Medicaid Policy
Medicaid Policy
Medical Condition
The TB Positive program is for individuals who are infected with tuberculosis or are suspected of being infected with tuberculosis.
Eligibility for Other Medicaid Coverage Groups
An individual who is eligible for any Medicaid program without a spenddown or MWI premium is not eligible for the TB Positive Group.
Other Medicaid Requirements
The general eligibility requirements apply. Individuals must:
Complete an application
Be a state resident
Be a US citizen or eligible non-citizen
Income
Determine household size and income using MAGI methodology (Sections 234, 234-1 and 234-2). The income limit is equal to the earned income break-even point for SSI eligibility. (Table II) Deduct 5% of the FPL for the applicable household size to determine if the individual is under the income limit.
Resources
There is no asset test for this coverage group.
Restriction on Medical Services
Those individuals infected with TB who are eligible under other Medicaid programs receive the full Medicaid Scope of Services. Members eligible for the TB Positive Group program receive a more limited range of benefits for treatment of their tuberculosis.
Section 1902(z) (2) of the Act describes the scope of services for this program:
Prescribed drugs
Physicians’ services and services described in section 1905(a)(2)
Laboratory and X-ray services (including services to confirm the presence of infection)
Clinic services and federally-qualified health center services
Case management services (as defined in section 1915(g)(2))
Services (other than room and board) designed to encourage completion of regimens of prescribed drugs by outpatients, including services to observe directly the intake of prescribed drugs.
To be covered, these services must be related to the treatment of tuberculosis.