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Job Aid Member Coverage Desciptions Version 1.0

2 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 007 - Protected Foster Care Child to age 26 Former foster children (IV-E or CWS) who leave foster care after turning age 18 are automatically covered by Medicaid until reaching age 21 without regard to any change in income/resources. Effective 01/01/2014, the age limit was raised from 21 to 26, as required by the ACA. Children Age 18 – 26. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 010 - Nursing Home under 300% Long Term Care - 31 days or longer admission to a title XIX facility (Nursing Facility, Hospital, ICF-IID Facility, PRTF Facility) Aged, blind, and disabled Individuals. Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 011 - Long-Term Hospitalization under 300% Long Term Care - 31 days or longer admission to a title XIX facility (Nursing Facility, Hospital, ICF-IID Facility, PRTF Facility) Aged, blind, and disabled Individuals. Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefit 012 - Swing Bed under 300% Long Term Care - 31 days or longer admission to a title XIX facility (Nursing Facility, Hospital, ICF-IID Facility, PRTF Facility) Aged, blind, and disabled Individuals Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits