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Job Aid Member Coverage Desciptions Version 1.0

4 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 019 - Disabled Child Living at Home (DCLH) Participants qualify based on income under 300% of the SSI limit (NF limit). Must meet level of care requirement for Nursing facility/ICF- MR placement. Long term care rules apply except for resource limit, which is $2,000 (SSI limit). No parental deeming of income or resources. Disabled Individuals under age 19. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 020 – Emergency - SSI Limitations Case Individuals eligible for SSI cash assistance but for a systems limitation preventing SSI eligibility from posting to DOM's eligibility file. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 021 - Emergency Immigrant Emergency Services for Immigrants - a required service for immigrants who are otherwise eligible for Medicaid except for immigrant status. Coverage is limited to a life-threatening emergency with certain exemptions (transplants prohibited). Children or adults who would otherwise qualify for Medicaid. Full Medicaid but only for treatment of the emergency condition (labor and delivery is considered an emergency). Full Medicaid Benefits 025 - Working Disabled Individuals who are disabled but work and have earnings under 250% of poverty. Unearned income under 135% of poverty. Resource limit = $24,000 for an individual and $26,000 for a couple. Premium required if countable income exceeds 150% FPL. Any age. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 026 - CWS Foster Care or Adoption Assistance State Foster Care/ State Adoption Assistance - referred to as CWS (Child Welfare Services). Child must receive or be entitled to a foster board payment or adoption is subsidized in full or part by the Department of Child Protection Services. CWS foster children can receive Medicaid in other poverty level Medicaid groups or as SSI. Children to Age 18 or to age 21 at CPS discretion. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 027 - Breast/Cervical Cancer Group Women screened and diagnosed with Breast or Cervical Cancer under the CDC's screening program administered by the State Department of Health. Income limit for screening program is 250% of FPL. Women under 65 with no other insurance. Full Medicaid benefits but only during the course of active treatment. Full Medicaid benefits but only during the course of active treatment.