400.01 INTRODUCTION

This chapter provides instructions for both ABD and MAGI eligibility and budgeting criteria unique to each category of eligibility or COE. Budgeting requirements are based on the category of eligibility an applicant is applying or otherwise qualifies for and the living arrangement of the ABD and/or MAGI applicant or recipient. The system uses financial and non-financial data entered to determine the most appropriate coverage for an applicant or recipient under review unless the Specialist selects a COE, as explained below. MEDS is the generic on-line eligibility system that determines eligibility for both ABD and MAGI-related eligibility. A household can be ABD-only, MAGI-only or a blended household consisting of both MAGI and ABD applicants or recipients, including household member(s) that are institutionalized, either temporarily or on an indefinite basis. As the Specialist enters all necessary non-financial and financial information, including information about each household member’s living arrangement and whether the member is applying, MEDS uses the data about each applicant or recipient to determine the most appropriate category of eligibility based on a hierarchy of all available coverage groups. Certain COE’s are considered “worker-entered COE’s,” which means MEDS will only determine eligibility for the COE selected. These COE’s are limited to types where other coverage is not possible or appropriate. For example, if a parent applies for a disabled child and indicates on the ABD application that the only COE the parent wants considered for the child is COE-019, Katie Beckett Program, then MEDS will determine eligibility only for COE-019. If a worker-entered COE is not selected, MEDS will trickle through the COE hierarchy to determine eligibility for the applicant or recipient in the most appropriate COE available based on verified information. Data entry into MEDS controls whether MEDS will consider ABD-only or MAGI-only or both ABD and MAGI eligibility for each applying household member. It is the responsibility of the Specialist to ensure that all needed verifications for ABD and/or MAGI eligibility determinations are present in the record to substantiate each MEDS eligibility decision. Once a COE has been determined, MEDS determines the budget type that applies to each applying household member. Budget types are broadly described as: • ABD At-Home • MAGI • Institutional This chapter describes ABD and MAGI eligibility and budgeting requirements. Chapter 500 describes institutional eligibility and budgeting requirements.