2664.4 Financial Requirements

Financial eligibility exists if countable resources do not exceed the limit in 5130 and countable income does not exceed the limit in 7430 (4) . Countable income is established per 7240 . Also see 7531 . The methodologies, exemptions, and disregards applicable to the spenddown program apply. In addition, see 5430 (20) regarding retirement funds and 6410 (34) regarding deposits into Individual Development Accounts (IDA). These exemptions are applicable only to the Working Healthy program.

Coverage is established under a spenddown for Working Healthy (WH) program. One month base periods apply [see 7330 (1) ].

Twelve (12) month review periods are applicable. A special income reviews every 6 months to establish the premium amount must also be completed.

Requirements for Current Medical Recipients – When a current Medicaid Recipient becomes eligible for Working Healthy (WH), coverage must be adjusted as follows: For persons moving from HCBS, Working Healthy begins the month following the month HCBS services end (see 8272.2 ). Any HCBS obligation due in the final month would still be applicable. For persons moving from LTC to Working Healthy, coverage is adjusted the month the change occurs. If an existing 6-months base period exists when Working Healthy (WH) eligibility begins. The existing base period is shortened to end the month prior to the month WH eligibility begins. One month bases apply thereafter. If a premium is applicable, the person must actually choose Working Healthy prior to taking action. WH eligibility may be backdated up to three months prior to the month of request, provided all WH criteria are met.

Prior Medical Coverage - Prior medical eligibility per 7330 (2) is available for those meeting the criteria.

Ongoing Eligibility - Eligibility continues until the end of the review period as long as all applicable general, financial, and non-financial eligibility criteria continue to be met, including cooperation with the six-month desk review. The change reporting requirements of the spenddown program apply, and eligibility must be adjusted accordingly, given timely and adequate notice as required except for changes resulting in decreased premium amounts (see 2664.5 ) and persons temporarily unemployed (see 2664.7 )