The following examples show the category to be assigned in both NMP and MNO cases. In each example, the applicants have given all needed proof. The CAO must determine eligibility first for NMP and then for MNO. The CAO must always provide MA under the program that best meets the individual’s medical needs.
Mary F., age 40, applies for MA for herself and Joyce N., age 10. Joyce's mother is a close friend of Mary's and granted legal custody of Joyce to Mary. Because Mary has legal custody of Joyce, she is considered a custodial caretaker.
If they both meet non-financial and financial requirements for NMP, then:
Joyce is PS.
Mary is PD. She does not qualify as a specified relative but does meet one of the GA criteria.
If they both meet non-financial and financial requirements for MNO, then:
Joyce is TC.
Mary is TD, if she verifies that she works at a job that pays minimum wage for 100 hours per month.
As Joyce and Mary can be in two separate applicant/recipient groups, they may get MA in different programs, as follows:
Joyce is PS, and Mary is PD or TD.
Joyce is TC, and Mary is PD or TD. Joyce and Mary can be treated together or separately for MNO eligibility.
Mr. P. and his wife, both age 22, apply for MA. Mrs. P. is pregnant and works at a job for 20 hours a week. Mr. P. is expected to be temporarily disabled through the due date of the baby.
If they meet non-financial and financial requirements for NMPF, then both will be PC 27.
If they meet non-financial and financial requirements for NMP, then:
Mrs. P. is PS 16.
Mr. P. will most likely be found to have too much income for PD.
If Mr. P. meets non-financial and financial requirements for MNO, then he will be TD.
Mr. M., age 19, applies for MA.
If Mr. M. meets the non-financial and financial requirements for NMP, his category is PC. He qualifies for this category because he is under age 21.
If Mr. M. meets only non-financial and financial requirements for MNO, his category is TC.
Mr. W., age 28, applies for MA for himself, his wife, and their children, Steve, age 9, Martha, age 5, and Naomi, age 2. Neither Mr. W. nor Mrs. W. is incapacitated.
If NMP for the Family requirements are met, then:
Mr. and Mrs. W. are PU 27.
The children are PU 27.
If NMP for each individual’s requirements are met, then:
Mr. and Mrs. W. are PU 00.
The children are PS 16.
If non-financial and financial MNO and Healthy Beginnings requirements are met, then:
Mr. and Mrs. W. are TU.
The children are PS 16.
Mrs. B. and her two children, Maureen, age 3, and Carol, age 5, apply for MA. Mrs. B. gets spousal support and child support for each of the children.
If NMP for the Family non-financial and financial requirements are met, then all are PC 27.
If Healthy Beginnings non-financial and financial requirements are met, then:
Maureen and Carol are PS 16.
Mrs. B. may be PC 00 if NMP non-financial and financial requirements are met.
Mrs. B. may be TC if she is not eligible for NMP and if MNO non-financial and financial requirements are met.
NOTE: The children getting Healthy Beginnings are not legally responsible relatives (LRR) to Mrs. B. The CAO must not include the children or their income when determining NMP or MNO unless doing so will benefit Mrs. B.
Mr. and Mrs. H., both age 25, apply for MA. Mrs. H. is pregnant with their first child. Mr. H. gets partial UC and is employed 15 hours a week.
If NMP non-financial and financial requirements are met, then both Mr. H. and Mrs. H. are PU.
If they do not meet NMP non-financial and financial requirements, then the CAO will review eligibility for MNO and the Healthy Beginnings program. If they are eligible, then:
Mrs. H. is PS.
Mr. H. is TU.
Mr. D., age 64, applies for MA and meets one of the GA criteria. He has applied for Social Security Retirement benefits.
If he meets NMP non-financial and financial requirements, then Mr. D.'s category is PD.
If he meets only MNO non-financial and financial requirements, then Mr. D's category is TD.
Mr. Y., age 63, applies for MA. He suffered a stroke six months ago, which left him forced to stay in bed. The Social Security benefits he gets are retirement benefits. He retired 11 months ago.
The CAO will consider this a potential disability case and submit a referral to DAP for a disability determination by the MRT.
If Healthy Horizons non-financial and financial requirements are met, Mr. Y. may get PH pending a decision by the MRT about permanent and total disability.
Mrs. F., age 46, applies for MA for herself and her daughter, Pat, age 18. Pat is a 12th-grade student who is expected to graduate before she is age 19. Mrs. F. is divorced from Pat's father and gets no support for Pat.
If NMP for the Family non-financial and financial requirements are met, then Mrs. F. and Pat are PC 27.
If NMP non-financial and financial requirements are met, then:
Pat is PS 16.
Mrs. F. is PC.
If only MNO non-financial and financial requirements are met, then Mrs. F. and Pat are TC.
Mr. D., age 65, applies for MA for himself, his wife, age 43, and their children, Ron, age 15, Stan, age 13, and Roz, age 10. Mr. D. retired three years ago and gets Social Security retirement benefits. Mrs. D. has never worked outside of the home. Neither parent claims to have any health problems.
If NMP non-financial and financial requirements are met, then:
Mr. D. is PH, because he is age 65;
The children are PS.
Mrs. D. is PU.
Ms. H., age 19, applies for MA for herself, her 10 month-old daughter, Violet, and her boyfriend, Mark J., age 21. Mark states that he is Violet's father, but paternity has not been legally proven. Mark would have to be opened in a separate case record, if he is eligible for GA-related MA, until paternity is established.
If NMP for the Family non-financial and financial requirements are met, then:
Ms. H. and Violet are PC 27, because Violet meets TANF-related absent-parent deprivation requirements.
When Ms. H. turns 21, she will remain PC if paternity has not been legally proven.
If non-financial and financial requirements are met for NMP, then:
Violet is PS 16.
Ms. H. is PC.
If only MNO non-financial and financial requirements are met, then:
Ms. H. is TC.
Violet is TC.
Mr. E., age 40, applies for MA for himself, his wife, age 39, and their children Sam, age 10, and Diane, age 9. Sam got SSI but lost his benefits eight months ago because of Mr. E.'s income from employment. His condition has not improved since his SSI stopped. Mr. E. was laid off two months ago and is getting UC.
The family is evaluated for NMP for the Family. Sam is included when counting income. If they are found eligible, then:
Mr. and Mrs. E. are PU 27.
Diane is PU 27.
Sam is PH 00.
NOTE: If Sam is at any point found eligible for an SSI payment, then he will become a J and will not be included in the NMP for the Family computation.
Reminder: An individual who is eligible for SSI-related MA/Healthy Horizons must be included in the NMP when family income is counted.
If the family meets non-financial and financial requirements for NMP, then:
Sam is PH 00 or PS 16.
Diane is PS 16.
Mr. and Mrs. E. are PU 00.
If the family meets non-financial and financial requirements for MNO, then:
Mr. and Mrs. E. are TU.
Sam and Diane are TU.
If Sam fails all other categories and non-financial and financial requirements are met, then:
Sam is PH 95.
Mr. G., age 46, applies for MA for himself, his wife, age 40, and his two stepdaughters (her daughters), ages 15 and 10. The family's only income is support from the children's father. The family was reviewed for and did not meet the requirements for NMP for the Family.
If NMP non-financial and financial requirements are met, then:
The children are PC or PS.
Mrs. G. is PC, because she is the specified relative to a child who meets the requirements of a TANF-dependent child.
Mr. G. is not eligible for PD, because he does not meet any of the GA requirements.
If only MNO non-financial and financial requirements are met, then:
The children are TC;
Mrs. G. is TC.
Mr. G. is not eligible for TD, because he does not meet the work requirements and he is not the custodial parent.
Mr. S., age 66, applies for MA for himself and his 64 year-old wife. Mr. S. is blind. Mrs. S. has health problems and meets the requirements for GA.
If Healthy Horizons and NMP non-financial and financial requirements are met, then:
Mr. S. is PH. (Although he is blind, the Healthy Horizons category applies to all individuals age 65 or older.)
Mrs. S. is PD. Her category changes to PH on the first day of the month in which she has her 65th birthday.
If NMP spend-down requirements are met, then:
Mr. S., is PA.
Mrs. S. is PD.
They are in different applicant/recipient groups.
If only MNO non-financial and financial requirements are met, then:
Mr. S., is TA.
Mrs. S. is TD.
They are in the same applicant/recipient group.
Updated February 14, 2012, Replacing January 29, 2010