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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 July 2022 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.502 18

2. Not QMB If the individual is NOT a Qualified Medicare Beneficiary (QMB) - the individual does NOT have Medicare Part A, OR has countable income over the QMB income limit - the AC is “060.” E. 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. For unmarried individuals, redetermine resources using the F&C medically needy policy in chapter M06. Do not recalculate resources of a married individual. Determine the individual’s eligibility as QMB, SLMB, QDWI or QI if the individual has Medicare Part A.

M0330.502 F&C RECEIVING WAIVER SERVICES (CBC)

A. Policy 42 CFR 435.217 - The State Plan includes the covered group of individuals who meet a families & children definition who live in the community, who would be eligible for Medicaid if institutionalized; are authorized to receive Medicaid waiver services and have selected the option to receive Medicaid waiver services in lieu of nursing facility care; in the absence of the waiver services would require the level of care furnished in a hospital, nursing facility or ICF- ID; and have income that does not exceed 300% of the SSI individual payment limit (see M0810.002 A. 3). B. Nonfinancial Eligibility An individual who receives Medicaid waiver services is eligible in this covered group if the individual: 1. meets the nonfinancial requirements in M02.

2. is not in a medical institution, may be in a residential institution that meets the institutional status requirements; and

3. is a child under age 18, under age 21 and meets the adoption assistance or foster care definition, a parent or caretaker-relative of a dependent child, or a pregnant woman as defined in M0310. Verify receipt of Medicaid waiver services; use the procedures in chapter M14. Do not wait until the individual starts to receive the waiver services to determine eligibility in this covered group. Determine eligibility in this covered group if the individual is authorized to receive Medicaid waiver services, has not been placed on a waiting list for services, and has selected the option to receive Medicaid waiver services in lieu of nursing facility services. Presume that the individual will receive the services and go on to determine financial eligibility using the policy and procedures in C. below. If determined eligible, the individual is not entitled to Medicaid in this covered group unless the policy in item D. below is met. See item D. below for the entitlement and enrollment procedures.