Page 85

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2013 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.501 32

If current resources are NOT within the limit, the individual is NOT eligible in this covered group; he/she may be eligible in an MSP covered group (which has more liberal resource methods and standards). 3. Income To determine if an individual has income within the 300% of SSI limit, use gross income, not countable income. Determine what is income according to chapter S08 and subchapter M1460. DO NOT subtract the $20 general exclusion or any other income exclusions. The individual is an assistance unit of 1 person. DO NOT DEEM any income from the individual’s spouse or parent. Compare the total gross income to the 300% of SSI limit (see M0810.002 A. 3). If countable income is equal to or less than this limit, the individual is eligible for Medicaid in this covered group. If the total gross income exceeds this limit, the individual is not eligible for Medicaid in this covered group. Evaluate his/her eligibility as medically needy. C. 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. If the individual has Medicare Part A, re-calculate the individual’s income - subtract appropriate exclusions. Compare the countable income to the QMB and SLMB limits. 1. Dual-eligible As QMB or SLMB If the individual is also a Qualified Medicare Beneficiary (QMB) or Special Low Income Medicare Beneficiary (SLMB) - the individual has Medicare Part A and has countable income within the QMB or SLMB income limits - the AC is:

• 022 for an aged individual also QMB; • 042 for a blind individual also QMB; • 062 for a disabled individual also QMB; • 025 for an aged individual also SLMB; • 045 for a blind or disabled individual also SLMB. 2. Not QMB or SLMB If the individual is NOT a QMB or SLMB - the individual does NOT have Medicare Part A, OR has countable income over the QMB and SLMB income limits - the AC is: • 020 for an aged individual NOT also QMB or SLMB; • 040 for a blind individual NOT also QMB or SLMB; • 060 for a disabled individual NOT also QMB or SLMB. D. 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. If the individual is not eligible for Medicaid in this covered group because of resources, determine the individual’s eligibility as QMB, SLMB, QDWI or QI if he/she has Medicare Part A.