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M0320 Changes

Changed With Effective Date Sections Changed TN #DMAS-38 4/1/26 M0320.400 TN #DMAS-35 7/1/25 M0320.400 M0320.500 (formatting only)

Virginia Medical Assistance Eligibility Manual

Chapter M03 Section Revision Date July 2025 M0320.000 AGED, BLIND & DISABLED GROUPS M0320.400 MEDICAID WORKS A. Policy

The Appropriations Act of 2006 authorized an amendment to the Virginia State Plan for Medical Assistance that allows disabled (including blind) individuals to work and earn higher income while retaining Medicaid coverage. This program is called MEDICAID WORKS and includes individuals: • at least age 16 and are under age 65, and • who have countable income less than or equal to 138% FPL and • who have countable resources less than or equal to $2,000 for an individual and $3,000 for a couple; and • who are working or have a documented date for employment to begin in the future. • Current participation in the Social Security Administration (SSA) programs Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) will satisfy the condition for disability. Any applicant without SSA documentation of disability should be evaluated by the state’s Disability Determination Services program before eligibility can be established. These individuals can retain Medicaid coverage as long as they remain employed, and their Countable earned income is less than or equal to $6,250 per month. MEDICAID WORKS is Virginia’s Medicaid Buy-In (MBI) program. B. Relationship Between MEDICAID WORKS and 1619(b) Status An individual with SSI or eligible for Medicaid as a Qualified Severely Impaired Individual (QSII) (1619(b)) must meet the 138% FPL income requirement for entry into MEDICAID WORKS and should not be discouraged from enrolling in MEDICAID WORKS. An individual who meets the criteria for 1619(b) status and the 138% income limit may choose to participate in MEDICAID