Page 12
I. Individuals receiving Home and Community based Services Who Are Eligible Under a Special Income Level. (1) An individual living in the community may be eligible for MAO if he meets all of the following requirements: (a) Meets SSI criteria for either age, disability or blindness; (b) Meets all SSI financial eligibility criteria except for the income limitation; (c) Has been certified by CLTC to be eligible for skilled or intermediate nursing care; (d) Receives home and community based services provided under a home and community- based waiver. (2) The criteria found in 126.365 H.(2) through (4) apply to these individuals. (3) An individual must apply all available income, less allowable exclusions to the cost of waivered services. The amount of income to be applied to the cost of waivered services shall be determined in accordance with Title XIX of the Social Security Act and the federal regulations promulgated in accordance therewith. J. Pregnant women and children with family income below the poverty level. (1) An individual eligible for Medicaid under this category is one who— (a) is a pregnant woman whose pregnancy has been medically verified; or, is a child under the age of one year (or as otherwise specified in the Title XIX State Plan); and (b) has a countable family income, as determined in accordance with Title XIX of the Social Security Act and federal regulations promulgated in accordance therewith, which is below 100 percent of the federal poverty level (or as otherwise specified in the Title XIX State Plan) for the appropriate family size; and (c) meets all non-financial criteria required by Title XIX of the Social Security Act and federal regulations promulgated in accordance therewith. (2) A pregnant woman who is determined eligible under this category is eligible throughout the term of her pregnancy and remains eligible for sixty (60) days after the end of her pregnancy, regardless of changes in income. K. Medicaid is available to children under age eighteen (18) who meet AFDC income and resource standards. Eligibility is determined in accordance with Title XIX of the Social Security Act and the federal regulations promulgated in accordance therewith. L. Children for whom there is in effect a State adoption assistance agreement. An individual eligible for Medicaid under this category is one whom: (1) the State adoption agency has determined cannot be placed for adoption without medical assistance because of special needs for medical or rehabilitative care; and (2) before the execution of the agreement, had such special need and would have been eligible for Medicaid if the standards and methodologies of the Title IV-E foster care program were applied. M. Aged, blind and disabled individuals with income below the poverty level. (1) An individual eligible for Medicaid under this category is one who: (a) meets SSI criteria for either aged, disability or blindness; (b) has countable income, as determined in accordance with Title XIX of the Social Security Act and federal regulations promulgated in accordance therewith, which is below 100 percent of the federal poverty level (or as otherwise specified in the Title XIX State Plan); (c) has countable resources, as determined in accordance with Title XIX of the Social Security Act and federal regulations promulgated in accordance therewith, which is below the level specified in the Title XIX State Plan; and (d) meets all non-financial criteria required by Title XIX of the Social Security Act and federal regulations promulgated in accordance therewith. (2) As allowed by Section 1902(r)(2) of the Social Security Act, the State has elected to use special methodologies to determine income and resource eligibility. These methodologies are specified in the Title XIX State Plan.