Page 157

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.804 38

d. Child in ICF or ICF- ID A child in an ICF or an ICF- ID is an institutionalized individual in a medical facility when he meets the definition of “institutionalized individual” in section M1410.010 B.2. When he meets the institutionalized individual definition, he is an assistance unit of one person. E. Resources The resource limit and requirements are found in chapter M06. If the resources exceed the limit, the child is not eligible for Medicaid. If the child is under age 19, determine the child’s eligibility as FAMIS Plus because that classification has no resource limits. F. Income The MN income requirements are found in subchapter M0710. Income Limits For the MN Individuals Under Age 21 covered group, the income limit is the medically needy income limit found in chapter M0710, Appendix 5. The foster care or adoption subsidy payment is excluded when determining the unit’s income eligibility. Foster care or adoption assistance children in residential facilities do not have a different income limit. For a foster care/adoption assistance child living outside the State of Virginia, the MN income limit for the unit is the income limit for the Virginia locality which holds custody, pays the adoption subsidy, or signed the adoption assistance agreement. 2. Income Exceeds MN Income Limit If the unit’s resources are within the medically needy limit, but the income exceeds the medically needy income limit, the unit is placed on a spenddown. All medical expenses of the unit members are used to meet the spenddown. Once the spenddown is met, only the child and family members who meet an MN covered group and who applied for Medicaid are enrolled in Medicaid. G. Entitlement & Enrollment 1. Entitlement Entitlement to Medicaid begins the first day of the month in which the Medicaid application is filed, if all eligibility factors are met in that month. If the individual is eligible after meeting a spenddown, entitlement begins the date the spenddown was met and ends after the last day of the spenddown period. Retroactive entitlement, up to three months prior to application, is applicable if all Medicaid eligibility criteria were met during the retroactive period. 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. 2. Enrollment The aid category for medically needy individuals in the MN covered group of Individuals Under Age 21 are: • 086 for an MN Non-IV-E foster care, MN Non-IV-E adoption assistance, • 085 for an MN Juvenile Justice Department child; • 098 for an MN child under age 21 in an ICF or ICF- ID.