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MEDICAL SERVICES POLICY MANUAL,SECTION E

E 100 FinancialEligibility

E-100 Financial Eligibility

MS Manual 10/26/15 Each individual applying for or receiving Medicaid benefits must have a financial eligibility determination made at application and, if eligible, on an on-going annual basis or when a change affecting eligibility occurs. Financial eligibility consists of an income test and if the category requires, a resource or asset test. Most Medicaid eligibility groups have an income limit which an individual’s countable income must fall under in order to be eligible for coverage in that group. Income limits and the manner in which countable income is determined vary by eligibility groups. The groups to which an income limit does not apply, and therefore no income determination is made, are the following: • Newborns (MS B-220); • Former Foster Care Adults (MS B-280); • Workers with Disabilities (MS B-330).  NOTE: For the Workers with Disabilities category, before determining eligibility, the applicant must pass a pre-test screening to ensure his/her unearned income does not exceed the SSI individual benefit plus $20. If the applicant meets this criteria, all income is disregarded in the financial eligibility determination. However, both unearned and earned income will be used to determine cost sharing. See MS A-115. A resource limit applies to most of the eligibility groups that do not use MAGI methodologies for financial eligibility. For these groups, the value of an individual’s countable resources must be determined. There is no resource limit, and therefore no resource determination is made, for the following groups: • Those using MAGI methodologies (MS E-110); • Newborns (MS B-220); • Former Foster Care Adults (MS B-260); • Workers with Disabilities (MS B-330).

E-110 Incomeand Resource Limits for MAGI and Non-MAGI Groups MS Manual 01/01/2024 Below are the income and resource limits for all Health Care groups. When the income limit is based on a percentage of the federal poverty level (FPL), the countable household income will be compared to the FPL for the applicable household size. Refer to Appendices F and S for the specific income level amounts.