Page 1

North Carolina Department of Health and Human Services Division of Medical Assistance Medicaid Eligibility Unit AGED, BLIND, AND DISABLED MEDICAID MANUAL Transmitted by Change No. 15-03

MA-2120

MEDICALLY NEEDY REGULATIONS 12/01/02 MA-2120: MEDICALLY NEEDY REGULATIONS{ XE "MEDICALLY NEEDY REGULATIONS" } 12/01/02

I. INTRODUCTION TO MEDICALLY NEEDY (M)

Medically Needy is a Medicaid classification for aged, blind, or disabled individuals whose countable income and/or resources exceed the categorically needy limits. Medically Needy coverage extends Medicaid to needy aged, blind, and disabled individuals who have too much income/resources to receive SSI, but not enough to pay for medical care. This section defines the requirements to determine eligibility as Medically Needy. Always evaluate aged, blind or disabled individuals who are financially ineligible as Categorically Needy under Medically Needy regulations.

II. POLICY RULES FOR MEDICALLY NEEDY{ XE "MEDICALLY NEEDY POLICY RULES" }

A. Meet the Eligibility Requirements in MA-2000, Non-SSI Eligibility Regulations

B. Medically Needy Income Limits{ XE "Medically Needy Income Limits" }

When an individual/couple’s countable income exceeds the categorically needy income limit, compare his income to the MN income limits. Refer to MA-2260, Financial Eligibility Regulations

C. Resource Limit{ XE "Medically Needy Resource Limit" }

The resource limit for individuals/couples under MN is the same as the Categorically Needy resource limits. Refer to MA-2260, Financial Eligibility Regulations.

D. Reduction of Resources{ XE "Medically Needy, Reduction of Resources" }

The resource limit and countable resources are the same as Categorically Needy. However, for Medically Needy eligibility an individual whose countable resources exceed the resource limit as of the “first moment of the month” can establish eligibility on the day of the month that the value of countable resources is reduced within the allowable limits. Refer to MA-2230, Financial Resources.

E. Deductible{ XE "Deductible" }

Only individuals evaluated as Medically Needy can have a deductible.

1. When the net countable income for an individual/couple exceeds the medically needy income limit, the individual/couple has a deductible.

2. The deductible is met by incurring medical expenses equal to the amount of the excess income. 1