101.02.05 OPTIONAL CATEGORICALLY NEEDY – ABD

Optional Coverage of the Aged, Blind and Disabled Living At-Home The Division of Medicaid certifies eligibility in full or in part for the following groups of optional ABD groups: • Disabled individuals who work more than an established number of hours each month whose net family earned income is at or below 250% of the federal poverty level and whose unearned income is at or below 135% of the federal poverty level. Resource limits and other non-financial factors of eligibility are required. Premiums are payable for households with countable earnings that exceed 150% of the poverty level. • Women who have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program and need treatment for breast or cervical cancer, including a precancerous condition of the breast or cervix. Coverage is limited to women who are uninsured and are otherwise not eligible for Medicaid under any other mandatory coverage group and have not attained age 65. The MS State Department of Health is responsible for the screening, diagnosis and financial eligibility decisions; the Division of Medicaid is responsible for the non-financial eligibility decisions and for certifying Medicaid eligibility during the woman’s active treatment. Optional Coverage of the Aged, Blind and Disabled Considered to be in an Institution • Individuals who would be eligible for cash assistance if not institutionalized. The individual must be in a title XIX nursing facility or hospital and meet income, resource and other non-financial factors of eligibility, as determined by the Division of Medicaid. • Individuals in institutions who are eligible under a special income test, including the use of an Income Trust, if applicable. The individual must be in a title XIX nursing facility or hospital and meet income, resource and other non-financial factors of eligibility, as determined by the Division of Medicaid. • Certain disabled children age 18 or under who are living at home, who would be eligible for Medicaid if in a medical institution and for whom the Division of Medicaid has made a determination as required under section 1902(e)(3)(B) of the Social Security Act. Optional Waiver Coverage of Non-Medicare Aged, Blind and Disabled Individuals Section 1115 waiver coverage is granted to certain non-Medicare entitled individuals who are aged, blind or disabled and have income at or below 135% of the federal poverty level. Coverage under the waiver is subject to an enrollment cap. Resource limits and other factors of eligibility apply, as determined by the Division of Medicaid. Optional 1915 Waiver Coverage under Home & Community Based Services (HCBS) The following is a list of waiver coverage offered by the Division of Medicaid. Eligibility for waiver participation is determined in full or in part by the Division of Medicaid, as noted. Waiver participants receive full Medicaid coverage plus additional waiver services that allow the individual to remain in a private living arrangement rather than a medical institution. 1. Elderly and Disabled (E&D) Waiver – is operated by the Division of Medicaid. This HCBS waiver includes aged or disabled individuals age 21 or older whose level of care has been certified using a preadmission screening tool. The aged or disabled individual must be eligible as SSI or qualify under an income level that is equal to the Medicaid institutional limit. Institutional income and resource limits and rules apply, including the use of an Income Trust to qualify for coverage. A waiver participant may not reside in a nursing facility or personal care home. The Division of Medicaid certifies eligibility for individuals who do not receive SSI. 2. Independent Living (IL) Waiver – is operated jointly by the Division of Medicaid and the MS Department of Rehabilitation Services. Eligibility is limited to individuals age 16 or older who exhibit severe orthopedic and/or neurological impairments. Clinical eligibility for waiver services is determined through a preadmission screening tool. An individual can participate in the IL waiver and be eligible as SSI, a Katie Beckett recipient, a Disabled Adult Child, a Working Disabled recipient or be eligible in a MAGI-related category or adoption assistance or foster child category of eligibility provided clinical waiver criteria is met. If an individual is not eligible in an allowed category, the individual may be determined eligible using institutional income and resource eligibility rules and limits, including the use of an Income Trust to qualify for coverage. The Division of Medicaid certifies eligibility for individuals who do not receive SSI or foster care/adoption assistance Medicaid through Child Protection Services. 3. Assisted Living (AL) Waiver – is operated by the Division of Medicaid. This HCBS waiver includes aged, blind or disabled individuals age 21 or over whose level of care has been certified by a preadmission screening tool. The individual must be eligible as SSI or qualify under the Medicaid institutional income limit. Institutional income and resource limits and rules apply, including the use of an Income Trust to qualify for coverage. Participants must reside in AL facilities that are approved to participate in the AL waiver. 4. Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver – is operated jointly by the Division of Medicaid and the MS Department of Rehabilitation Services. TBI’s and SCI’s must meet certain conditions specified by the waiver and the extent of the injury must be certified by a physician. An individual can participate in the IL waiver and be eligible as SSI, a Katie Beckett recipient, a Disabled Adult Child, a Working Disabled recipient or be eligible in a MAGI-related category or adoption assistance or foster child category of eligibility provided clinical waiver criteria is met. If an individual is not eligible in an allowed category, the individual may be determined eligible by the Division of Medicaid using institutional income and resource eligibility rules and limits, including the use of an Income Trust to qualify for coverage. The Division of Medicaid certifies eligibility for individuals who do not receive SSI or foster care/adoption assistance Medicaid through Child Protection Services. 5. Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver – is operated jointly with the MS Department of Mental Health as an alternative to institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). This HCBS waiver carries no age restrictions and includes individuals eligible as SSI, a Katie Beckett recipient, a Disabled Adult Child, a Working Disabled recipient or eligible in a MAGI-related category or adoption assistance or foster child category of eligibility provided clinical waiver criteria is met. If an individual is not eligible in an allowed category, the individual may be determined eligible by the Division of Medicaid using institutional income and resource eligibility rules and limits, including the use of an Income Trust to qualify for coverage. The Division of Medicaid certifies eligibility for individuals who do not receive SSI or foster care/adoption assistance Medicaid through Child Protection Services. The Division of Medicaid offers 1915(i) State Plan services to individuals with an intellectual and/or developmental disability that need the services offered under 1915(i), specifically; day habilitation services, prevocational services and supported employment services. If a Medicaid recipient in a full services at-home category of eligibility has the clinical qualifications needed, the recipient can qualify for 1915(i) services without being placed on the ID/DD waiver program provided their income does not exceed 150% of the federal poverty level. Individuals enrolled in a Medicare cost-sharing group (QMB, SLMB or QI) or recipients in a full-service COE with income above 150% FPL can qualify for the 1915(i) services only by qualifying for the ID/DD waiver.