133% Program for Children Ages One Through Five

The 133% Program provides MC with no SOC to certain otherwise eligible children ages one through five.

To qualify under this program, the net nonexempt family income must be over the maintenance need but below 133% of the FPL. Cases with a SOC are potentially eligible for the 133% Program.

Only applicable AFDC-MN/MI deductions are allowed.
Private health insurance premiums are not deducted when determining if the family income is under the FPL.

Application for the 133% Program

The 133% Program does not require a separate application.

Eligibility for this program is determined as part of the MN/MI application.
Retroactive eligibility can be established for the 133% Program.
If found ineligible for the 133% Program it must be denied and the denial NOA deleted when child(ren) ages one through five are ineligible due to income in excess of 133% of the FPL.

Period of Eligibility

Eligibility for the 133% Program can begin no earlier than age one and can continue, depending on family income, until the end of the month in which the child reaches age 6.

Exception: Eligibility for the 133% Program can be continued after age six if the child is receiving inpatient services for a continuous period which began before and continues beyond the child's sixth birthday.

Note: State MEDS programming is in place which will generate an EW alert message (CEWA) in the month prior to the child's sixth birthday.

Aid Codes

The following aid codes are granted for children eligible under the 133% Program:

Aid Code	Description
72	Citizen/lawful permanent resident/PRUCOL/Conditional Status. (full scope benefits).
74	Undocumented status/temporary visa (emergency medical services only).

Eligibility Determination

CalSAWS will determine eligibility for all FPL Programs however if a manual determination is required for the 133% Program follow the steps below:

Determine eligibility for FPL programs using reguar rules or using Sneede rules if the MFBU includes a Sneede member, when a case has both:

A SOC, and
A child ages 1 through 5

Includes all family members in the MFBU (eligible and ineligible individuals) when determining the Maintenance Need and Poverty Level amounts. (Do not count excluded individuals or PA recipients.)
Allow only AFDC-MN/MI deductions when computing the family's net nonexempt income for the 100/133/200% Programs.

Exceptions: Health insurance premiums are not an allowable deduction. If the MFBU includes an ABD-MN individual, allow only AFDC-MN/MI deductions for the 133% Program. ABD-MN deductions are not allowed.

Repeat these steps if income changes and/or new information is received which affects the SOC or children eligible for the program.

Approvals and Denials

Use this chart to determine the appropriate Approval/Denial actions. These rules apply to both new applications and continuing cases.

If net nonexempt income of the MFBU is:	Then:...
At or below Maintenance Need	Approve under the regular AFDC-MN/MI program.(May qualify for Property Waiver)
Between Maintenance need and 133% of FPL	Approve eligible child(ren) under the 133% Program with no SOC.
Over 133% of FPL but less than 250% of FPL	Record 133% Program denial and delete the 133% denial NOA. Approve AFDC-MN/MI with no SOC.
Over 250% of FPL	Approve AFDC-MN/MI with a SOC.

Note: The COLA increase in Social Security benefits which is received in January is to be disregarded for all Federal Poverty Level Programs (including Income Disregard, 100%, 133%, and Property Waiver programs) from January through March, if applying the increase will make the individual ineligible for those programs.

MFBU Requirements

A 133% eligible child will receive benefits under the no cost 133% Program, either full-scope or restricted to emergency care. The 133% eligible children must be included in the MFBU of other eligible MN/MI family members.

When discontinuing a child from the 133% Program because he/she has turned age six, evaluate eligibility for the 100% FPL Program. CEC rules apply if the child does not qualify for the 100% FPL program.

Notice of Action Requirements

Approval of Benefits

An approval notice for the 133% Program must be issued when establishing eligibility for that program.

Discontinuance of 133% Benefits Only

A timely 10-day notice of action is required when discontinuing individuals from the 133% Program due to either of the following reasons:

Increased income.
A child reaches age six. (Determine eligibility for the 100% Program.)