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Chapter 12 - Categorical Eligibility INTRODUCTION 12.1

Some groups are categorically eligible for FS or MA.

In MA, being categorically eligible means that the group does not have to be tested against asset and income limits. Since the group is categorically eligible, it automatically meets financial eligibility criteria. Individuals receiving TANF, GC, IV-E foster care or adoption assistance, department wards placed in foster care, etc. (though not in penal institutions), and SSI recipients are categorically eligible for MA.

In FS, a group that is categorically eligible does not have to meet the FS asset limit or the net income limit. Effective November 1, 2013, categorically eligible households of one or two persons are automatically eligible for $15 in benefits. Households in which all members receive TANF or SSI are categorically eligible for FS and do not need to meet the gross income test. Other households that receive a non-cash TANF-funded service are categorically eligible, but must have gross income at or below 200% of the Federal Poverty Level. These households meet expanded categorical eligibility requirements.

If there are changes in group composition or the circumstances of group members, the SSR must assess whether or not the group remains categorically eligible. If the group is no longer categorically eligible for MA, the SSR must determine whether the groups, or individuals within the group, qualify for MA based on other eligibility categories. Similarly, if a household is no longer categorically eligible for FS, the SSR must determine whether the group remains eligible for FS and categorically eligible under expanded categorical eligibility rules.

LEGAL AUTHORITY 12.2 AREA/TOPIC DISTRICT FEDERAL Categorical Eligibility MA: 42 USC 1383c; 42 USC 1396u-1; 42 CFR 435.4; 435.909; 435.916 FS: 7 USC 2014(a); 7 CFR 273.2 (j)

WHO IS CATEGORICALLY ELIGIBLE 12.3 MA Individuals receiving TANF, GC, SSI (see Section 12.3.1: SSI in this Chapter), IV-E foster care or adoption assistance are categorically eligible for Medicaid. Individuals under 21 who are Department wards, except those in penal facilities, are also categorically eligible for Medicaid. Department wards under 21 in penal facilities are eligible for Medicaid only for an inpatient hospital stay. Example Sharon, age 13, receives SSI and lives with her parents who do not receive SSI or TANF. Sharon is categorically eligible for Medicaid, but her parents are not. Her parents may still qualify for Medicaid under standard eligibility rules. FS Categorical eligibility for FS benefits may be conveyed in one of two ways. The following households are categorically eligible for FS benefits: