The Standard Filing Unit (SFU) is the automated process that determines which case members are connected with which categories of Medical Assistance (MA). The SFU includes all eligible members of the applicant/recipient group and other household members whose income, resources or needs may be considered in determining the applicant/recipient group’s eligibility for MA. Household members who must be included in the SFU are called mandatory household members. Those who may be included in the SFU are called optional household members.
NOTE: The Healthy Beginnings and Healthy Horizons applicant/recipient group is made up of individuals who are applying for or receiving MA benefits. The Healthy Beginnings and Healthy Horizons family includes individuals whose income and resources are counted in determining eligibility for the applicant/recipient group and are included in the SFU.
An applicant/recipient group is (a) an individual applying for or receiving MA or (b) a group of related individuals who are living together and who choose to apply for or receive MA as one group.
Unless otherwise noted in this chapter, members of the immediate family who are applying for MA must be included in each SFU group, as either an eligible member, a counted member, or a noneligible member. Immediate family members include the following:
Spouse
NOTE: Under Act 144 of 2004, Pennsylvania does not recognize a union in which two individuals agree to be married without a civil or religious ceremony (also known as a common-law marriage) unless it began before January 1, 2005. If an applicant claims that he or she is a common-law spouse, the CAO needs proof the couple was presenting themselves to the community as a married couple before January 1, 2005.
The CAO needs proof, which can include, but is not limited to, the deed to their residence, income tax records, bank records, leases, utility bills, or statements from other individuals. For recipients whose records show that they have been presenting themselves as married under common law before January 1, 2005, the CAO continues to recognize the common-law marriage.
Parents of an unemancipated child under age 21.
NOTE: Stepparents are not considered immediate family members of a stepchild.
Unemancipated children (but not stepchildren) under age 21.
Brothers and sisters, including half-brothers and half-sisters (but not stepbrothers and stepsisters), who are under age 21 and unemancipated.
NOTE: Half-siblings have one parent in common. Stepsiblings do not have a common parent.
A child under age 21 is considered emancipated if one or more of the following apply: 55 Pa. Code § 140.2
The child is married.
The parents, caretaker relative, legal guardian, or individual taking care of and having control of the child do not currently provide a majority of financial support for the child.
The child has lived apart from the parents, caretaker relative, legal guardian or individual who was, but is no longer, taking care and control of the child.
The parents, caretaker relative, legal guardian, or individual who was previously taking care of and having control of the child is not viewed as the responsible party by school officials.
An individual can apply for MA without including all immediate family members. If an immediate family member living in the household wants to apply later, the family member must be added to the existing applicant/recipient group.
Example: Mrs. C. applies for MA for herself and two of her three children on August 1. She does not wish to apply for her son Paul, because he receives $400 a month in support and his father carries medical insurance for him. The CAO opens PC for Mrs. C. and the two children. On November 15, Mrs. C. requests MA for Paul. His father is unemployed, the support order has been reduced, and his father no longer has medical insurance. Paul is added to the PC applicant/recipient group of Mrs. C. and her other two children.
The applicant can determine which related individuals to include in the MA application.
Unrelated individuals who apply for and have MA are separate applicant/recipient groups.
The CAO will tell the applicant how his or her choice of who is included affects eligibility. One or more family members with medical problems may be found eligible if other family members are not included in the applicant/recipient group. The CAO will consider the medical needs of each applicant when discussing the possible options.
Each applicant/recipient group has its own income and resource limit. The CAO determines eligibility separately for each applicant/recipient group.
An applicant/recipient group may include one or more categories of MA. Separate applicant/recipient groups may be set up for members of the same household even if they qualify for the same category. The CAO determines the correct category for each recipient (see Chapter 305, Category).
When determining the size of the applicant/recipient group, the CAO must count the unborn child of a pregnant woman who is included in the group. The woman must have medical proof that she is pregnant. If multiple births (such as twins or triplets) are expected and verified, the CAO will count each unborn child.
If the individual applies for a month that has already passed, the applicant/recipient group may include a related individual who lived in the household during the month for which MA is being requested.
Families with children are first evaluated for NMP for the Family (PC/PU 27). If the family is not eligible for NMP for the Family, the CAO determines each individual’s eligibility for other MA programs.
The CAO will consider choices that would make it possible to include or not include certain individuals when setting up different applicant/recipient groups. The CAO determines what is most helpful to the members of the household.
The applicant/recipient group requirements of this chapter do not apply to families with extended benefits under Chapter 339, Extended Medical Coverage, or Chapter 338, Section 338.4, Automatic Medical Assistance Coverage Extensions.
Updated February 14, 2012, Replacing October 23, 2008