Revision 22-3; Effective September 1, 2022
Eligibility income budgeting for Medicaid Buy-In for Children (MBIC) is different from other MEPD programs.
The family gross income (earned and unearned) must not exceed 300% of the FPL.
Due to substantial income exclusions, the income limit used for the eligibility determination is equal to or less than 150% FPL for the family size. The income limit for each case may be different depending on the family size.
Related Policy
Budget Reference Chart, Appendix XXXI
N-6310 Income Treatment
Revision 11-3; Effective September 1, 2011
Treat earned and unearned income the same in MBIC budgeting. Do not deduct:
- the $20-general exclusion, or
- the earned income exclusion of $65 plus one-half of the remaining income.
N-6320 MBIC Income Exclusion
Revision 11-3; Effective September 1, 2011
The MBIC income exclusion is $85 plus one-half of the remaining income and is deducted at the end of the budget calculation.
N-6330 Ineligible Sibling Exclusion
Revision 24-2; Effective June 1, 2024
Allow an exclusion from an ineligible sibling's income before counting the ineligible sibling's income in the eligibility budget. Allow this exclusion for each ineligible sibling in the family unit. The base exclusion amount changes each year and is equal to two times 150% FPL for a family of one plus $85.
Effective March 1, 2024, the ineligible sibling's exclusion amount is $3,851. Deduct this amount from the ineligible sibling's total income and count any remaining income in the budget. If the ineligible sibling's income is less than the total exclusion, disregard all the ineligible sibling's income in the budget.
Related Policy
Examples of Budgeting Steps, N-6351
N-6340 Determining the Budget Group
Revision 15-4; Effective December 1, 2015
The budget group is determined by identifying the members of the family unit whose income is countable in the eligibility budget. The number of people in the family unit and in the budget group may be different.
Do not count any of the income of a family unit member that:
- has needs-based income, such as veteran's pension or Supplemental Security Income (SSI); or
- is a Medicaid-eligible person, such as another MBIC applicant/recipient in the household.
For a stepparent's income to count, the stepparent must:
- be the current spouse of a natural or adoptive parent, and
- live in the same household as the MBIC applicant or recipient and the natural or adoptive parent.
If a stepparent's income is not considered because these criteria are not met, do not consider a stepsibling's income either.
Reminders:
- If school or job training attendance has not been verified for an ineligible sibling between ages 18 and 22, that sibling is not part of the family unit and, therefore, is not included in the budget group.
- Consider absences due to active military assignments as temporary and include that individual in the budget group.
N-6350 Budgeting Steps
Revision 22-3; Effective September 1, 2022
Income related budget steps:
- Determine the family unit members.
- Determine the appropriate FPL based on the family size. The FPL that corresponds to the total number of family unit members is the income limit for the family. Example: For a family unit of five, the income limit is 150% of the FPL for a family of five.
- Determine the budget group members.
- Determine the monthly gross countable earned and unearned income, if any, of the MBIC applicant or recipient.
- Determine the combined monthly gross countable earned and unearned income of the applicant or recipient's parents.
- For each ineligible sibling, determine any monthly gross countable income that exceeds the ineligible sibling's exclusion amount. If the exclusion amount is greater than the ineligible sibling's income, disregard all of that ineligible sibling's income.
- Total the income amounts determined in steps 4-6.
- Subtract $85 from the total in step 7.
- Divide the amount in step 8 by two.
The remainder is countable income. Compare this to the income limit determined in step 2.
Related Policy
Budget Reference Chart, Appendix XXXI
N-6351 Examples of Budgeting Steps
Revision 24-2; Effective June 1, 2024
The figures used in these charts are examples only. They may not reflect the current FPL limits or the deduction amounts that are based on FPL.
Example 1
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — no income
Applicant's parent — gross earnings $2,400 monthly
Applicant's stepparent — gross earnings $3,000 monthly
Applicant's ineligible 16-year-old sibling — no income
Applicant's ineligible 19-year-old sibling, non-student — gross earnings $800 monthly
Applicant's ineligible 14-year-old stepsibling — no income |
| Children Employed | None |
| Family Unit Members | Applicant
Applicant's parent
Applicant's stepparent
Applicant's ineligible 16-year-old sibling
Applicant's ineligible 14-year-old stepsibling |
| Income Limit | 150% FPL for family of five |
Note: Since the 19-year-old ineligible sibling is over 18 and not a student, do not consider the sibling or the sibling's income.
| Budget Group and Eligibility |
|---|
| Steps | Amount |
|---|
| Applicant's monthly gross countable income | $0 |
| Add parents' monthly gross countable income | $5,400 |
| Add the income of each ineligible sibling that exceeds $3,851 | $0 |
| Total budget group income | $5,400 |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $2,742.50 |
| Total countable income | $2,657.50 |
| 150% FPL for family of five | ≤ $4,573 |
| Eligibility result | Eligible |
Example 2
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — Retirement, Survivors, and Disability Insurance (RSDI) $167
Applicant's parent — gross earnings $4,500 monthly
Stepparent, died one year ago
Applicant's ineligible 16-year-old sibling — gross earnings $100 monthly
Applicant's 20-year-old ineligible sibling, student — gross earnings $400 monthly
Applicant's 10-year-old stepsibling — no income |
| Children Employed | Two |
| Family Unit Members | Applicant
Applicant's parent
Applicant's ineligible 16-year-old sibling
Applicant's ineligible 20-year-old sibling (student) |
| Income Limit | 150% FPL for family of four |
Note: Since the stepparent is deceased, do not consider the ineligible stepsibling or the ineligible stepsibling's income.
| Budget Group and Eligibility |
|---|
| Steps | Amount |
|---|
| Applicant's monthly gross countable income | $167 |
| Add parent's monthly gross countable income | $4,500 |
| Add the income of each ineligible sibling that exceeds $3,851 | $0 |
| Total budget group income | $4,667 |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $2,376 |
| Total countable income | $2,291 |
| 150% FPL for family of four | ≤ $3,900 |
| Eligibility result | Eligible |
Example 3
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — RSDI $88
Applicant's stepparent — gross earnings $5,925 monthly
Applicant's parent, died two years ago
Applicant's ineligible 2-year-old sibling — no income
Applicant's ineligible 19-year-old sibling, non-student — gross earnings $800 monthly
Applicant's ineligible 7-year-old stepsibling — no income |
| Children Employed | None |
| Family Unit Members | Applicant
Applicant's ineligible 2-year-old sibling |
| Income Limit | 150% FPL for family of two |
Note: Since the natural parent died and the stepparent is no longer a current spouse of the natural parent, do not consider the stepparent and the ineligible stepsibling or their income. Since the 19-year-old ineligible sibling is over 18 and not a student, do not consider the sibling or the sibling's income.
| Budget Group and Eligibility |
|---|
| Steps | Amount |
|---|
| Applicant's monthly gross countable income | $88 |
| Add parent's monthly gross countable income | $0 |
| Add the income of each ineligible sibling that exceeds $3,851 | $0 |
| Total budget group income | $88 |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $86.50 |
| Total countable income | $1.50 |
| 150% FPL for family of two | ≤ $2,555 |
| Eligibility result | Eligible |
Example 4
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — RSDI $88
Sibling, 7-year-old, also an applicant — RSDI $88
Applicant's parent — gross earnings $7,800 monthly
Applicant's other parent, died two years ago
Applicant's ineligible 2-year-old sibling — no income |
| Children Employed | None |
| Family Unit Members | Applicant
Applicant's 7-year-old sibling, who is also an MBIC applicant
Applicant's parent
Applicant's ineligible 2-year-old sibling |
| Income Limit | 150% FPL for family of four |
Note: If a sibling is also applying for MBIC, count this sibling in the family unit size, but calculate separate budgets since one "eligible" sibling's income is not counted in the other "eligible" sibling's budget group.
| Budget Group and Eligibility |
|---|
| Steps | Applicant One | Applicant Two |
|---|
| First applicant's monthly gross countable income | $88 | $88 |
| Second applicant's monthly gross countable income | N/A | N/A |
| Add parent's monthly gross countable income | $7,800 | $7,800 |
| Add the income of each ineligible sibling that exceeds $3,851 | $0 | $0 |
| Total budget group income | $7,888 | $7,888 |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $3,986.50 | $3,986.50 |
| Total countable income | $3,901.50 | $3,901.50 |
| 150% FPL for family of four | > $3,900 | > $3,900 |
| Eligibility result | Not eligible | Not eligible |
Note: Use separate budgets when more than one child with disabilities in the same family unit is applying for MBIC.
Example 5
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — RSDI $88
Applicant's parent — RSDI $699
Applicant's ineligible 2-year-old sibling — RSDI $88
Applicant's ineligible 5-year-old sibling — RSDI $88 |
| Children Employed | None |
| Family Unit Members | Applicant
Applicant's parent
Applicant's ineligible 2-year-old sibling
Applicant's ineligible 5-year-old sibling |
| Income Limit | 150% FPL for family of four |
| Budget Group and Eligibility |
|---|
| Steps | Amount |
|---|
| Applicant's monthly gross countable income | $88 |
| Add parent's monthly gross countable income | $699 |
| Add the income of each ineligible sibling that exceeds $3,851 | $0 |
| Total budget group income | $787 |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $436 |
| Total countable income | $351 |
| 150% FPL for family of four | ≤ $3,900 |
| Eligibility result | Eligible |
Example 6
| Determining Family Unit Members and FPL Limit to Use |
|---|
| Household Composition | Applicant — no income
Applicant's parent — gross earnings $4,500 monthly
Applicant's other parent — $850 Veterans Affairs (VA) benefits with aid and attendance monthly; gross earnings of $300 monthly |
| Children Employed | None |
| Family Unit Members | Applicant
Applicant's parents |
| Income Limit | 150% FPL for family of three |
| Budget Group and Eligibility |
|---|
| Steps | Amount | Documentation |
|---|
| Applicant's monthly gross countable income | $0 | |
| Add parents' monthly gross countable income | $4,500 | VA income is needs-based, so none of the other parent's income is included in the budget. |
| Add the income of each ineligible sibling that exceeds $3,851 | N/A | |
| Total budget group income | $4,500 | |
| Subtract the MBIC exclusion ($85 + one-half of remainder) | $2,292.50 | |
| Total countable income | $2,207.50 | |
| 150% FPL for family of three | ≤ $3,228 | |
| Eligibility result | Eligible | |