Page 1

210-RICR-50-00-2 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 50 – MEDICAID LONG-TERM SERVICES AND SUPPORTS SUBCHAPTER 00 – LONG-TERM SERVICES PART 2 – Long-term Services and Supports (LTSS) Medically Needy Eligibility Pathway 2.1 Scope and Purpose A. Medically Needy (MN) eligibility for Medicaid long-term services and supports (LTSS), previously referred to as the “Flexible Test of Income”, enables people with income above the Federal benefit cap to obtain Medicaid LTSS coverage in certain circumstances. The Federal benefit cap rate is three hundred percent (300%) of the Supplemental Security Income (SSI) benefit rate and is the income eligibility ceiling for both the “special income” and home and community-based services (HCBS) LTSS pathways identified in Part 1 of this Subchapter. B. Under the Federal law, the LTSS MN pathway is for LTSS beneficiaries only without regard to type of care – institutional or HCBS settings. The provisions related to MN Non-LTSS Community Medicaid are set forth in Part 40-05-2 of this Title. LTSS MN is distinguished from MN Community Medicaid in that the spenddown is based on monthly projected expenses rather than the costs that must be incurred over a six (6) month budget period. 2.2 Incorporated Materials A. These Regulations hereby adopt and incorporate 42 C.F.R. § 435.301 et seq. (2016) by reference, not including any further editions or amendments thereof, and only to the extent that the provisions therein are not inconsistent with these Regulations. B. These Regulations hereby adopt and incorporate 42 C.F.R. § 435.831(3)(g)(1) (2016) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations. 2.3 Legal Authority A. Federal Authorities 1. Federal Law: Title XIX, of the Federal Social Security Act at: 42 U.S.C. §§ 1396a, 1396b, and 1396k; 2. Federal Regulations: 42 C.F.R. § 435.301 et seq. (2016).