All Medicaid Programs |
Obsolete Policy |
A. New Choices Waiver income category summary
1. To be eligible for the NCW, an individual must meet the criteria for one of the 6 eligibility coverage groups listed below. There are two main categories: Community Medicaid groups and Institutional Medicaid groups.
a. Community Medicaid Groups consist of:
i. SSI recipients
ii. SSI Protected Group individuals: 1619(a) and (b); Adult Disabled Child; Disabled Widows/Widowers; Pickle Amendment
iii. 100% FPL Aged and Disabled (not spenddown clients)
iv. Medicaid Work Incentive
b. Institutional Medicaid Groups consist of:
i. Special Income Group
ii. Spenddown Waiver Group
B. Community Groups
Determine eligibility under regular community Medicaid groups, if possible, before moving to Institutional groups. Clients who meet the eligibility income test for a community group, will have a post eligibility test to determine the contribution to the cost of care. Most clients in the Community Medicaid group will not have a contribution to the cost of care.
1. SSI recipients
Use the following guidelines for NCW clients who meet the guidelines of SSI recipients (329)
a. Resources
i. For single clients, use the applicable resource limit found in section 503-3 for a one person ABD household size
ii. For a married client, apply the spousal impoverishment asset rules found in section 373.
iii. Transfer of asset rules do not apply to this income category.
b. Income
i. For single clients, client will meet income eligibility as long as they meet the criteria found in section 329.
ii. For married clients, count only the clients income. Subtract, from total income, the deductions allowed in 409-16. Any remaining amount is the clients contribution to the cost of care.
2. SSI protected groups.
Use the following guidelines for NCW clients who qualify under an SSI protected group.
The protected income groups are:
· Disabled Adult Children (331)
· 1619(a) and 1619(b) (329-1)
· Eligible because of the Pickle Amendment (336)
· Widows and Widowers (337)
a. Resources
i. For single clients, use the applicable resource limit found in section 503-3 for a one person ABD household size.
ii. For a married client, apply the spousal impoverishment asset rules found in section 373.
iii. Transfer of asset rules do not apply to this income category.
b. Income
i. For single clients, client will meet income eligibility as long as they meet the criteria for a SSI protected group (see sections 330, 331, 336, 337).
ii. For married clients, count only the clients income. Subtract, from total income, the deductions allowed in 409-16. Any remaining amount is the clients contribution to the cost of care.
3. 100% of Poverty, Aged or Disabled (does not include spenddown group)
For clients who do not receive SSI and are not in an SSI protected group and income is at or below 100% FPL.
a. Resources
i. For single clients, use the applicable resource limit found in section 503-3 for a one person ABD household size.
ii. For a married client, apply the spousal impoverishment asset rules found in section 373.
iii. Transfer of asset rules do not apply to this income category.
b. Income
i. For single clients, client will meet income eligibility as long their income is below the 100% Poverty limit.
ii. For married clients, count only the clients income. Subtract, from total income, the deductions allowed in 409-16. Any remaining amount is the clients contribution to the cost of care.
iii. If income of the client exceeds 100% of the FPL, and the client has earned income, determine eligibility for the Medicaid Work Incentive. If the client does not have earned income, decide if the client is eligible under the Special Income group or the Spenddown Waiver group.
4. MWI (Medicaid Work Incentive - Individual must have earned income)
If the client has earned income but does not receive SSI, does not meet SSI protected group eligibility, and does not pass the 100% FPL test, decide if the client qualifies for the Medicaid Work Incentive.
a. Resources - Follow the resource rules in 314 to decide eligibility.
b. Income – Follow the income rules in 314 to decide eligibility.
c. If the client does not qualify for the Medicaid Work Incentive, determine eligibility under the Special Income Group or the Spenddown Waiver group.
C. Institutional Groups:
5. Special Income Group
The special income group is for individuals who do not meet eligibility under regular community Medicaid groups, but would qualify if they were living in a medical institution.
a. Resources
i. For single clients, use the applicable resource limit found in section 503-3 for a one person ABD household size.
ii. For a married client, apply the spousal impoverishment asset rules found in section 373.
b. Income
There are two separate calculations for the special income group, an eligibility test and a post eligibility process:
i. Eligibility Test:
The special income group is for clients whose countable income does not exceed 300% of the SSI payment rate. Clients may qualify under this group when:
1. Income is over 100% of the poverty level using community rules but the client's countable income is not more than 300% of the SSI payment rate, and the client passes the nursing home resource test.
a. 300% of SSI Payment Rate Income Test.
i.Count only the individual's income. Do not deem income from the spouse.
ii.Do not count income that is excluded income according to section 403 or 405.
iii.Deduct $20 general disregard from unearned income. Any remaining amount of the deduction can then be deducted from earned income.
iv.Deduct from earned income only, impairment-related work expenses, if applicable.
v.Deduct from earned income only, $65 and 1/2 of the remainder.
vi.Compare countable income to 300% of the SSI payment rate for one person
ii. Post-Eligibility Process:
After deciding a client's eligibility for the special income group, the post eligibility test is used to decide how much a client must pay toward the cost-of-care, if any. Do not include income of the spouse. Deduct from income the post eligibility deductions listed in section 409-16
c. Transfer of Assets rules apply to the Special Income coverage group. See policy 386-2 and 371 for specifics.
6. Spenddown Waiver Group (Institutional Group)
If a client's countable income exceeds 300% of the SSI rate, the client may qualify under the Spenddown Waiver group.
a. Resources
i. For single clients, use the applicable resource limit found in section 503-3 for a one person ABD household size.
ii. For a married client, apply the spousal impoverishment asset rules found in section 373.
iii. Transfer of asset rules do not apply to this income category.
b. Income
i. Count only the clients income. From total income subtract the deductions allowed in 409-16 (Spenddown Waiver Group Income Deductions).