|
Living
Situation
|
Person’s
Characteristics
|
Status
|
Who Completes
Statement of Facts
|
Whose Income
and Property is Counted
|
Contact with
Parent1
|
|
Adult
|
Child
|
|
1
|
Any
living situation, claimed as tax dependent by parent.
|
A
|
18-
to 21-year-old.9
|
|
X
|
Parents.
|
Parent’s,
18- to 21-year-old’s, other MFBU members.
|
Yes
|
|
B
|
Under
18.
|
Determine
in accordance with 2 through 5, below
|
|
2
|
Independent
living situation. 9
|
A
|
18-
to 21-year old.
|
X
|
|
18-
to 21-year old.
|
18-
to 21-year-old’s..
|
No
|
|
B
|
14-
to 18-year-old handling all of his/her own financial affairs.
|
X
|
|
14-
to 18-year-old.
|
14-
to 18-year-old’s. 2
|
No
|
|
C
|
14-
to 18-year-old with a parent, caretaker relative, or legal guardian
handling some or all of his/her financial affairs.
|
|
X
|
Parent,
caretaker relative, or guardian. If
they will not and public agency also refuses, 14- to 18-year-old may
complete.
|
14-
to 18-year old’s. 2
|
Yes/No
|
|
D
|
Under
14.
|
|
X
|
Parent,
caretaker relative, or legal guardian.
If they will not and public agency also refuses, child may complete.
|
Under
14-year-old’s.
|
Yes/No
|
|
3
|
Living
on the parent’s property in a building that would be considered the
parent’s “other real property” for Medi-Cal
purposes.
|
A
|
18-
to 21-year-old not receiving any financial support from parents. 9
|
X
|
|
18-
to 21-year old.
|
18-
to 21-year-old’s.
|
No
|
|
B
|
18-
to 21-year-old receiving financial support from parents. 9
|
|
X
|
Parent.
|
Parent’s,
18- to 21-year-old’s, other MFBU member’s.
|
Yes
|
|
C
|
14-
to 18-year-old.
|
|
X
|
Parent.
|
Parent’s,
14- to 18-year-old’s, other MFBU member’s.
|
Yes
|
|
D
|
Under
14.
|
|
X
|
Parent.
|
Parent’s,
under 14-year-old’s, other MFBU members.
|
Yes
|
|
4
|
Attending
school away from parent’s home.9
|
A
|
18-
to 21-year old who always returns home when not in school or considers the
parent’s home his/her home. 3
|
|
X
|
Parent.
|
Parent’s,
18- to 21-year-old’s, other MFBU member’s.
|
Yes
|
|
B
|
18-
to 21-year-old who handles his/her own financial affairs and considers
himself/ herself to be living on his/her own and returns home only for
visits. 3
|
X
|
|
18-
to 21-year-old.
|
18-
to 21-year-old’s.
|
No
|
|
C
|
14-
to 18-year-old handling all his/her own fanancial
affairs.
|
Determine
as in 4. A and B.
|
|
D
|
14-
to 18-year-old with parent handling his/her financial affairs.
|
|
X
|
Parent.
|
Parent’s,
14- to 18-year-old’s, other MFBU member’s.
|
Yes
|
|
E
|
Under
14.
|
|
X
|
Parent.
|
Parent’s,
under 14-year-old’s, other MFBU member’s.
|
Yes
|
|
5
|
Out-of-home
care (non-medical) public agency assuming financial responsibility in whole
or part (aid Code 45) 4, 5
|
A
|
Under
21.
|
|
X
|
Public
agency assuming financial responsibility.
|
N/A—assumption
that public agency has made needy determination (form MC 250).
|
No
|
|
6
|
Out-of-home
care (non-medical) including custodial care in the state hospital).
|
A
|
18-
to 21-year-old.
|
Determine
in accordance with 1 or 2, above.
|
|
B
|
Under
18.
|
Determine
in accordance with 2, above.
|
|
7
|
Long-term
care (LTC)
|
A
|
Disabled,
18- to 21-year-old.
|
X
|
|
18-
to 21-year-old.
|
18-
to 21-year-old’s.
|
No
|
|
B
|
Disabled,
under 18.
|
|
X
|
Parent
or person or agency responsible for child. 6
|
Disabled
child’s.
|
Yes
|
|
C
|
Living
with parents prior to LTC status, not disabled. 7
|
|
X
|
Parent.
|
Parent’s,
LTC child’s, other MFBU member’s.
|
Yes
|
|
D
|
Independent
living, attending school, out-of-home care prior to LTC status, not
disabled.
|