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when the a/b left the home. (a) Dependency may be of any kind. The relative may depend on the a/b for housing, financial support, food, clothing etc. Accept the a/b’s statement or if the a/b is unable to state his intent, the written statement of his representative (guardian, power of attorney, spouse, or Medicaid representative as defined in MA­ 2301, Conducting a Face-to-Face Interview, II.B.) regarding who lives in the home and their dependency. (b) Relative means the following: • Natural child, adopted child, stepchild, grandchild; • Parent, stepparent, grandparent; • Aunt, uncle, niece, nephew; • Brother, sister, stepbrother, stepsister, half-brother, half- sister; • Cousin, or • In-law. (c) The written statement must specify: • Who lives in the home, • How they are related, and • How the person is dependent on him. Complete the DMA-5160, Statement of Spouse or Dependent Relative in The Home, and file the completed and signed form in the Medicaid case record. (3) The a/b (or financially responsible person), spouse, or dependent relative does not live in the home, but the a/b (or financially responsible person) states in writing his subjective intent to return home. The term “subjective intent” means that it is his intent, regardless of the circumstances of his absence from the home, to return home.) If the a/b is unable to state his intent, obtain the written statement of his representative (guardian, power of attorney, spouse, or Medicaid representative as defined in MA­ 2301, Conducting a Face-to-Face Interview, II.B.). d. If an a/b (or financially responsible person) has left his home and it is not excluded under VII.A.1.c., it ceases to be his home site the month after he leaves the home. It remains the home site during the month he leaves. e. Once ownership is established by the a/b or financially responsible person in a new principal place of residence, the former principal place of residence becomes non-home site property. 31