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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 September 2012 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.700 53

7. QDWI Enters Long-term Care The enrollment of a QDWI who is admitted to long-term care and who becomes eligible for Medicaid in another covered group is handled like a QDWI who meets a spenddown. Cancel the QDWI-only coverage effective the last day of the month before the admission to long-term care, reason “024.” Reinstate the coverage with the begin date as the first day of the month of admission to long-term care.

M0320.700 MEDICALLY NEEDY (MN) GROUPS

A. Introduction 1. Medically Needy Individuals All medically needy covered groups are optional; the federal Medicaid law does not require the state to cover the MN groups in its Medicaid State Plan. Virginia has chosen to cover individuals who • meet all the nonfinancial requirements in chapter M02,

• meet the “Aged,” “Blind” or “Disabled” definitions in subchapter M0310,

• have countable resources within the MN resource limits,

• are not financially eligible in a full-benefit CN covered group; and

• have insufficient income to meet their medical care needs. 2. Spenddown Feature The major feature of the MN covered groups is a spenddown. An individual who meets the nonfinancial and MN resource eligibility requirements but whose income exceeds the MN income limit may “spenddown” the excess income by deducting incurred medical expenses and become eligible for a limited period of MN Medicaid coverage. An individual who has excess income becomes eligible when he/she has incurred medical expenses equal to the difference between his/her income and the MN income limit. 3. Different Benefit Package Some medical services that are covered for the CN covered groups are not available to the MN groups. ICF-MR services and IMD services are not covered for MN eligibles. However, the basic services such as inpatient and outpatient hospital, physicians, X-rays, prescription drugs, home health services and Medicare premiums, coinsurance and deductibles are covered for the MN. LTC nursing facility and most CBC waiver services are also covered for the MN.