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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.502 20

2. Income To determine if an individual has income within the 300% SSI income limit, use gross income, not countable income, and use the ABD income policy and procedures in chapter S08 and subchapter M1460. Determine what is considered income according to subchapter S0815, ABD What Is Not Income and subchapter M1460, LTC Financial Eligibility. DO NOT subtract the $20 general exclusion or any other income exclusions. The F&C waiver services individual is an assistance unit of 1 person. DO NOT deem any income from a spouse or parent. Compare the total gross income to the 300% of SSI income limit (see M0810.002 A.3). If gross income is less than or equal to this limit, the individual is eligible for Medicaid in the CN covered group of F&C individuals receiving Medicaid waiver services. If the total gross income exceeds the 300% of SSI income limit, the individual is not eligible for Medicaid in the covered group of F&C individuals receiving Medicaid waiver services. D. Entitlement & Enrollment Eligible individuals in this group are entitled to full Medicaid coverage beginning the first day of the individual’s application month if all eligibility requirements are met in that month. Retroactive coverage is applicable to this covered group. Children under 19 receive 12 months of continuous eligibility unless they reach age 19; are no longer Virginia residents; the child or child’s representative requests eligibility be closed; the agency determines that eligibility was incorrectly approved because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or the child is deceased. Eligible individuals in this group are classified as 300% of SSI. If the individual has Medicare Part A, re-calculate the individual’s income - subtract the appropriate ABD income exclusions. Compare the countable income to the QMB limit. 1. Dual-eligible As QMB If the individual is also a Qualified Medicare Beneficiary (QMB) – the individual has Medicare Part A and has countable income within the QMB income limit - the AC is “062.” 2. Not QMB If the individual is NOT a QMB – the individual does NOT have Medicare Part A, OR has countable income over the QMB income limit - the AC is “060.” E. Ineligible In This Covered Group If the individual is not eligible for Medicaid in this covered group because of income, determine the individual’s eligibility as medically needy spenddown. For unmarried individuals, re-determine resources using the F&C medically needy policy in chapter M06. Do not recalculate resources of a married individual. Determine the individual’s eligibility as QMB, SLMB, QDWI or QI if he/she has Medicare Part A.