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REV. APRIL 29, 2024 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-009

Example 4 – Disabled Infant with Ineligible Parents: The family consists of a married couple with a newborn child. The child was premature and there were a number of complications related to the early birth. As a result, the child remained in neonatal intensive care for some six weeks and was hospitalized for over two months total. The child was approved presumptively for SSI. The child was also approved for Medicaid. When the child finally came home, the SSI stopped (due to parental income) but the child remained Medicaid-eligible and is still considered to be disabled for 12 months from the date of the last SSI payment (477 NAC 27-001.05A). Because the child was found eligible for Medicaid, the child would be continuously eligible for 12 months from their initial Medicaid eligibility determination. If the child was born to a Medicaid eligible mother, the child would be continuously eligible through the month of her first birthday. When the child’s eligibility was reviewed, the countable parental income was found to exceed 100% FPL for three, so the child is no longer Medicaid-eligible as ABD-OMB. However, before the child’s Medicaid coverage can be closed, the eligibility worker must determine if the child is eligible using 145% FPL for three or, if the child is uninsured, CHIP at 213% FPL for three. Example 5 – Disabled Single Parent and One Child: The household consists of a disabled father and a 7-year-old child. Dad receives $790 SSA disability. The child receives $395 SSA due to Dad’s disability. Dad’s countable income of $770 (SSA of $790- $20 general disregard) is less than 100% FPL for two, so Dad is eligible. Because Dad is disabled, we will not use the child’s SSA in determining Dad’s eligibility. If the child is insured or uninsured, the countable income of $1,185 (Dad’s SSA of $790 + child’s SSA of $395) does not exceed 133% FPL for two, the child is Medicaid eligible. The child’s income is counted as he is required to file an income tax return. Example 6- Medicaid Insurance for Workers with Disabilities (MIWD):

For calculation procedures for MIWD see 477-000-046. Example 7- Budgeting Reported Changes for ABD (Non-MAGI only) It must be determined if the reported change(s) affects Medicaid eligibility. If it does: 1.) Compare resources to the resource limit; 2.) Compare the income to the medically needy income level; 3.) Determine eligibility based on the household composition; 4.) Re-compute the budget; and 5.) Send an adequate and/or timely notice of change.