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Job Aid Member Coverage Desciptions Version 1.0

7 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 065 - HCBS Independent Living Waiver Participants qualify based on income under 300% of the SSI limit (NF Limit). Income/Resource criteria, including Spousal Impoverishment and Income Trust provisions, are the same as Nursing Home/Long Term Care rules. There is no cost of care paid by the waiver participant. Certain recipients do not have to file a separate application to participate. Dept. of Rehabilitative Services is the start point. Disabled individuals age 16 and over with severe orthopedic and/or neurological impairments. Participating COE's: 001, 003, 007, 019, 025, 026, 073, 074, 075, 094. Full Medicaid benefits plus case management, personal care attendant services, specialized equipment and supplies, home modification and transition assistance. Full Medicaid benefits plus case management, personal care attendant services, specialized equipment and supplies, home modification and transition assistance. 066 - HCBS Traumatic Brain/Spinal Cord Injury Waiver Participants qualify based on income under 300% of the SSI limit (NF Limit). Income/Resource criteria, including Spousal Impoverishment and Income Trust provisions, are the same as Nursing Home/Long Term Care rules. There is no cost of care paid by the waiver participant. Certain recipients do not have to file a separate application to participate. Dept. of Rehabilitative Services is the start point. Disabled individuals of any age with spinal cord or brain injuries. Participating COE's include: 001, 003, 007, 019, 025, 026, 071, 072, 073, 074, 075, 088, 094. Full Medicaid benefits plus case management, in-home & institutional respite, attendant care services, home modification, specialized medical equipment and supplies and transition assistance. Full Medicaid benefits plus case management, in- home & institutional respite, attendant care services, home modification, specialized medical equipment and supplies and transition assistance. 071 – Newborn age 0-1 Pregnant Women/Infants to age 1 under 185% of Poverty - Eligibility based on household income only - no asset test. Pregnant women remain eligible 2 months post-partum. Effective 01/01/2014, MAGI- equivalent limit = 194% FPL. Pregnant females of any age. Infants to age 1. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 072 – Children age 1-5 Children up to age 6 under 133% of Poverty - Eligibility based on household income only - no asset test. Effective 01/01/2014, MAGI- equivalent limit = 143% FPL. Children up to age 6. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 073 - Children age 6-19 with income at/below the MAGI Eligibility is based on household income only - no asset test. Effective 01/01/2014, MAGI-equivalent limit = 107% FPL. Children to age 19 (eligibility ends the month the child turns age 19) This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits