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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2019 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.501 16

M0330.500 300% of SSI INCOME LIMIT GROUPS

M0330.501 F&C IN MEDICAL INSTITUTION, INCOME ≤ 300% SSI

A. Policy 42 CFR 435.236 - The State Plan includes the covered group of individuals who meet a families & children definition who are in medical institutions and who • meet the Medicaid resource requirements; and • have income that does not exceed 300% of the SSI individual payment limit (see M0810.002 A. 3). B. Nonfinancial Eligibility An individual is eligible in this covered group if he/she meets the nonfinancial requirements in M02. The individual must be a child under age 18, under age 21 who meets the adoption assistance or foster care definition or under age 21 in an ICF or ICF- ID, or must be a parent or caretaker-relative of a dependent child, or a pregnant woman as defined in M0310. If the individual is a parent or caretaker-relative of a dependent child, the stay in the medical institution must be temporary while receiving treatment, rehabilitation, etc. for him to meet the definition of living in the home with the dependent child. C. Financial Eligibility When determining income to compare to the 300% of SSI income limit, use the ABD income policy and procedures, regardless of the individual’s definition or covered group. MAGI methodology is not used to determine eligibility for this covered group. When determining resources, use F&C resource policy in chapter M06 for unmarried F&C individuals; use ABD resource policy for married F&C individuals. The individual must also meet the asset transfer policy in M1450. 1. Resources a. Resource Eligibility – Married Individual Age 18 and Older When determining resources for a married F&C institutionalized individual with a community spouse, use the resource policy in subchapter M1480. When determining resources for a married F&C institutionalized individual who has no community spouse, use the resource policy in subchapter M1460. Evaluate countable resources using ABD resource policy in chapter S11. If current resources are within the limit, go on to determine income eligibility. If current resources are NOT within the limit, the individual is NOT eligible in this covered group; he/she may be eligible in a different covered group (which has more liberal resource methods and standards).