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210-RICR-40-00-1 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 40 – MEDICAID FOR ELDERS AND ADULTS WITH DISABILITIES SUBCHAPTER 00 – INTEGRATED HEALTH CARE COVERAGE GROUPS PART 1 – OVERVIEW OF MEDICAID INTEGRATED HEALTH CARE COVERAGE 1.1 Overview of this Chapter A. This Chapter establishes the Medicaid Integrated Health Care Coverage (IHCC) groups for elders, adults with disabilities, and certain individuals who qualify as medically needy (MN) due to high health care expenses. In addition, sections of this Chapter set forth the basic tenets of the Supplemental Security Income (SSI) methodology for determining Medicaid eligibility in general and, specifically, for those applicants and beneficiaries seeking coverage through an IHCC Community Medicaid eligibility pathway. B. The term Community Medicaid refers hereinafter to anyone applying for or renewing eligibility for non-LTSS Medicaid health coverage as MN or through a pathway for elders and adults with disabilities on the basis of SSI, an SSI-related characteristic (that is, age, blindness or disability), or special requirements related to a particular characteristic, condition or circumstances. Community Medicaid also encompasses Medicare beneficiaries seeking financial assistance through the State’s Medicare Premium Payment Program (MPPP). C. Although all the IHCC groups for MN and elders and adults with disabilities are described in this Chapter – both Community Medicaid and LTSS – there are separate sections, as indicated below, that provide more in-depth provisions related to IHCC groups, as follows: 1. The Sherlock Plan and Ticket to Work Plan provide eligibility pathways for adults with disabilities who are working. Although referenced in this Section as two of the IHCC groups subject to the SSI methodology, the Sherlock Plan and Ticket to Work Plan are covered in detail in a separate section (Subchapter 15, Part 1 of this Chapter) along with other eligibility opportunities for persons with disabilities who are working. 2. An overview of the LTSS coverage groups subject to the SSI methodology is included in this Chapter to show areas of overlap in the application process and determination of financial eligibility. However, LTSS eligibility and services are covered in detail in Chapter 50 of this Title.