Medicaid Policy
Medicaid Policy
Previous Policy (416-1 renumbered to 443-1 as of June 1, 2020)
A. Married Couple: Both are Aged, Blind or Disabled
1. For Aged, Blind and Disabled Medicaid programs, compare the countable income to 100% FPL for a two person household.
a. If the income is equal to or less than 100% of the FPL, the couple is income eligible for Medicaid without a spenddown.
b. Use the Blind Medicaid program when both spouses are blind. If their income is under 100% FPL, they are eligible without paying a spenddown.
c. If the income is above 100% of the FPL, the couple may spenddown (461).
· If one spouse will be on the New Choices waiver, see 386 for the NCW policy. Do not have the couple spenddown on a case together when one spouse will be on the NCW.
· If one disabled spouse has earned income, and both spouses want coverage, decide if they would owe a spenddown as a couple. If so, then both must be enrolled in the Medically Needy spenddown program and meet the spenddown.
· If only the disabled spouse with earned income wants coverage, and income of the couple exceeds 100% FPL, the disabled spouse may choose to be on the MWI program.
2. For Medicare Cost-Sharing programs compare the countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.
B. One Spouse in a Married Couple
1. Compare the couple's countable income to 100% of the FPL for a household size of:
a. Two:
o If the other spouse is also aged, blind or disabled and will not be covered by Medicaid (it doesn’t matter if the spouse has deemable income) or,
o If the other spouse is not aged, blind or disabled but has deemable income.
b. One:
o If the other spouse is not aged, blind or disabled and has no deemable income.
2. If the income is equal to or less than 100% of the FPL, the individual is income eligible for Medicaid without a spenddown.
3. If the income is above 100% of the FPL, the individual may spenddown (461).
a. Use 100% of the FPL for a household size of one to determine the spenddown if the other spouse has no deemable income.
b. Use 100% of the FPL for a household size of two to determine the spenddown if the other spouse has deemable income.
c. If one spouse is on a HCB waiver, do not use this income test to determine a spenddown for the non-waiver spouse. (See 'Single Adult' below.)
4. For Medicare Cost-Sharing programs compare the couple's countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.
C. Single Adults and Children
1. Compare the individual's countable income to 100% of the FPL for a household size of one.
a. If the income is equal to or less than 100% of the FPL, the individual is income eligible for Medicaid without a spenddown.
b. If the individual has earned income and income is over 100% FPL, the individual will be eligible under the MWI program (314).
c. If the income is above 100% of the FPL and the individual does not have earned income, the individual may spenddown (461).
2. For Medicare Cost-Sharing programs compare the individual's countable income to the applicable income limit. See 320 to determine eligibility for Medicare Cost-Sharing programs.