MFBU Determinations

All family members living in the home, other than those specified in the exceptions outlined below must be included in the MFBU, whether or not they are eligible for, or request to receive MC.

MFBU Composition Examples

Family Composition Examples

Family Composition	No. of MFBUs	Who is Included in Each MFBU
Individual adult	1	Individual adult
Individual and spouse	1	Individual and spouse
Parent(s) and children	1	Parent(s) and children
Both unmarried parents and mutual children	1	Both unmarried parents and mutual children
Both unmarried parents, mutual children and separate children of either/both parents	1	Both unmarried parents, mutual children, separate children. EXCEPTION: When all the mutual children are excluded, each unmarried parent and that unmarried parent's separate children shall be in a separate MFBU = 2 MFBUs
Parent, spouse, mutual children	1	Parent, spouse, mutual children
Parent, spouse, mutual children and/or separate child of either or both parents	1	Parent, spouse, mutual children, separate children or the parent and the separate children of that parent.
Sibling children if all other family members are PA or Other PA	1	Sibling children
Sibling children, with a caretaker relative other than a natural/adoptive parent.	1 OR	Sibling children and caretaker relative, if latter chooses to be included in children's MFBU. There would be an AFDC-MN linkage for the caretaker relative [one case, child(ren's) mother's name].
	2	Two MFBUs: Sibling children (separate case) Caretaker relative with other linkage, (separate case) If the caretaker relative chooses to be in his/her own MFBU, there is NO AFDC-MN linkage for the caretaker relative. Exception: The caretaker relative of a PA or SSI child retains AFDC-MN linkage.
Sibling children, non parent caretaker relative, caretaker relative's spouse and/or children (spouse has no linkage)	2	Two MFBUs: Caretaker; related sibling children Caretaker relative and caretaker's spouse as ineligible members; their eligible children
Minor married child (living with parents), her spouse, their children, minor child’s parent(s) and or spouse and children.	3	Three MFBUs: Minor married child as eligible; minor child’s spouse and children as ineligible; minor parent’s parent(s) and /or spouse and children as ineligible Minor parent as ineligible; spouse and children as eligible Minor parent’s parent(s) as eligible; minor child as ineligible

Ineligible Members

Ineligible members of an MFBU include:

Individuals who refuse to apply for a Social Security number (SSN).
- Note: Undocumented individuals are not required to possess or apply for a SSN as a condition of eligibility.
Individuals who refuse to apply for medicare.
Individuals who refuse to apply for and accept unconditionally available income.
Individuals who are eligible for Edwards, Four Month Continuing or Transitional Medi-Cal.
Married or unmarried minor parent(s) living with parents when minor parent's children need MC
- Note: A minor parent who applies for Minor Consent Services is eligible for Medi-Cal in his/her own MFBU.
Parent of the separate children in stepparent cases in which only the one parent's separate children request MC.
Parents who reside outside California who claim their California resident children as tax dependents.
A married child living with his/her own parents, whether claimed by parents as tax dependents or not is considered to be a child and must not be included in his/her own MFBU as an adult. The married child is in one MFBU as the only eligible member. The married child’s spouse and children and the married child’s parent(s) must be included in the same MFBU as ineligible (IE) members.
If a married child’s parent(s) want MC, a separate MFBU would include the married child's parents as eligible members, and the married minor parent child as an IE member.
If a married child’s spouse and children want MC, their MFBU would include the married child’s spouse and children as eligible members and the married child as an ineligible (IE) member because he/she is financially responsible for his/her spouse and children.
Individuals unable to meet the basic eligibility criteria for any MC programs.
A parent or a spouse who chooses to be aided with his/her related child in the MN program is also an ineligible member in his/her spouse/children’s MN/MI MFBU.
A parent or caretaker relative who refuses to assign to the state all rights to medical support and payments for medical care from any third party.
A parent or caretaker relative who refuses, without good cause, to
- Cooperate in establishing paternity for a child under eighteen years of age born out of wedlock for whom MC is requested, and/or
- Obtain medical support and payments, and/or
- Identify and provide any information concerning any third party who is or may be liable to pay for medical care or support.
Individuals who are eligible, but refuse MC; their income and property must be included in the eligibility determination.

The following applies to ineligible members of an MFBU:

Property is included in determining eligibility.
Income is used in determining SOC.
Maintenance need for the MFBU includes all ineligible members.
Medical expenses of ineligible members can be used to meet the SOC for the MFBU.
Ineligible Members who are receiving MC under any of the following aid types may also use their non MC covered health care costs to help meet the SOC for the MFBU:

Edwards, Aid Code 38.

Four-Month Continuing Eligibles, Aid Code 54.

Transitional Medi-Cal Eligibles, Aid Codes 39, 3T, 59, 5T.

Ineligible members do not receive MC cards.

Note: Ineligible child(ren) cannot establish AFDC-MN linkage for the MFBU.

Excluded Members

Excluded members of an MFBU may include the following:

Any child, other than an unborn, who either:
- Chooses not to receive Medi-Cal, or
- Refuses to provide information about his/her property and/or income.
Members of a stepparent unit (other than the parent) when only the separate children of one parent want Medi-Cal.

An excluded person cannot be included in the MFBU. If an excluded person later wishes to apply for Medi-Cal, he/she can only be added the month of request and up to 3 months Retro.

A client receiving SSI benefits cannot be included in the MFBU.

Rules Applied to Excluded Members

The following rules apply to individuals who are excluded from an MFBU:

Property is not included in determining eligibility for the MFBU.
Income is not used in determining the SOC for MFBU.
The maintenance need or the property limit for the MFBU does not include these individuals.
Medical expenses of excluded members cannot be used to meet the SOC for the MFBU.
Excluded members do not receive MC cards.
Applications cannot be made separately, unless for Minor Consent Services.
Excluded child(ren) cannot provide AFDC linkage for the MFBU.

Adding Excluded Individuals to the MFBU

If MC is later requested for an excluded person, s/he can be added to the MFBU the month of request and up to three months Retro.

Unmarried Pregnant Women

An unmarried pregnant woman (including Minor Consent applicants) may choose to apply for MC only for herself, even though the unmarried father is residing in the home.

When Continued Eligibility (CE) rules apply, the unmarried father must be added to the MFBU when the child is age one unless he is requesting MC for himself and/or his other mutual or separate children.
The unmarried father may choose to be included in an MFBU with the unborn and mother. He may receive MC if he has linkage.
- Note: EWs must evaluate AFDC-MN linkage for the unmarried pregnant woman whenever possible before establishing MI.
The unmarried pregnant woman may choose to exclude:
- Her other mutual child(ren).
  - If other mutual child(ren) are included, then the father must also be in the MFBU.
- Her separate child(ren).

MFBU Determination When the Child Lives at Home

The minor child living at home is included in the parent's MFBU with the following exceptions:

A child applying only for Minor Consent Services is not included in the parent's MFBU.
An excluded child is not included in the parent's MFBU.
A blind or disabled MN person who is 18-21 years of age living in the home is considered an adult.

The minor living with CalWORKs (cash) parents will be set up in his/her own MFBU. The AFDC parents are receiving PA, and not considered part of the family composition.

Example

MFBU Determinations when an Unmarried Minor Parent Lives in the Home of Senior Parent(s)

MFBU Rules for Unmarried Pregnant Minor

Minor parent cases are three generation households. The senior parents are financially responsible for the minor parent but not for his/her child (their grandchild).

A minor parent may be included in the senior parent(s) MFBU.

If the senior parent(s) have knowledge of the pregnancy and are applying for or receiving MC, the minor's unborn can be included in the senior parent(s)' MFBU at their request, in addition to an MFBU which includes the unborn's parent(s).

Once the minor's child is born, the child must be placed in his/her own MFBU apart from the grandparents the month following the month of delivery (establish a separate case in the minor mother's name). This will insure that the grandparent’s income and property do not affect the child’s eligibility and SOC.
The minor parent is an ineligible member of the newborn’s MFBU because she is financially responsible for her children.
The minor mother will have her MC eligibility determined in the senior parent’s MFBU once the 60 day Postpartum period has passed.
- The minor mother's eligibility and SOC during the 60-day postpartum period are not affected.

A minor parent may be in his/her own MFBU under the Minor Consent Program. When the minor requests only minor consent services, the unborn is not added to the senior parent’s MC case. The unborn can establish linkage for the unmarried father if he is also in the home and applying for MC.

Unmarried Minor Parent’s Child(ren)

The child(ren) (with the exception of unborns) are in their own MFBU which:

Includes the minor parent as an ineligible person.
May include the second unmarried parent if in the home as an eligible member.
May include the separate children of either unmarried parent as eligible members.

Example

Property and Income for Unmarried Minors

The property and income of the unmarried minor parent is used in both the senior parent(s)' and minor parent(s)' MFBU. Sneede v. Kizer rules may apply if there is excess property or a SOC.

The parent(s) of the minor are responsible relatives. Do not count income in-kind to the minor parent when determining the SOC for the MFBU which includes his/her children. Income in-kind may apply to others in this MFBU.

MFBU- Unmarried Minor Parent(s) Living in the Home

Family Composition

No. of MFBUs

Who is Included in Each MFBU

Unmarried minor parent

Unmarried minor parent’s children

Senior parent(s) and his/her spouse and/or children.

Unmarried minor parent as an ineligible member, minor parent's children.
Unmarried minor parent, the senior parent(s) and his/her spouse and/or child(ren). **

Unmarried minor parent

Second parent

Their mutual children

Separate children of either or both, Senior parent(s) and his/her spouse and/or children.

Unmarried minor parent as an ineligible member, second parent, separate children of either parents, and their mutual children.
Unmarried minor parent, the senior parent(s) and his/her spouse and/or child(ren). **

** The unmarried minor's unborn can also be included in the senior parent's MFBU at their request when the senior parent(s) are aware of the pregnancy. Once the child is born, a separate MFBU (and separate case) must be established the month following the month of delivery.

MFBU Determination When a Married Minor Child (Parent or not) Lives in the Home of Senior Parent(s)

MFBU- Married Minor Child

Family Composition

No. of MFBUs

Who is Included in Each MFBU

Married minor child Minor child’s spouse

Their mutual children (if any)

Separate children of either or both (if any)

Minor child’s parent(s) and his/her spouse and/or children.

Eligible Members: Married minor child
Ineligible Members: Married minor child’s spouse and children, and senior parents.*
Eligible Members: Married minor child’s spouse and child(ren)
Ineligible Members: Married minor child.*
Eligible Members: Married minor’s parent(s) and that person’s spouse
Ineligible Members: Married minor child. **

Married minor child (no spouse in the home), his/her children and minor child’s parent(s) and his/her spouse and/or children.

Eligible Members: Married minor child and his/her parent(s) and his/her spouse and/or children.
Eligible Members: Married minor child’s children.
Ineligible Members: Married minor parent.

** The Minor's unborn can also be included in the senior parent's MFBU at their request when the senior parent(s) are aware of the pregnancy. Once the child is born, a separate MFBU (and separate case) must be established the month following the month of delivery.

Children in Foster Care or Eligible for Adoption Assistance

Children in Foster Care:

Must be eligible for MC:
- On the basis of the information provided by the public agency on the MC 250.
- Without considering the property or income of the child or the child's parents.
Must be eligible under the MI program.
Must be in his/her own MFBU.

Children eligible for the Adoption Assistance Program are eligible for MC under the MI program in his/her own MFBU.

MFBU Chart — Foster Care/ Eligible for Adoption Assistance

Family Composition	No. of MFBUs	Who Is Included In Each MFBU
Child in foster care	1	Child
Two sibling children in foster care	2	Each sibling child is in his/her own MFBU, even if placed in the same foster home
Child detained or placed by a court or court designated agency.	1	Child
Child not living with a parent or another caretaker relative, and for whom a public agency is assuming financial responsibility in whole or in part	1	Child
Child not living with a parent or another caretaker relative when parents or public agencies have been contacted to determine whether they will accept legal responsibility for the child	1	Child