBC to call the BRE, CalHEERS will grant APTC as of December 1, 2018. Chastinne’s monthly income is over 138% FPL ($5900/monthly) and her annual income is also over 100% due to her new job.

• Election Specialist ($5900 x 2 months = $11,800/annually) • Movie Extra ($250/weekly x 4.33 = $1082.50/monthly x 9 months = $9,742.50/annually).

Since her total annual income in 2018 is $21,542.50, CalHEERS will grant her APTC/CSR immediately, because the Bounce Back Rule does not apply.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=7


Table 53: Bounce Back Rule Guidelines

138% FPL Monthly 100% FPL Annually Program Eligibility Bounce Back Rule

Income Over Income Under MAGI MC Yes

Income Over Income Over APTC/QHP No

Income Under Income Under MAGI MC No

*Bounce Back Rule generally applies when income begins on or after the month of June.

9.3 Accessing MAGI MC Budget

The MAGI MC budget can be accessed in CalWIN or CalHEERS.

9.3.1 Accessing MAGI MC Budget in CalWIN

The MAGI MC budget can be accessed in CalWIN on the [MAGI] tab of the Display Health Care Financial Eligibility Results window. The following is a description of the fields on this tab:

Table 9-1: CalWIN Fields on MAGI Budget Tab

CalWIN Fields Description

Employment Monthly Income Earned Income.

Other Monthly Income Unearned Income.

Projected Monthly Income Projected Annual Income divided into a monthly amount.

Countable Income Deduction Income deductions that are counted for MAGI.

Total Income After Deduction Total income less any deductions.

MAGI Income Limit Income limit for the assigned aid code.

MAGI FPL 100% monthly FPL amount for given household size.

Status MAGI eligibility status (i.e. Pass, Fail, Pending)

MAGI Eligible Type When MAGI eligible, this field will display “MAGI Medi-Cal”. If not MAGI eligible, it will display “N/A”

Start Date Eligibility effective begin date.

Unmarried Pregnant Woman Disregard Exception

Y/N indicates whether or not the individual is receiving the unmarried pregnant woman disregard exception.



9.3.2 Accessing MAGI Budget Worksheet in CalHEERS

The CalHEERS Business Rules Engine (BRE) determines clients’ eligibility for MAGI MC. The MAGI MC budget worksheet can be located in CalHEERS by following these steps:

1. Login to CalHEERS

2. Click on the Search Individual link

3. Select a Search option [Case ID, SSN, Combo (Name/Date of birth)]

4. Enter corresponding Search Value

Meets 603F2 Non-tax filer household composition used for MAGI evaluation.

Meets 119C Exception The value will be either Yes or No. Individual is not eligible for MAGI Adult Coverage group because his/her dependent child under 19 years old does not have Minimum Essential Coverage.Note:

The age limit is under 21 years old if the dependent child is attending school full-time.

Meets 603I Exception Bounce Back Rule. The value will be either Yes or No.

Self Employment Monthly Income Self Employment Income.

Total Income Total Earned, Unearned, and Self Employment income before deductions.

Non Countable Income Deduction Income deductions that are not counted for MAGI.

Total Countable Income Total countable income less any deductions.

FPL Percentage The percentage of the FPL the income is.

MAGI Size Tax filing household size.

MAGI Aid Code Aid code the individual qualifies for.

End Date When the eligibility to the MAGI aid code ends.

Renewal Date Redetermination Date.

Soft Pause Reason Reason case is on Soft Pause (i.e. Child, Parent, Aged, or N/A).

Contingent End Date The date conditional eligibility ends if missing information is not provided.

Table 9-1: CalWIN Fields on MAGI Budget Tab

CalWIN Fields Description



5. Click on [Search] button

6. Click on a radio button to select an individual.

7. Click on [View Case] button.



8. Click on the View Eligibility Results link. [Make sure to check the Date/Time Requested column to select the most recent budget worksheet.

9. On the Household Eligibility Results Summary Window click View Budget Worksheet.



9.3.3 MAGI Budget Worksheet

In CalHEERS, the budget worksheet will display an individual budget for MAGI MC and a household budget for Advanced Premium Tax Credit (APTC) and Cost Sharing Reduction (CSR). The MAGI MC individual budget is a monthly budget, APTC and CSR budgets are annual.



See the following chart for a description of each line item in the CalHEERS Budget Worksheet “CalWIN Fields on MAGI Budget Tab,” page 9-17

Table 54: CalHEERS Budget Worksheet

CalHEERS MAGI Budget Worksheet Line Description

Soft Paused Due To This indicates whether or not the client has been placed on Soft Pause in CalHEERS.

• Child (the member is a child)

• Parent (the member is a parent)

• Aged/Blind/Disabled (the member attests to being 65 or older, blind, or disabled)

• Not Applicable (Soft Pause is not applied to this member)

Note:The 19 to 64 year old expansion group is not eligible for Soft Pause. Parent/Caretaker Relatives over 109% FPL (114% FPL if receiving Medicare) are no longer considered ‘Parent/Caretaker Relatives’ for the purpose of Soft Pause.

Person Primary Tax Filer The value will be either Yes or No. This line indicates if the client is the primary tax filer in the tax filing household.

Person Included in Primary Tax Filer’s Tax Household

The value will be either Yes or No. This line indicates if the client is a member of the primary tax filer’s tax filing household.

Person Plans to File Taxes The value will be either Yes or No. This line indicates if the client plans to file taxes for the current tax year.

Person Expected to be Required to File Taxes The value will be either Yes or No. This line indicates if the client is required to file taxes for the current tax year.

Person Tax Filing Status Individual’s tax filing status (i.e. Single, Married Filing Jointly, etc.)

Person Tax Dependent Status The value will be either Yes or No. This line indicates if the client is a dependent of the primary tax filer’s tax filing household.

a. Employment Income (Monthly) This is the individual’s earned income, not the tax filing household’s income.

b. Self-Employment Income (Monthly) This is the individual’s earned income, not the tax filing household’s income from self-employment.

c. Other Income (Monthly) This is the individual’s unearned income, not the tax filing household’s unearned income.

d. Total Income (Sum of a, b, c) This is the individual’s total income, not the total tax filing household’s income.

e. Allowable Deductions (Monthly) This is the individual’s allowable deductions, not the tax filing household’s deductions.

f. Total Income after Deductions (Subtract e from d)

This is the individual’s total income after allowable deductions have been subtracted.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap09.pdf#page=17


9.3.4 Non-MAGI Budget in CalWIN

In CalWIN, the Non-MAGI budgets will display in the Initiate Wrap Up Window. To view a specific Non-MAGI budget, select the appropriate screen name(s) and click the [Start Workflow] button.

g. Projected Monthly Income This is how much income the individual projects as his/her monthly income not the tax filing household monthly income.

h. Countable Income (Sum of f and g) Monthly income after allowable deductions.

i. Number of household members + Number of expected babies

Total tax filing household members.

j. Federal Poverty Level for (i) (Monthly) FPL dollar amount limit for individual.

k. FPL% for individual (Divide (h) by (j) and round)

FPL percentage for individual.

MAGI Medi-Cal Eligible? The value will be either Yes or No. This line indicates if the client is eligible for MAGI MC.

Medi-Cal Access Program (MCAP) Eligible? The value will be either Yes or No. This line indicates if the client is eligible for MCAP.

MCAP is a program for Pregnant Women between 213% - 322% FPL, previously known as (AIM). [Refer to Chapter 5, Section 5.22 "Clients’ Right to be Evaluated for Non-MAGI,” page-79]

County Children’s Health Initiative Program (CCHIP) Eligible?

The value will be either Yes or No. This line indicates if the client is eligible for CCHIP.

Meets 435.603(f)(2)(i-iii) to use a non tax filer household composition for MAGI Medi-Cal

The value will be either Yes or No. This line indicates the individual is being evaluated using non-tax filer rules.

Meets 435.603(i) exception to use APTC income/deduction calculations for MAGI Medi-Cal determination

Bounce Back Rule. The value will be either Yes or No.

Meets 435.119(c): Adults ineligible to the New Adult Group due to dependent child under age 19 without Minimum Essential Coverage

The value will be either Yes or No. Individual is not eligible for MAGI Adult Coverage group because his/her dependent child under 19 years old does not have Minimum Essential Coverage.The age limit is under 21 years old if the dependent child is attending school full-time.

Table 54: CalHEERS Budget Worksheet

CalHEERS MAGI Budget Worksheet Line Description


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap05.pdf#page=79https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap05.pdfhttps://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap05.pdfhttps://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap05.pdf#page=79


9.4 Use of Medi-Cal Budget Worksheets For Non-MAGI MC

Completion of these forms is optional as CalWIN automatically calculates the budget based on the information entered by the EW. However, in some circumstances a Letter of Authorization is required for a period that cannot be updated in CalWIN; a MC Budget Worksheet is required.

Form MC 176M, Share of Cost Determination - MFBUs Which Do Not Include Long Term Care (LTC) Persons, is used for computing the share of cost (SOC) for all MFBUs which do not include persons in LTC.



9.5 Completion of Medi-Cal Budget Worksheets for Non-MAGI MC

9.5.1 Column I of MC 176M

Income of MFBU members applying as aged, blind, or disabled plus income of spouse or parent(s). No members are in LTC.

9.5.2 Column II of MC 176M

• Income of MFBU members not listed in Column I (those members who are not aged, blind, or disabled and their spouses). This would include persons who are AFDC-MN/MI linked. No members are in LTC.

• DO NOT include the income of family members who are Public Assistance (PA) or other PA (but four or nine month continuing persons' income must be included). DO NOT include the income of excluded children.

• Court ordered alimony or child support, or child support paid under an agreement with the District Attorney, is an income deduction AFDC MN/MI individuals.

9.5.3 Column III of MC 176M

• Count the income from computation on MC 176W, Part III, in which the spouse and/or children at home have unmet needs and there is an allocation from the spouse in LTC/B&C who is in a separate MFBU. This amount is added to the countable income.

• Allocations and Deductions

• When an excluded child does not have enough income to meet his/her needs, an amount from the parent's MFBU can be allocated to this child. The computation is done on MC 176W, Part I, and the amount of allocation is entered here. This amount of allocation is subtracted from the countable income.

• When some of a family member's income is used to determine PA eligibility, the amount is an allowable income deduction in the MFBU. That amount is entered here and subtracted from the countable income.

• ROUND the net nonexempt income to the nearest dollar. If $50 or more, round up to the nearest dollar. If $49 or less, round down to the nearest dollar.



• Maintenance Need

• Include the ineligible members (IE) and four and nine month continuing family members in the maintenance need.

• Any current SOC adjustments due to a previous month's overstated SOC or due to Hunt v. Kizer is entered.

9.6 Use of MC 176W, Allocation/Special Deduction Worksheet-A

1. Calculate:

a. Allocations to excluded children.

b. The amount of SSI/SSP income deemed available.

c. An allocation from a person in board and care to the spouse and/or children at home.

d. An allocation from an ABD MN LTC person with no community spouse to children at home.

e. AFDC-MN/MI earned income deductions.

f. DO NOT USE Section V. of the MC 176 W to do a stepparent calculation, effective 4/1/91, due to the Sneede v. Kizer lawsuit. Use the “Stepparent Computation” (MC 176 W.1) to determine property and income.

g. ABD income deductions.

Note:

Only those portions of the form that are applicable to the case should be completed. Unused sections should be crossed out.

9.6.1 MC 176W-Allocation/Special Deduction Worksheet-A

Part I. Children with Separate Income or Property Excluded from the MFBU

This portion of the form is completed whenever a child(ren) over two months of age with separate income or property is excluded from the MFBU. Part I is used to determine if the excluded child has enough income to meet his/her needs. If not, an allocation from the family's income towards the



excluded child's unmet needs is made. This allocation is an income deduction on the parent's budget, entered on Column III, line 5 of the MC 176M.

Part II. SSI/SSP or IHSS Recipient(s) in Family - Income Available/Allocated

This portion of the form is completed when a family member receives an SSI/SSP grant or IHSS. This person is not included in the MFBU but a computation must be made to determine how much of the family's income was used to calculate the SSI/SSP grant or IHSS eligibility.

Note:

When an SSI/SSP person is receiving a full SSI/SSP grant amount according to his/her living situation, no allocation from the family has been made and it is not necessary to complete this section.

Part III. Allocation from Board and Care Person to Spouse and/or Children at Home, or from LTC Person with No Community Spouse to Children at Home

Do not complete this section for family members who receive PA. Do not complete this section when the ABD-MN person has a community spouse. Complete the MC 176WB, Parts VII through X if the ABD-MN person with LTC status has a community spouse.

Part IV: AFDC-MN/MI Earned Income Deductions

This portion of the form is completed when deductions are allowed from the gross earned income of AFDC-MN/MI persons in the MFBU.

Part V.

Due to the Sneede v Kizer lawsuit, effective 4/1/91 DO NOT USE this form for stepparent budgeting when MC is requested for only the separate child(ren) of one parent. Use the “Stepparent Computation” (MC 176 W.1) to determine property and income.

Part VI. Aged, Blind, and Disabled (ABD) Income Deductions

This portion of the form is used only in conjunction with the MC 176M and is completed only when any of the following deductions apply to a person’s income (listed in Column I, MC 176M):

• Educational Expenses

• Absent Parent Support

• Student Deduction



• Work Experience for the Blind

• Income for Self-Support

• Conservator/guardian fees (not allowed from Title II disability benefits




9. Budgeting9.0.1 Income at ApplicationDate Received/Expected to be Received

9.0.2 Income Change ReportedDate Received/Expected to be Received

9.1 Treatment of Income for MAGI and Non-MAGI9.1.1 Actual Income9.1.2 Treatment of Apportioned IncomeIncome Received other than Monthly or Semi-MonthlySelf-Employment IncomeLoansInterest Income

9.1.3 Apportionment of Income Exemptions and Deductions9.1.4 Fluctuating Income9.1.5 CalWIN9.1.6 Ending IncomeCollect Income Received DetailCollect Earned Income DetailCollect Employment History Detail

9.1.7 Documentation Requirements

9.2 Bounce Back RuleINTAKE Bounce Back Rule ExamplesCONTINUING Bounce Back Rule Examples

9.3 Accessing MAGI MC Budget9.3.1 Accessing MAGI MC Budget in CalWIN9.3.2 Accessing MAGI Budget Worksheet in CalHEERS9.3.3 MAGI Budget Worksheet9.3.4 Non-MAGI Budget in CalWIN

9.4 Use of Medi-Cal Budget Worksheets For Non-MAGI MC9.5 Completion of Medi-Cal Budget Worksheets for Non-MAGI MC9.5.1 Column I of MC 176M9.5.2 Column II of MC 176M9.5.3 Column III of MC 176M

9.6 Use of MC 176W, Allocation/Special Deduction Worksheet-A9.6.1 MC 176W-Allocation/Special Deduction Worksheet-APart I. Children with Separate Income or Property Excluded from the MFBUPart II. SSI/SSP or IHSS Recipient(s) in Family - Income Available/AllocatedPart III. Allocation from Board and Care Person to Spouse and/or Children at Home, or from LTC Person with No Community Spouse to Children at HomePart IV: AFDC-MN/MI Earned Income DeductionsPart V.Part VI. Aged, Blind, and Disabled (ABD) Income Deductions

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