Procedures

Follow the steps below to determine ABD Medicaid eligibility under a specific COA.

Step 1 Accept the individual’s ABD Medicaid application and register the application on the system. Step 2 Screen each A/R to determine potential SSI eligibility, Family Medicaid, PeachCare for Kids® and/or TANF eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting, to determine which SSI trial budget to complete (Individual, Couple or Spouse to Spouse Deeming). Use the FBR as the income limit when completing the SSI trial budget. Step 3 Refer the A/R to the appropriate worker if the A/R appears to be eligible for Family Medicaid and/or TANF and wishes to file an application for either. The A/R’s application for assistance is protected indefinitely. Refer the A/R to SSA to file an SSI application if his/her Federal Countable Income (FCI) is less than the appropriate Federal Benefit Rate (FBR) unless one of the following situations exist: The A/R requests coverage for any of the 3 months prior to the SSI or ABD Medicaid Application Month. The A/R is ineligible due to the deemed income or resources of his/her spouse or parents. The A/R dies prior to applying for SSI. The A/R is ineligible for Family Medicaid/SSI due to excess resources. The A/R has Medicare or other insurance that is expected to pay (or pays) more than 50% of medical expenses, and the A/R is in a public or private hospital or nursing home. Step 4 Obtain information necessary to process application. Request verification, if necessary. Step 5 Determine the COA most advantageous to the A/R. Explain the advantages of each COA if the A/R is potentially eligible under more than one COA and allow the A/R to choose the COA. Step 6 Determine basic eligibility. Refer to Chapter 2200, Basic Eligibility Criteria. Step 7 Determine financial eligibility. Refer to PROCEDURES under the specific section on each COA. Step 8 If the A/R is eligible under the COA currently being used to determine eligibility, approve ABD Medicaid on the system. If the A/R is ineligible under the COA currently being used to determine eligibility, complete a CMD. Refer to 2052 Continuing Medicaid Determination .