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Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2024 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.400 28

4. Income Exceeds 138% FPL at Eligibility Determination Spenddown does not apply to the Medicaid Works covered group. Therefore, admission into MEDICAID WORKS is not available to individuals whose income exceeds 138% of the FPL. Evaluate the individual’s eligibility in all other Medicaid covered groups. E. Good Cause An individual may remain eligible for MEDICAD WORKS if one of the following good cause exceptions is met: • If the individual is unable to maintain employment due to illness or unavoidable job loss, the individual may remain in MEDICAID WORKS for up to six months. The six-month period begins the first day of the month following the month in which the job loss occurred. The individual should be asked to provide documentation that he is unable to work from a medical or mental health practitioner or employer. However, do not cancel the individual’s eligibility under MEDICAID WORKS due to the lack of documentation if the individual indicates that he is still seeking employment.

• DMAS may establish other good cause reasons. Requests for good cause other than the temporary loss of employment due to a documented illness or unavoidable job loss must be submitted to DMAS on the enrollee’s behalf by the local department of social services. Submit Good Cause request to MedicaidWorks@dmas.virginia.gov G. Safety Net Enrollees who are unable to sustain employment for longer than six months must be evaluated for continued coverage in all other Medicaid covered groups for which the individual meets the definition. Resources held in the WIN Account that are accumulated from the enrollee’s earnings while in MEDICAID WORKS will be disregarded up to the 1619(b) threshold amount for this eligibility determination. If found eligible and enrolled in another Medicaid covered group, the individual shall have a “safety-net” period of up to one year from MEDICAID WORKS termination and enrollment in another group to dispose of these excess resources before they are counted toward ongoing eligibility. If the individual resumes working within the safety-net period, he may be re-enrolled in MEDICAID WORKS provided that all eligibility requirements are met, except that the resources in the WIN Account are disregarded up to the 1619(b) threshold amount. If the individual wishes to be re-enrolled in MEDICAID WORKS after the one-year safety net period, any resources retained in the WIN Account remain exempt.