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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 September 2012 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.121 32
M0310.120 MEDICALLY NEEDY (MN)
A. Definition "MN" is the short name for "medically needy." MN is one of the two federal classifications of Medicaid covered groups. All MN covered groups are optional; the state can choose whether or not to cover MN individuals in its State Plan. However, if the state chooses to cover MN individuals, it must at least cover children under age 18, pregnant women and the protected group of individuals who were eligible as MN blind or disabled in December 1973 and continue to meet the December 1973 eligibility criteria. The state may choose to cover additional groups of individuals as MN. The MN individual is one who has income and resources enough to meet his maintenance needs, but not enough to meet his medical needs. MN individuals whose income exceeds the MN income limit may be placed on a spenddown (SD) and establish eligibility when incurred medical and/or remedial expenses equal or exceed the SD amount. B. Procedure The procedures used to determine if an individual meets a MN covered group are in subchapter M0320 for ABD and M0330 for F&C.
M0310.121 MEDICARE BENEFICIARY
A. Definition A Medicare beneficiary is an individual who is entitled to Medicare (Title XVIII of the Social Security Act). Medicare is a federally funded and administered health insurance program and consists of hospital insurance (Part A), medical insurance (Part B) and, beginning January 1, 2006, prescription drug coverage (Part D). 1. Part A A person is entitled to Medicare Part A if he a. is age 65 or older and: • eligible for monthly Social Security benefits on the basis of covered work under the Social Security Act, • a qualified Railroad Retirement beneficiary, • not eligible for Social Security or Railroad Retirement benefits but meets the requirements of a special transitional provision, • not eligible for Social Security or Railroad Retirement benefits but voluntarily enrolls and pays a monthly premium, or