Page 87

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 M0320.502 34

living in the home. Count actual resources the parent makes available to the child. If current resources are within the limit, then determine income eligibility. If current resources are NOT within the limit, the individual is NOT eligible for Medicaid in this covered group. b. Resource Eligibility - Married Individual If the individual is married and has a community spouse, use the resource policy in subchapter M1480. If the individual is married, but has no community spouse, use the resource policy in subchapter M1460. Evaluate countable resources using ABD resource policy in chapter S11. If current resources are within the limit, then determine income eligibility. 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. Retroactive coverage does not apply to this covered group because an individual cannot be eligible in this covered group until he/she applies for Medicaid. [The individual cannot have received Medicaid covered waiver services in the retroactive period because he was not receiving Medicaid on or before the date he applied.] If the individual has Medicare Part A, re-calculate the individual’s income - subtract the 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: