Manual Pickle Eligibility Determination Process

Pickle eligibility is determined in CalSAWS, however, the Pickle eligibility determination can be done manually if needed following the process below:

  1. Screen for potential Pickle eligibility using the “Pickle Screening and Title II Disregard Computation Worksheet” (SCD 1363).
    1. Part I Screening Process
    2. Part II Disregard Computation
  2. SCD 1363 Part I Screening Process
    1. If the answer to questions 1, 2, and/or 3 is NO, the individual is not eligible for Pickle. The EW must:
      1. Document the reason for ineligibility in the Journal page.
      2. Send a Pickle denial notice.
      3. Evaluate for other Non-MAGI eligibility.                   
    2. If the answer to 1, 2, and 3 are YES but 4 is NO, there is potential Pickle eligibility after the next RSDI COLA. The EW must:
      1. Deny Pickle, but review for potential Pickle eligibility after each annual RSDI COLA.

      2. Exception: If the answer to 3 is YES because the SSI/SSP discontinued due to an RSDI COLA increase, then the answer to question 4 is YES and the individual may be considered potentially PICKLE eligible.    

    3. If the answer to ALL questions 1 through 4 is YES, the applicant is a potential Pickle person, and the EW must:
      1. Verify and document the date the client was last eligible for and received SSI/SSP.
      2. Complete the disregard computation and the financial eligibility process.                    
  3. SCD 1363 Part II Disregard Computation
    1. Multiply the RSDI Income by the pickle multiplier from the year the SSI/SSP was discontinued and round down to the lowest full dollar.
    2. Note: For a couple, each spouse may have a different Pickle multiplier if their date of discontinuance from SSI/SSP is different.
  4. CalSAWS determines the financial eligibility for Pickle, however, the following forms can also be used:
    1. “Pickle Needs Test” (DHCS 7075
    2. “Financial Eligibility Worksheet (DHCS 7021)
    3. “Statement of Living Arrangements, In-Kind and Maintenance (DHCS 7044)
      1. Note: The Pickle financial eligibility test must be completed for Pickle eligibility at intake whenever there is a change in the Pickle individual’s income. When a change in income is the result of an RSDI COLA, the Pickle budget must be updated at the time of the regularly scheduled redetermination.
  5. CalSAWS determines the resource eligibility for Pickle, however the following form can also be used:
    1. “Pickle Resource Worksheet” (DHCS 7037)
  6. SSI/SSP resource limits are used, which may be different than the Medi-Cal resource limits. If the individual or couple has excess resources:
    1. Deny/discontinue Pickle eligibility and send a timely 10-day NOA.
    2. Determine (or continue) eligibility for Non-MAGI MC.
  7. Record potential Pickle eligibility or ineligibility in the MEDS Pickle Tickler System.

Screening an ABD Couple

When screening an ABD couple, each person must be screened separately. One or both individuals may qualify as potential Pickle eligibles separately or together.

If... Then...
Both individuals pass the screening process, They are potentially eligible as a Pickle couple. Combine their income and disregard amounts when computing the VTR - Value of One Third Reduction.
Both individuals pass the screening process but are ineligible after computing the VTR - Value of One Third Reduction for a couple, Complete the VTR - Value of One Third Reduction for each individual separately using his/her own income and disregard amount.
One spouse does not pass but the other does,  The spouse that did not pass is termed an “ineligible spouse”.

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.

When to Not Apply VTR

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.

PMV - Presumed Maximum Value

Definition

Instead of determining the actual dollar amount of any food or shelter received by the Pickle applicant/client, 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. The PMV never applies to earned income.

When to Apply the PMV

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

  • 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.

The DHCS 7044, Statement of Living Arrangement

The DHCS 7044 must be completed by the Pickle applicant/client 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.

Rebutting the PMV

The applicant/client 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 must be counted as unearned income.
  2. The applicant/client must be advised of his/her right to rebut the PMV.
  3. When the applicant/client intends to rebut the PMV, the EW must allow him/her ten days to provide proof of the actual value of ISM.

Examples of VTR and PMV

  1. Pickle applicant lives in a duplex, her parents own the duplex, they live elsewhere.
    1. If the Pickle client does not pay or owe rent and her parents provide all food, then this is a VTR case.
    2. If she has no rental liability and she buys her own food then this is a PMV case.
    3. 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.
    1. Use VTR rules.

Sharing

When determining ISM, sharing exists when an applicant/client 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.

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

ISM Values

The VTR and PMV amounts are found in the Chart Book.

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.

VTR for 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.”
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. Living in noninstitutional care noninstitutional care All non medical institutions including those for education or vocational trainingsituation 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.
  1. 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.
  1. 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.
  1. If the noninstitutionalized spouse lives in any other situation. 
 1/6 of the FBR for a couple plus $10.00.
  1. Paying less than Current Market Rental Value (CMRV) for shelter.
 Add PMV to other unearned income unless criteria for earned/unearned income is met.

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. 4ISM received under a governmental medical or social service program
  5. ISM which is assistance based on need from a state or political subdivision
  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 individuals by non-profit community organizations supported by any state or local assistance agency (i.e. subsidized meal program, CalFresh). 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).

Related Topics

Pickle Amendment - Lynch v. Rank

Treatment of Income for Pickle