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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2024 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.500 30

Current Enrollee 1. Cancel current coverage using Cancel Code 042. 2. Reinstate in AC 059 beginning the first day of the following month. Use the date the MEDICAID WORKS Agreement was signed for the application date.

Send a Notice of Action to the applicant/recipient advising him of his eligibility and acceptance into MEDICAID WORKS. Do not send the Advance Notice of Proposed Action when a recipient moves to MEDICAID WORKS, because his Medicaid coverage has not been reduced or terminated. Eligibility for MEDICAID WORKS continues as long if as the enrollee continues to: • be employed, • meet the definition of disability or blindness, • meet the age limitation, and • does not exceed the income and resource limits for MEDICAID WORKS.

The MEDICAID WORKS enrollee continues to meet the disability criteria as long as SSA has not completed a Continuing Disability Review and has not determined that the individual no longer has a disabling condition. The fact that the MEDICAID WORKS enrollee is earning over the SSA substantial gainful activity amount has no bearing on whether he meets the disability criteria. If the enrollee’s disability status is unclear, contact a Regional Medical Assistance Program Consultant for assistance. The individual’s continuing eligibility must be determined at least every 12 months. If the individual is no longer eligible for MEDICAID WORKS, the eligibility worker must determine whether the individual remains eligible in any other covered group. The policy in M0320.400 G above must be reviewed to determine whether the resource exclusion safety net rules apply. If the individual is not eligible for Medicaid in any other covered group, coverage shall be cancelled effective the first of the month following the expiration of the 10-day advance notice.

M0320.500 300% of SSI INCOME LIMIT GROUPS

A. Introductions The 300% of SSI income limit groups are for individuals who meet the definition of an institutionalized individual or have been authorized for long-term care (LTC) services (see M1410. B. 2) and are not eligible in any other full-benefit Medicaid covered group. B. Covered Groups • M0320.501 ABD in a Medical Institution, Income < 300% of SSI • M0320.502 ABD Receiving Medicaid Waiver Services (CBC) • M0320.503 ABD Hospice