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All County Welfare Directors Letter No.: 20-10 Page 11 April 30, 2020

4) Is Spouse 2 married? Yes. 5) Is Spouse 2 and Spouse 1 living apart and filing separately? No (Include Spouse 1 in the household composition). 6) Is Spouse 2 pregnant? No. 7) Is anyone included in the household composition pregnant? No. 8) No additional changes, end household composition determination here.

Child 1’s Household Composition: 1) Does Child 1 expect to file a federal tax return? No. 2) Does Child 1 expect be claimed as a tax dependent by another tax filer? Yes. 3) Does Child 1 meet one of the exceptions? No. 4) Child 1 qualifies for Tax Dependent Rules: household consists of the dependent, the people claiming the tax dependent, and all others the tax filer claims as a dependent (Spouse 1, Spouse 2, Child 1 and Child 2). 5) Is Child 1 married? No. 6) Is Child 1 pregnant? No. 7) Is anyone included in the household pregnant? No. 8) No additional changes, end household composition determination here.

Child 2’s Household Composition: 1) Does Child 2 expect to file a federal tax return? No. 2) Does Child 2 expect be claimed as a tax dependent by another tax filer? Yes. 3) Does Child 2 meet one of the exceptions? No. 4) Child 2 qualifies for Tax Dependent Rules: household consists of the dependent, the person claiming the dependent, and all others the tax payer claims as a dependent (Spouse 1, Spouse 2, Child 1 and Child 2) 5) Is Child 2 married? No. 6) Is Child 2 pregnant? No. 7) Is anyone included in the household pregnant? No. 8) No additional change, end household composition determination here. Medi-Cal Household Spouse 1 Spouse 2 Child 1 Child 2 Family Size Spouse 1 Included Included Included Included 4 Spouse 2 Included Included Included Included 4 Child 1 Included Included Included Included 4 Child 2 Included Included Included Included 4