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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2025 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.501 32

If current resources are NOT within the limit, the individual is NOT eligible in this covered group; he/she may be eligible in an MSP covered group (which has more liberal resource methods and standards). 3. Income To determine if an individual has income within the 300% of SSI limit, use gross income, not countable income. Determine what is income according to chapter S08 and subchapter M1460. DO NOT subtract the $20 general exclusion or any other income exclusions. The individual is an assistance unit of 1 person. DO NOT DEEM any income from the individual’s spouse or parent. Effective 12/1/2024, Virginia’s state Medicaid plan was updated to disregard Social Security Disability Income (SSDI) when determining eligibility for Long Term Services and Supports (LTSS) for approved Developmental Disability (DD) Waiver recipients. This change does not apply to CCC Plus waiver recipients. The disregard is not applicable to the post-eligibility calculation of patient pay. • SSDI over and above the current SSI payment limit (see M0810.002) will be disregarded for Medicaid applicants offered a DD waiver slot dependent upon Medicaid eligibility and enrollment.

• SSDI over and above the current SSI payment limit will be disregarded at renewal or change for individuals approved for LTSS through a DD waiver.

• SSDI will be countable as applicable for the covered group(s) in which the individual is being re-evaluated if they are no longer approved for a DD waiver, for example no longer meeting the level of care (LOC) requirement. VaCMS will automatically disregard the SSDI income of a client who meets the above criteria counting only the SSI maximum income limit for one person. Additionally, the MA institutionalized screen and various elements of the Eligibility summary screen have been updated with this change. Compare the total gross income to the 300% of SSI limit (see M0810.002 A. 3). If countable income is equal to or less than this limit, the individual is eligible for Medicaid in this covered group. If the total gross income exceeds this limit, the individual is not eligible for Medicaid in this covered group. Evaluate his/her eligibility as medically needy. C. Entitlement & Enrollment Eligible individuals in this group are entitled to full Medicaid coverage beginning the first day of the individual’s application month if all eligibility requirements are met in that month. Retroactive coverage is applicable to this covered group. If the individual has Medicare Part A, re-calculate the individual’s income - subtract appropriate exclusions. Compare the countable income to the QMB and SLMB limits.