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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.300 23

2. Resource Eligibility Resource eligibility is determined by comparing the SSI disabled child’s countable resources to the current ABD Medicaid resource limit. Determine resources using policy in Chapter S11 (including the real property requirements that are more restrictive than SSI). Calculate resources according to the assistance unit policy in subchapter M0530. If current resources are within the limit, go on to determine income eligibility. If current resources are NOT within the limit, the child is NOT eligible in the protected SSI disabled children covered group; the child may be eligible as FAMIS Plus – Medicaid for Children (see M0330.300) if under age 19 years. 3. Income Eligibility Income eligibility is determined by comparing the SSI disabled child’s income to the current SSI payment limit for an individual. Determine countable income using policy in Chapter S08. Calculate income according to the assistance unit policy in subchapter M0530. If countable income is within the SSI payment limit, the child is eligible for Medicaid in the covered group of protected SSI disabled children. D. Entitlement & Enrollment Children eligible for Medicaid in the covered group of protected SSI disabled children 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 protected SSI disabled children are enrolled with program designation “61.”

M0320.300 ABD WITH INCOME  80% FEDERAL POVERTY LIMIT (FPL)

A. Policy Section 1902(m) of the Social Security Act allows a State to provide full Medicaid benefits to the categorically needy covered group of aged, blind and disabled individuals whose income is less than or equal to a percentage of the federal poverty limit (FPL). The 2000 Appropriations Act mandated that effective July 1, 2001, the State Plan for Medical Assistance be amended to add the covered group of aged, blind and disabled individuals with income less than or equal to 80% FPL. An eligible individual's resources must be within the SSI resource limits.