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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.803 35

2. Resources All of the individual’s resources must be verified, evaluated, and counted together to determine if the individual meets the Medicaid resource requirements. The resources policy in chapter M06 applies. If the child is married and institutionalized, use the resource policy in subchapter M1480. a. Resources Within The Limit If the child’s resources are within the MN limit, go on to determine income eligibility. b. Resources Exceed The Limit If the child’s resources are NOT within the limit, the child is NOT eligible for Medicaid because of excess resources. 3. Income Determine MN countable income according to chapter M07. Subtract the appropriate exclusions. Compare the total countable income to the MN income limit for the child’s locality group (see section M0710, Appendix 5 for the MN income limits). 4. Income Exceeds MN and FAMIS Limits Because the Child Under Age 19 and FAMIS income limits are higher than the MN income limits, the child becomes eligible in the MN children under age 18 covered group when the child has incurred medical expenses equal to the difference between his/her income and the MN income limit (spenddown). See chapter M13 for spenddown policy and procedures.

5. Income is under the MN and FAMIS Limits Because of the differences between the Child Under 19 covered group/FAMIS (MAGI) and MN (non-MAGI) income-counting rules, such as the treatment of a stepparent’s income, a child may be ineligible for Medicaid as a Child Under 19 or for FAMIS coverage but have countable income under the income limit for MN coverage. In this case, the child’s spenddown liability is $0.00 (zero dollars). Even if the spenddown liability is $0.00, MN coverage cannot be open-ended. Enroll the child in one 12 month period of coverage, without the need for a new application. Complete a renewal following the procedures in M1520 at the end of the second spenddown period. Continue to enroll the child in one 12 month period of coverage per year as long as he continues to be eligible as MN at renewal.

C. Entitlement & Enrollment Children who become eligible after meeting a spenddown are entitled to full medically needy Medicaid coverage beginning the day the spenddown was met. Retroactive coverage is applicable to this covered group. Children under 19 receive 12 months of continuous eligibility unless they reach age 19; are no longer Virginia residents; the child or child’s representative requests eligibility be closed; the agency determines that eligibility was incorrectly approved because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or the child is deceased. Eligible children in this group are enrolled in aid category 088.