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210-RICR-40-05-2 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 40 – MEDICAID FOR ELDERS AND ADULTS WITH DISABILITIES SUBCHAPTER 05 – COMMUNITY MEDICAID PART 2 – Community Medicaid: Medically Needy Eligibility 2.1 Scope and Purposes A. A medically needy (MN) spenddown, previously referred to as the “Flexible Test of Income”, is a cost-sharing approach that provides a Medicaid eligibility pathway for certain people who have income above the limit for their applicable coverage group if they have high health expenses. Under the State’s Medicaid State Plan, members of these populations become eligible for Medicaid by “spending down” their income to a limit established by the State – known as the medically needy income limit or “MNIL” by deducting certain health care expenses. The following populations may be medically needy eligible under this section: 1. Elders and adults with disabilities with income above one hundred percent (100%) of the FPL; 2. Children with income above the MACC limit of two hundred sixty-six percent (266%) of the FPL (includes the five percent (5%) disregard); 3. Pregnant women with income above the MACC limit of two hundred fifty- eight percent (258%) of the FPL (includes the five percent (5%) disregard); 4. Parents/caretakers with income above the MACC limit of one hundred thirty-eight percent (138%) of the FPL (includes the five percent (5%) disregard); 5. Non-qualified non-citizens seeking coverage for emergency Medicaid if ineligible under all other pathways. (See § 1.7.5 of this Subchapter); and 6. Certain refugees, as defined in § 1.7.3 of this Subchapter, who do not otherwise qualify for Medicaid health coverage or commercial insurance with financial help through HSRI. B. This section describes the Community Medicaid (non-LTSS) MN eligibility pathway in general and establishes the provisions governing initial and continuing eligibility for persons in these populations seeking Medicaid health coverage through this option.