Medicaid Policy
Medicaid Policy
Previous Policy (416-2 rewritten into 443-2 as of June 1, 2020)
General Policy
Individuals who are either aged or disabled and who do not receive SSI or Protected Group status may qualify for the 100% FPL program or the Medically Needy spenddown program.
Blind individuals who do not receive SSI or Protected Group status may qualify for Medically Needy spenddown program with or without a spenddown depending on their countable income.
A. Aged or Disabled 100% FPL Group
1. Aged and disabled people with countable income equal to or below 100% of the FPL qualify for the aged and disabled FPL Medicaid group. They do not have to pay anything to receive Medicaid. They must also pass the asset limit test. (503)
· The 100% FPL group can include individuals eligible for the New Choices Waiver (386).
2. Blind individuals with no other disabling condition, who have income equal to or below 100% of the FPL are not in the 100% Aged and Disabled FPL Medicaid group. However, they do not have to pay a spenddown when their income does not exceed 100% of FPL.
See section 443-1 for people with income equal to or below 100% of the FPL who are eligible for Blind Medicaid.
B. Aged, Blind or Disabled Medically Needy
Aged, blind and disabled people may be income eligible for Medicaid by using medical expenses or cash to reduce their countable income to 100% of the FPL. First determine they do not meet criteria for a program without cost.
1. No Spenddown
Individuals in the following coverage groups will not have to pay a spenddown.
· SSI recipient
· SSI Protected Medicaid
· Aged and Disabled 100% FPL
· MWI (They may pay a premium)
2. Blind Medically Needy
Blind Medicaid recipients with countable income less than or equal to 100% FPL do not pay a spenddown to become eligible. When income is above 100% FPL, a blind recipient will have a spenddown.
a. Individuals open on Blind Medicaid may have to pay a spenddown when the COLA increase is received in January if the increase causes their countable income to exceed the 100% FPL rate (443-3).
· Do Not disregard the COLA increase for the Blind Medicaid program.
b. After the poverty level increases, their income may be under 100% of poverty again. If so, they will not have to pay a spenddown after the poverty level increases.
· The poverty level usually changes in March (but can be as late as April).
3. Aged or Disabled Medically Needy
Aged and disabled individuals will owe a spenddown when their income exceeds the 100% FPL level.
a. Do not disregard their COLA increase (443-3) if they did not qualify under the 100% FPL coverage group in the December before the COLA increase. The COLA amount counts when determining their spenddown.
b. For new applications received in January, February or March, determine retroactive eligibility for December. If the individual, or couple, qualified under the 100% FPL group in December, their COLA will not count in January or February (or March if the new poverty rates do not become effective until April.)
4. Medically Needy Income Test
a. Compare the individual's, or couple's, countable income to 100% of the FPL for the applicable household size to determine the amount of the spenddown.
· Follow income deeming policy in 427-2 and 427-3 to determine countable income from an ineligible spouse, or an ineligible parent.
· Household size depends on whether both spouses are aged, blind or disabled, or whether an ineligible spouse has deemable income.
· A disabled child's household size is always 1.
· Apply the appropriate deductions, including health insurance premiums as described in 431-1.1.
b. Do not disregard COLA's for individuals who did not qualify under the aged or disabled 100% FPL group in December of the previous calendar year. Refer to 443-3 for policy on COLA increases.
c. Section 461-5 explains what medical expenses can be used to meet the spenddown. It also explains when the individual may use cash to meet the spenddown.
d. individuals seeking services under a home and community based waiver may have to pay a spenddown, see the specific waiver policy. 380