Property Waiver Program

The Property Waiver Program provides no SOC MC eligibility for pregnant women and infants up to age one whose family income is at or below 200% of the FPL, but whose family assets exceed the MC property limit.

No property verification is required for any property listed on the MC 210 when it is determined that the applicant is requesting pregnancy related services (or full scope services for an infant), and the family income is at or below 200% of the FPL. In addition the applicant is not required to complete supplemental property forms.

The Property Waiver Program now applies to:

Pregnant women and infants up to age one with family income at or below 200% of the FPL,
Children ages one to six with a family income at or below 133% of the FPL, and
Children ages six to nineteen with a family income at or below 100% of the FPL.

Note: Any pregnant woman and/or child under 19 years with family net nonexempt income at or below the FPL for his/her applicable Income Disregard/Percent Program is potentially eligible for the Property Waiver Program.

Property Waiver Program Criteria

Pregnant Women and Infants

In order to qualify for the Property Waiver Provision of the Income Disregard Program, the following criteria must be met by pregnant women and infants:

Family income must be at or below 200% of the FPL, and
The family must have property, and
The pregnant individual is made aware of the choice between restricted and full scope options, and chooses restricted scope of benefits for herself (and/or full scope for an infant), and
The applicant does not want to verify property and/or spenddown any excess property in order to qualify for full-scope coverage for herself or to establish Medi-Cal eligibility for other family members.
The pregnant individual and/or infant are otherwise eligible for MC.

Other family members are ineligible unless property is verified and, if over the property limit, reduced to the MC limit.

Children One to Six Years Old

In order to qualify for the Property Waiver Provision of the 133% Program, the following criteria must be met by children who are at least one year of age but under six years of age:

Family income must be at or below 133% of the Federal Poverty Level (FPL), and
The family must have property, and
The applicant does not want to verify property and/or spenddown any excess property in order to establish MC eligibility for other family members.
The child is otherwise eligible for MC.

Children Six to Nineteen

In order to qualify for the Property Waiver Provision of the 100% program, the following criteria must be met by children who are at least six years but under nineteen years of age:
Family income must be at or below 100% of the Federal Poverty Level (FPL), and
The family must have property, and
The applicant does not want to verify property and/or spenddown any excess property in order to establish MC eligibility for other family members.
The child is otherwise eligible for MC.

Scope of Coverage

Under the Property Waiver Program:

Pregnant individuals are eligible for MC coverage for their pregnancy-related services only. They are not “dually” eligible for full scope MC with a share of cost as they can be in the Income Disregard Program.
Infants up to one year old receive either full-scope MC benefits, or If undocumented, emergency services only.
Children ages one to six with a family income at or below 133% of the FPL, and children ages six to nineteen with a family income at or below 100% of the FPL receive either full-scope MC benefits or if undocumented, emergency services only.

Property Verification Not Required

The family must answer all questions on the application. No property verification is required for any property listed on the application (unless the property produces income) whenever the EW determines that:

The applicant/recipient is only requesting pregnancy related services (and/or full scope services for an infant), and the EW has determined that the family income is at or below 200% of FPL, and/or
The applicant/recipient is only requesting services for a child, and the EW has determined that the family income is at or below 100% or 133% of the FPL for the appropriate Percent Program for that child.

Note: The applicant is not required to complete any supplemental property forms.

Income Generated From Waived Property

Income generated from property whose value is waived under the Property Waiver Program must be counted when determining the family’s share of cost/and or eligibility for the Property Waiver program. This income must be counted in all cases except if it is unavailable, exempted by specific court order or statute, etc.

The EW must document whenever a case has income generated from property which is exempt.

Although the family must answer all questions on the application, verification of property is not required if the family is applying under the Property Waiver Program. However, in those situations where the EW becomes aware that the family’s property is producing income, the client must provide verification of the income. The verification may include information normally used to verify property.

Rental Income from Real Property

If the client has earned or unearned rental income from real property the EW must give the family an opportunity to verify any expenses associated with the rental income by having the client complete and verify those questions on the MC 210 PS that specifically pertain to rental expenses. The Property Waiver client is not required to provide any verification of the property other than what is necessary to establish the amount of income and any associated expenses.

Note: If the applicant has other real property and would be over the property limit even if the utilization requirement was met, the applicant is not required to submit proof of utilization.

Determining Eligibility for Property Waiver

Pregnant Woman and/or a Child Under One

Follow these steps to determine eligibility for the Property Waiver Program when a household includes a pregnant woman and/or a child under age one:

Determine if income is at or below 200% of the FPL using regular FPL rules, or under Sneede rules if the MFBU includes a Sneede class member. If yes, proceed to step 2. If no, stop here.
If the criterion in step 1 is met, inform the client of the choice to either:

Receive full scope benefits for herself and other family members and provide property verification and spenddown any excess property to meet the regular MC eligibility requirements. Explain full scope benefits and the spenddown process.

Receive restricted benefits under the Property Waiver Program and choose not to verify and/or spenddown any excess property.

Explain the following to the applicant:

If there is excess property, the amount of excess property and how it can be spent down or converted to “exempt” property, and
What benefits the family will be eligible for if assets are spent down, and
What benefits are available to the pregnant woman and her baby if the family chooses to retain their assets and receive restricted benefits only.

Determine that all other eligibility factors are met.

Children ages one to six with family income at or below 133% of the FPL, and children ages six to nineteen with family income at or below 100% of FPL (No pregnant woman)

Children One to Six with Family Income at or Below 133%

Follow these steps to determine eligibility for the Property Waiver Provision of the 100% and 133% Programs when a household includes Percent Program children:

Determine eligibility if family income is at or below 100% or 133% of the FPL under regular rules or Sneede rules if the MFBU includes a Sneede class member. If yes, proceed to step 2. If no, stop here.
If the criterion in step 1 is met, inform the customer of the choice to either:

Receive full scope benefits for herself and other family members and provide property verification and spenddown any excess property to meet the regular MC eligibility requirements. Explain full scope benefits and the spenddown process.

Receive MC benefits under the Property Waiver Program or TLICP for the children only and choose not to verify and/or spenddown any excess property.

Explain the following to the applicant:

If there is excess property, the amount of excess property and how it can be spent down or converted to “exempt” property, and
What benefits the family will be eligible for if assets are spent down, and
What benefits are available to the children if the family chooses to retain their assets and receive benefits for the children only

Determine that all other eligibility factors are met.

No SOC and Property Waiver

If a child or pregnant woman is otherwise eligible for zero share-of-cost MC under the Medically Needy (MN) or Medically Indigent (MI) program, but has excess property and chooses not to verify property, Section 6 of Mail-In application is not completed, approve these individuals using the appropriate Income Disregard/Percent Program Aid Code to identify them as Property Waiver cases.

Note: The EW must not set up anyone on an FPL Program if they are eligible for regular zero SOC MC.

Denials

Deny MC benefits for the Property Waiver Program if a MC applicant’s family has income over 200% of FPL for pregnant women or infants.

Deny MC benefits for the Property Waiver Program if a MC applicant’s family has income over 133% of FPL for children ages one to six or 100% of FPL for children ages six to nineteen. (Eligibility for other MC must be evaluated.)

Note: Delete the FPL denial NOAs.

Discontinuance

A special discontinuance NOA must be used when terminating benefits under the Property Waiver program. Benefits must be discontinued for:

The pregnant woman, at the end of her 60 day postpartum period. (Set a case alert to flag this date.)
The infant, at the end of the month that the child turns one.
The child in the 133% program, at the end of the month that the child turns six.
The child in the 100% Program at the end of the month that the child turns nineteen.

Note: When discontinuing an infant or child from an FPL Property Waiver Program, the EW must evaluate the child’s eligibility for the other FPL Programs. If he/she is not eligible for the other FPL programs, then the EW must evaluate the child’s eligibility for share of cost AFDC-MN/MI MC.

Property Changes

When a pregnant woman, infant or child is income eligible for one of the FPL programs, but becomes property ineligible while receiving MC benefits under other than an FPL program and chooses not to verify and spenddown property, the EW should take the following action:

Discontinue all family members from regular MC benefits (including the pregnant woman for her non-pregnancy care).
If family income is at or below the FPL limit for the appropriate FPL Program, the pregnant woman and/or infant/child(ren) remain in active status and change their Aid Codes to the appropriate FPL Aid Code effective the first of the following month.
Send appropriate approval NOA.

Income Increases

Pregnant women and Infants are exempt

Once eligibility for the Property Waiver Provision of the Income Disregard Program has been established, increases in family income are to be disregarded for pregnant women and infants due to Continued Eligibility (CE)/Deemed Eligibility (DE) rules. These are the only Property Waiver eligibles who are not affected by increases in family income.