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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 July 2024 Subchapter Subject Page ending with Page M0210 NONFINANCIAL ELIGIBILITY REQUIREMENTS M0210.001 1

M0210.000 GENERAL RULES & PROCEDURES

M0210.001 PRINCIPLES OF MEDICAID ELIGIBILITY DETERMINATION

A. Introduction Medicaid is an assistance program which pays medical service providers for services rendered to eligible needy individuals. An individual's need for medical care, the state of his health, or his coverage by private health insurance, have no effect on his Medicaid eligibility. The eligibility determination consists of an evaluation of an individual's situation which compares each of the individual's circumstances to an established standard or definition. The evaluation provides a structured decision-making process. An individual must be evaluated for eligibility in all covered groups for which he meets the definition, and the applicant/enrollee shall be informed of all known factors that affect eligibility. B. Eligibility Requirements Although all the requirements that follow may not be applicable in a particular individual's situation, they must be looked at and evaluated. 1. Nonfinancial Eligibility Requirements

The Medicaid nonfinancial eligibility requirements are: a. Legal presence in the U.S., effective January 1, 2006 (M0210.150). b. Citizenship/alien status (M0220). c. Virginia residency (M0230). d. Social Security number (SSN) provision/application requirements (M0240).

Assignment of rights to medical benefits and pursuit of support from the absent parent requirements (M0250). f. Institutional status requirements (M0280). g. Covered group requirements (M03).

2. Financial Eligibility Requirements The Medicaid financial eligibility requirements are: a. Asset transfer for individuals who need long-term care (subchapter M1450). b. Resources within resource limit appropriate to the individual's covered group. (Chapter M06 for F&C covered groups; Chapter S11 for ABD covered groups). c. Income within income limit appropriate to the individual's covered group. (Chapters M04 and M07 for F&C covered groups; Chapter S08 for ABD covered groups).