Page 156

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.805 40

2. Resources The resource limits and requirements are found in chapter M06. If the resources exceed the limit, the child is not eligible for Medicaid as medically needy. If the child is under age 19, determine the child’s eligibility as F&C CN because that classification has no resource limits. 3. Income Adoption assistance children in residential facilities do not have a different income limit. The MN income limit for one person in the child’s locality is used to determine the child’s MN eligibility. For an adoption assistance child living outside the State of Virginia, the income limit for the child is the income limit for the Virginia locality which signed the adoption assistance agreement. The adoption subsidy payment is excluded when determining the child’s financial eligibility. If the child’s countable income exceeds the MN income limit, the child is placed on a spenddown. Only the child’s medical expenses are used to meet the spenddown. Once the spenddown is met, the child is enrolled in Medicaid. D. Entitlement & Enrollment Eligible individuals in this MN 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. Individuals who become eligible after meeting a spenddown are entitled to full Medicaid coverage beginning the day the spenddown was met and ending the last day of the sixth month in the spenddown period. 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. The AC for individuals in the Adoption Assistance Children With Special Needs for Medical or Rehabilitative Care MN covered group is “086.”